With only a cursory understanding of the underlying processes behind the high blood sugar that type 2 diabetes presents with, it's only natural to think that this is a stimulus response type of event.
For example, if your blood sugar is high, we may think that it may be a result of our carb intolerance, so we just consume less and we'll see our blood sugar normalize. Now we may indeed see it go down somewhat at first, and that's normal because we indeed are carb intolerant, but we may be disappointed in the early results we get.
This is a product of a fundamental lack of understanding about what actually causes high blood sugar with type 2 diabetes though, and there are a lot of people indeed who don't get this. In fact few people do get it, the ones familiar enough with the science behind this.
The key to understanding all of this lies in being aware that the primary source of high blood sugar does not come from the diet at all, and while diet can affect blood sugar dramatically, it's a secondary mechanism.
Imagine a bowl that water is to be poured into. We can think of carb tolerance as given amounts of water being poured into it, in relation to how much water is already in the bowl.
Non diabetics have little or no water in it, so a certain amount of water, say from a high carb meal, will be easily accommodated. The more water that is already in the bowl, the more that the bowl will get filled when more is added.
If the bowl overflows, then we'll say that this is high blood sugar. With diabetics, the bowl will be full in very mild cases of hyperglycemia, in cases for instance where one has a normal fasting blood sugar level, but will go up a little too high from meals.
With type 2 diabetes though, our fasting numbers in themselves tend to be too high, to various degrees, and almost always in the presentation of this disease the bowl has an internal source of water that keeps it overflowing all of the time, to various degrees.
If you pour more water into this bowl, then all of this extra water will be excess, because there is no capacity for it. We tend to think of the problem as being amounts of this excess water, and may look to add less, but we need to also consider the fact that if we're too high to way too high without eating, there's more to this than the food we eat.
Just focusing on what we eat is a pretty simple minded view, but it's the one that just about everyone has. We do need to ask ourselves what we can do in order to manage all this, and looking to reduce our load here is indeed wise, but we must be aware how this may help us or we will get lost.
So why is the bowl overflowing already? Well there's too much glucose being secreted into our blood at baseline, without the influence of exogenous glucose, what we consume directly and what gets absorbed in our digestive system. We know how and why this happens, and it has to do with insulin resistance, where insulin normally controls and limits the release of non dietary glucose, but has run amok.
So what causes insulin resistance? Too much insulin. Now too much insulin itself isn't enough to cause this alone, there are other factors involved, and there are people who have high insulin for years and get spared of diabetes, but too much insulin is the necessary condition here.
More and more people are getting hyperinsulinemia, high insulin, and more and more of those people are becoming diabetic. It comes down to how much resistance this high insulin will produce in a given individual, and when enough insulin resistance is present, one's endogenous glucose production starts to rise, glucose primarily secreted by our liver which is designed to prevent lows but now is causing highs, all by itself.
The only effective way to overcome insulin resistance long term is to look to reduce insulin levels, preferably to normal. Given the choice, it's better to have them a little too low than too high, although even non diabetics tend to have levels abnormally high these days, and the goal with any hormone needs to be to strive for healthy levels, levels the body was designed to handle, levels that don't cause imbalance and disease.
So what we need to be doing with type 2 diabetes is turning insulin down, because it's too high in the overwhelming majority of cases, and this is how we got into this mess. Here's the tricky part though. You can't use short term blood sugar measurement to guide you here or you will often be guided in the wrong direction.
When we have a lot of insulin resistance, too much insulin both serves to keep our blood sugar in check to some degree, although it also worsens the situation by causing more resistance. So if you turn it down, with dietary modification for instance, or with certain supplements, or drugs such as Metformin, there will be an adjustment period and we need to be aware of it.
This is one of the reasons why Metformin for instance takes several weeks to kick in. This isn't just about improving insulin resistance, there are other pathways that become adjusted here, but it's the same principle. We're looking to balance things but we're not going to see that balance right away and we may even appear more imbalanced at first.
If you switch to a low carb diet for instance, it could take quite a while for you to adapt to the lesser amounts of insulin that you secrete on this diet, as your endogenous glucose production may be even less suppressed at first. As the body heals from being less ravaged by high insulin, we eventually become less insulin resistant and this turns down the excess glucose generated.
The same thing happens with a lot of supplements, and people think that they can just take stuff like this for a few days or a couple weeks and then when they don't see any results they claim it doesn't help them.
There's a reason why studies are set to 90 days or more generally, and if you don't, you aren't testing the thing properly. That's about the minimum amount of time to see some healing, and in some cases, the process may take a year or longer to fully play out.
The same is true with diets, people get better, but gradually. I was even surprised when I first went on a low carb diet as to how slow the process is. This varies depending on how bad off you are and I was particularly bad off so it really took quite a bit of time, almost a year, before I saw the full benefit of dietary restriction.
Going the other way, increasing insulin, is the opposite. We can see some so called results right away, but over the long run, this worsens our disease because it worsens what is wrong with us, insulin resistance. Our excess endogenous glucose keeps going up and up and we need more and more excess insulin to try to keep it in check, until the insulin resistance simply wins and we can no longer control this even with the most insulin we dare to give ourselves.
If you're going to look to fix this though, this requires a lot of patience and understanding, especially patience.