Endocrinology (including Diabetes)/hyperinsulinemia/Diabetes 2

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Question
QUESTION: Hi Sheri: I'm 72.Just diagnosed w/hyperinsulinemia. There's family history of Type 2 diabetes. Like yourself, I also answer questions in areas: fitness/swimming!  I jog, rollerblade, swim, play volleyball routinely.For the hyperinsul... my doctor prescribed Metformin. I have tinnitus 12 yrs.(left ear#& very reluctant ingesting meds that might exacerbate T. Also researched/found that high levels of blood sugars elevate tinnitus levels as well! Question:(a) How can diet & exercise reduce high blood sugar(s);break down the simple sugars into useable glucose if the insulin produced cannot do the job? (b)if the (white) sugars cannot be broken down by body's insulin where do they go?
If you need to further research this question, I can patiently wait for your response#s).  Thanks Ken

ANSWER: Ken,
  At least you asked me easy questions!  For (a), exercise itself allows blood glucose uptake into muscle cells via a contraction-induced mechanism that is independent of insulin. The use of muscle glycogen (stored carbs) and subsequent need for replenishment post-exercise heighten insulin action for anywhere from two to 24 or more hours afterwards.  Fat oxidation is also enhanced.  So, during exercise you don't need insulin, and following exercise the insulin that you do have works better for a while.  Diet can help by reducing your intake of excess carbs (especially white, or refined ones) and calories that raise blood glucose quickly after meals and (b) end up being stored as body fat if your muscle glycogen stores are already full.  In other words, making slight modifications to your diet can lower the need for insulin, and keeping your muscle carb stores in a reduced state by using them on a regular basis through physical activity also heightens insulin's action.  Building more muscle mass can also increase the size of the muscles' carb storage "tanks."
  Hope this answers your questions.  Sheri

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QUESTION: Sheri: re Part(b) rephrase: My family and myself love imbibing in lots of refined (white) sugar in coffee, sweet breads, ice cream, etc. In normal body's processing of refined white sugar, and those like myself (w/type2 diabetes) is this processed sugar transformed into glucose? Remain in its ingested state in the blood? Eliminated partially-totally?   Does body's Insulin interact so that the body can/does use it for energy?  
 Finally: Is glucose a simple sugar energy source? Is refined white sugar  classified as 'simple sugar'? I appreciate your thoughfulness and understanding of my concerns! ken

ANSWER: Ken,
  Since my PhD is in Exercise Metabolism and I also teach nutrition, I can answer your rephrased question.  In everyone, ingested carbs are first converted into blood glucose (except for the fiber). When blood glucose rises, the pancreas releases more insulin to try to transport glucose into muscle cells for storage (and into the liver to a lesser extent).  A certain amount of glucose is used every day for normal brain and nerve function, likely around 130 grams.  The typical storage load of carbs in muscle as glycogen is 300-400 grams, depending on how much muscle you have (the equivalent of 1,200-1,600 calories), whereas the liver stores about 75-100 grams (400 calories max).  Most of the liver's glycogen gets used up overnight while you're fasting and is replaced daily.  When you become more insulin resistant, which is the usual case for people with type 2 diabetes, glucose doesn't go into storage in muscle easily--mostly because the "tank" is already full.  The glucose then goes to the liver where it can be converted into fatty acids, which then can be stored in fat cells.  If blood glucose levels go above ~200 mg/dl, some glucose can be lost in the urine.  At rest, insulin is the main mechanism that you have to get glucose into muscle cells (the most metabolically active ones) for either immediate use or storage.  At rest, though, at lot of basal energy is supplied by fat, not glucose.

Glucose is considered a simple sugar, along with fructose (fruit sugar) and galactose (part of milk sugar).  White sugar is technically a disaccharide, meaning that it is comprised of two simple sugars, glucose and fructose.  Fructose is either converted into glucose in the body or, if eaten as excess calories, converted into fat for storage.  Are you familiar with the glycemic index (www.glycemicindex.com)?  Choosing carbs that spike your blood glucose less (i.e., those with a lower GI) may help with blood glucose management.  When sugar enters the bloodstream more slowly, insulin release may be more equipped to handle it.  Ice cream generally has a lower GI due to its fat content, but I would advise you to cut back on the addition of sugar to your coffee and consumption of sweet breads!

Sheri

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QUESTION: Dear Sheri: For type 2 Diabetes (w/insulin-resistance)you stated: "glucose doesn't go into storage easily" [Am I correct:If the body was functioning  efficiently, this glucose (blood sugar) would be stored as glycogen? Why do the "tanks" remain full? Why can't stored glycogen be converted back to glucose as needed. Then, when there is  excess blood sugars [glucose], most if not all,  can be converted 'taken up' for storage? Does the malfunctioning of insulin usage have a major part in this dilemma.     
 Just researched:glycemic index. In changing my present diet, appears as useful tool in monitoring my blood sugars, thanks. Sorry I got back to you so late! Your enlightening answers perked my quest to know more about diabetes and what personally I could do about it. Knowing the  "why's of a condition leads to understanding how to possibly "fit it!" yes??

Answer
Ken,
  In order to empty the muscle glycogen tanks, you have to exercise.  People who eat plenty of carbs and calories every day and sit around are usually fully glycogen loaded at all times (and very insulin resistant).  Muscle becomes resistant to insulin because your muscles have a limited capacity to store glucose as glycogen.  Fat cells don't usually become insulin resistant, though, and can continue to store excess glucose/carbs that are converted into fat for storage.  That's why they found that when people eat a lot of refined carbs, their blood triglycerides (fats) usually go up.  Glycogen is broken down to usable energy by muscles as needed, but not if you are sedentary.  Also, being inactive leads to muscle mass losses over time and a decreased maximal glycogen storage capacity--this is why type 2 diabetes occurs more frequently as people age and naturally lose some muscle mass for that reason (and then lose even more from being inactive--if you don't use your muscles, you lose them).  Feel free to visit my web site (www.shericolberg.com) to access more free materials.  I have also written several books that may be of interest to you.  Sheri

Endocrinology (including Diabetes)

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Sheri Colberg, PhD

Expertise

I am an exercise physiologist with a PhD who specializes in diabetes--as such I CANNOT answer general questions about other endocrine problems as I am neither an expert in all areas of endocrinology nor am I a medical doctor. My expertise lies in answering questions about diabetes (of any type) and physical activity, so please limit your questions to those areas. I can help you if you want to begin exercise or if you're already a diabetic athlete, and I am prepared to respond to questions about physical activity to which even your diabetologist may not know the answer. I can give suggestions about changes in your diabetic medications that differing types and intensities of exercise may necessitate, but I will have to refer you to your regular health care team to get final approval to make such changes. I can also answer questions about physical fitness, exercise metabolism, prediabetes reversal, and prevention of type 2 diabetes and diabetic complications.

Experience

I have both personal and professional experience in the areas of diabetes and exercise/physical activity. On a personal level, I have had type 1 diabetes since 1968, and I have been an avid exerciser since I was a child. Professionally, I have been conducting clinical studies on diabetes and exercise since 1992, largely with funding from the American Diabetes Association. I am also the author of 8 books related to diabetes, exercise, and more: The Diabetic Athlete (2001), Diabetes-Free Kids (2005), The 7 Step Diabetes Fitness Plan (2006), 50 Secrets of the Longest Living People with Diabetes (2007), The Science of Staying Young (2007), Matt Hoover's Guide to Life, Love, and Losing Weight (2008), Diabetic Athlete's Handbook (2009), and Diabetes? No Problema! (2009).

Organizations
I am a Fellow of the American College of Sports Medicine, a professional member of the American Diabetes Association (and professional volunteer for the ADA), and a former member of the Board of Directors of the Diabetes Exercise & Sports Association.

Publications
I have published research and review articles in the following journals and magazines: Diabetes Care, Diabetes, Journal of Diabetes & Its Complications, Diabetes Self-Management, Medicine & Science in Sports & Exercise, Journal of Applied Physiology, The Physician and Sportsmedicine, Journal of Clinical Investigation, International Journal of Obesity, FASEB Journal, The Diabetes Educator, Journal of Physical Education, Recreation, and Dance, Clinical Exercise Physiology, Clinical Diabetes Reviews, Insulin, ACSM's Health & Fitness Journal, Biomechanics, On the Cutting Edge, Diabetes Technology & Therapeutics, Microvascular Research, Drug Benefit Trends, ACSM Certified News, Diabetes Health, SportEX Health, Diabetes Focus, Diabetes In Control, dLife-For Your Diabetes Life, Pediatrics for Parents, and My TCOYD (Taking Control of Your Diabetes) Newsletter. I have also been interviewed in myriad other magazines, such as Men's Health, Men's Fitness, Diabetes Forecast, Countdown Magazine, Joe Weider's Muscle & Fitness, Health, Tidewater Parent, Barron's News, Diabetes New Day, and Newsweek International.

Education/Credentials
I have an undergraduate degree (1985) from Stanford University, a Master's degree in exercise physiology (1987) from the University of California, Davis, and a Ph.D. (1992) from the University of California, Berkeley, in the same field. I also spent two years in an NIH-funded postdoctoral research position in endocrinology (studying obesity, diabetes, metabolism, and exercise) at the University of Pittsburgh School of Medicine (1993-1994).

Awards and Honors
Fellow, American College of Sports Medicine (FACSM) - 1996 Old Dominion University Darden College of Education Young Investigator Grant Award 2003 Honor Society of Phi Kappa Phi, Old Dominion University Chapter 2004-Present Great Women of the 21st Century by the American Biographical Institute 2005 Edition Old Dominion University Darden College of Education Largest Research Grant Award 2006 Old Dominion University Darden College of Education Publications Award (for greatest number) 2006 Saint Louis University, The Max K. Horwitt Memorial Lecture Distinguished Lectureship Award 2008 Old Dominion University Darden College of Education Publications Award 2009 Old Dominion University Darden College of Research Grants Award 2009

Past/Present Clients
I have consulted for numerous groups, including Can-Am Care, Numera|Social, California Commission on Peace Officer Standards and Training(about candidates with diabetes), Animas Corporation (an insulin pump company), Therasense, Inc. (makers of the Freestyle blood glucose meters), Council of Healthcare Advisors, and the City of Chesapeake (Virginia) Health Department.

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