Everyone has heard of diabetes, and most people know what it is, too. Some of you may be aware of the fact that half of all people estimated to have diabetes have not yet been diagnosed, and that those who have been diagnosed number about 150 million worldwide. A phenomenal figure, and one which is set to rise to 300 million by the year 2030.

But few people seem to be aware of the importance of distinguishing between the two main types of diabetes, namely type 1 and type 2 diabetes.

Diabetes is basically a condition in which you have higher blood glucose levels than normal. These high blood glucose levels are responsible for many of the symptoms and complications of the illness. But the cause of these elevated blood glucose levels in type 2 diabetes is very different to that in type 1 diabetes, and this is why it is so important to differentiate between the two.

Ninety percent of all diabetics have type 2, which is invariably caused by insulin resistance.

Type 1 diabetes, on the other hand, is caused by a primary failure of the pancreas to produce insulin. In other words, there is no insulin! This is why people with type 1 diabetes need insulin injections.

Type 2 diabetes is caused by the body’s failure to recognise and respond to insulin as it should. So there is plenty of insulin circulating in the body, it just isn’t working. The tissues are ignoring the insulin, which is responsible for getting glucose into the cells of these tissues, and so blood glucose levels rise. Eventually the pancreas may become exhausted, and it may fail to produce any insulin at all, and this is when people with type 2 diabetes need to start using insulin injections.

Ultimately, the end point of both type 1 and type 2 diabetes is an elevated blood glucose, which is probably why they have traditionally been treated in similar ways… with the goal being to reduce the high blood glucose levels.
With type 1 diabetes, the solution will always be the same. Because there is no insulin being produced by the pancreas, insulin must be given, usually with injections under the skin.

Unfortunately, the treatment of type 2 diabetes is a lot more complex. Getting that blood glucose level down is not as simple as it is with type 1 diabetes. This is because, although there is insulin being produced by the pancreas, this insulin is being ignored by the body’s tissues, and so it is unable to get glucose from the bloodstream into the tissues. Stimulating the pancreas to produce more insulin may help for a bit, but is ultimately futile.

So the treatment of type 2 diabetes should be aimed at achieving two objectives:

1. increase the tissue’s sensitivity to insulin.

2. avoid increasing blood glucose levels by eating the wrong food types. If you don’t push your blood glucose levels up, your body will have less of a battle trying to keep them down.

The first objective is usually accomplished, to a limited extent, by medications such as metformin. Exercise also helps to get glucose into muscle tissue, because contracting muscle does not need insulin to absorb glucose.

The second objective, however, can only be accomplished with dietary modification, and this is where problems arise.

As soon as a person is diagnosed with type 2 diabetes, they are automatically given a diet sheet outlining the types and proportions of foods that are recommended as being suitable for diabetics. Food pyramids are often used to illustrate these proportions… a large chunk at the base to represent “complex carbohydrates”, such as rice, potatoes and pasta, with smaller proportions of fruit and vegetables, proteins and dairy products, and a tiny fragment on top of the pyramid for oils, fats and sugar. Sounds terribly “balanced”, doesn’t it? Well, it’s not. It is, in fact, the worst way to eat if you have type 2 diabetes.

So why is it recommended by most healthcare practitioners? I don’t have the answer to that question, but I suspect that because it seems to be a good diet for people with type 1 diabetes, it has been assumed that it should be suitable for type 2 diabetes too.

Let us examine the reasoning behind the recommendation that a diabetic diet be based on carbohydrates. “Complex carbohydrates” provide energy, and very little else. This energy is rapidly released in the form of glucose, which people with type 2 diabetes can’t use, and which increases blood glucose levels even more. Plus it is a well-known fact that most people with type 2 diabetes are overweight, and really struggle to lose any weight at all. They don’t need “energy”, which will ultimately be converted to excess weight in their bodies. They need proteins and fats and vitamins and fibre and all these important things.

But as soon as someone recommends a diet that does not contain all these “complex carbohydrates”, the medical world starts huffing and puffing about ketones and acidosis. What they seem to have forgotten, is that vegetables contain carbohydrates, fruit contains carbohydrates, and dairy products contain carbohydrates too. All these carbohydrates are released slowly, and in manageable amounts, preventing high glucose levels, but also providing enough glucose to prevent ketoacidosis. Whereas the majority of “complex carbohydrates” have a high or medium glycaemic index, most fruit and vegetables have a low glycaemic index, perfect food for someone with type 2 diabetes.

Let’s face it, it is time to break away from the traditional diets that are recommended for people with type 2 diabetes, and formulate new diets based on reason, and not just assumption.

Dr Guin Van Niekerk is the author of “Why Fat Sticks : An Introduction to Insulin Resistance” For more information on insulin resistance, go to www.insulinresistancesite.com