Obesity and Type 2 Diabetes: why the connection?

We've all heard over and over that obesity and type 2 diabetes often go hand in hand. But two questions naturally come up from this: what is the connection, and why don't all obese people have diabetes? A report by Johns Hopkins explains.

What is the connection?

The body's first indication that diabetes might be coming is what is called insulin resistance, or a reduced responsiveness to the insulin naturally produced by the body. When that happens, the pancreas has to work harder to produce more insulin. The 30 units of insulin a day produced by a person of normal weight becomes too little to clear the glucose from the bloodstream of an overweight or obese person. When the pancreas just can't produce enough to control blood sugar levels, the result is type 2 diabetes.

Also, scientists have recently found that fat cells secrete substances similar to hormones that move through the bloodstream.

	Resistin. Higher blood levels of resistin can lead to insulin resistance, often the first step to type 2 diabetes. Some existing drugs appear to block the gene that makes resistin, which is at least partly why they work.
	Leptin. Leptin is the hormone that signals the brain that we've had enough to eat -- sometimes it's known as the satiety signal. In obese people there doesn't appear to be a shortage of leptin, but researchers speculate that the leptin they do have doesn't seem to be able to get the satiety message through to the brains of obese people, which makes it more difficult to control or reduce weight..
	Free fatty acids. Free fatty acids are formed when fat that is stored in our cells breaks down, and probably contribute to the insulin resistance that can trigger type 2 diabetes. Normally, glucose is removed from the fat cells by the muscle cells so that it can be used for energy. It seems, though, that the fatty acids accumulated in the muscle cells of obese people actually keeps the glucose from entering the muscle cells. This keeps the blood sugar levels high, which is the major characteristic of type 2 diabetes.

Why don't all obese people have diabetes?

There are a couple of factors that decide whether obesity will trigger diabetes.

	Genetics. Your genes can actually decide whether obesity and type 2 diabetes will go together in any individual. If genetically you have a strong, hardy pancreas, well you might be lucky and not become diabetic.
	It depends where you extra weight is on your body. If it's on your abdomen, that's a bigger risk. Most overweight men fall into this category. For women, although they complain about having too much weight on their hips and lower body, that actually puts them at less risk for the obesity and type 2 diabetes combination.

The good news, as always, is that type 2 diabetes is sensitive to weight loss, and many people are amazed at the immediate and noticeable affect on their blood sugar levels when they lose just a few pounds of that excess weight. Obesity and type 2 diabetes are a potent combination, so it's well worthwhile taking control of our weight as part of our diabetes management system.