If You Are Diabetic, Fat Is Not Your Fault

Most newly diagnosed type 2 diabetics (and even some newly diagnosed type 1 diabetics) have a few extra pounds around the waist.

It's common for diabetics, their families, their friends, their coworkers, and even their doctors to blame diabetes on fat.

The fact is, diabetes makes diabetics fat, not the other way around. The reason is a phenomenon called insulin resistance. The way insulin resistance packs on the pounds is something like this:

You eat a food containing fat, and your body converts the fat into fatty acids that begin to circulate in the bloodstream. Some of these fatty acids arrive at fat cells, where insulin helps move the fat inside the fat cell for storage.

Insulin that's "busy" transporting fat isn't available to remove sugar from the bloodstream and into the cells where it's needed. Fortunately, for non-diabetics there's enough insulin to go around.

The problem in people with a genetic predisposition to diabetes is, fat cells aren't very good at using insulin to store sugars, but they're great (300 times better) at using insulin to store fat. In people who have the genes for diabetes, fat cells are particularly unskilled at storing sugars but just fine at storing fat.

It's as if fat cells gulp down fatty acids and try to suck up glucose through a tiny straw. As fat cells grow larger and larger, it's harder and harder for glucose to find that "straw," its receptor sites. It's no problem for fat to get in, however. Eventually, the fat cells are leaving so much glucose in the bloodstream that the pancreas acts to remedy the problem by pumping out extra insulin.

This extra insulin, of course, also transports fat. Fat cells get fatter and fatter and blood sugar levels go higher and higher.

The problem is even worse in the liver and the muscles. Liver and muscle store (and use) glucose, too, but they have protective mechanisms to keep them from being overwhelming with toxic free radicals of oxygen.

The free radicals of oxygen become a problem when there's so much glucose in the bloodstream it begins to "burn," that is, to oxidize, before it even reaches a cell.

To protect themselves against free radicals, liver and muscle cells turn off their receptors for insulin. They become "insulin resistant." This protects their RNA and DNA from free radical attack, but it makes it even more difficult for fat cells to remove glucose from the bloodstream.

Insulin, of course, is not the only hormone involved in fat storage and fat burning. But insulin is the key hormone in blood sugar regulation.

If you have type 2 diabetes, that is, your pancreas makes a lot of insulin that cells can't use, you'll store fat really well. If you have type 1 diabetes, that is, your pancreas makes little or not fat, your body will burn fat because that's the only fuel it can use well.

That's why type 2 diabetics are usually overweight. There are, however, genetic conditions (especially among people whose ancestors come from India, Pakistan, Sri Lanka, or Bangla Desh) that create super-storing fat cells even in type 1 diabetes.

Insulin resistance is the reason fat is not your fault. It's also the reason that dieting to lose fat when you have diabetes is especially difficult. Fortunately, weight loss, as you'll read in later posts, is not your primary goal in a diabetes diet.