Pathophysiology Behind Type 2 Diabetes: Ultimate guide 2020

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Welcome to type 2 on this article we're going to discuss some things that I consider important to know if you're dealing with Patho of type 2 diabetes.

Pathophysiology Behind Type 2 Diabetes
Pathophysiology Behind Type 2 Diabetes

 I'm an endocrinologist of Patho of Type 2 Diabetes. What I will try to do with these articles is explain to you the pathophysiology of type 2 diabetes in a way that everyone can understand and hopefully that can help you make better decisions.

If you're dealing with type 2diabetes of course now for this first video we'll compare type 2 diabetes with type 1 and see what we're dealing with... now let's say that you eat everyday right and you probably eat every day then why do we need to eat every day and many times a day... because the way you're looking at me.

Now I look like one person I'm actually one person but I what I mean is I look like one piece right it's not... I'm actually a bunch of cells put together with some precise engineering that I look like one I am one actually we have different organs with different cells doing different work now that I'm talking to you my brain cells are very active hopefully otherwise you will.


A Basic Introduction to Type 2 Diabetes

My heart is busy pumping blood here and there... the cells in my kidneys are busy filtering the blood... the pancreas beta cells, for example, might be busy producing insulin and you know stuff like that and for them to work 24/7 every day every minute every second they need energy and where does this energy come from it comes from the food we eat and it goes to different cells in our body.

So that they can function... they can do different things that they're supposed to do... now sometimes when we
when we tell patients that they have high blood sugar they take it like some of them make it sound like glucose is some evil thing that just dropped into your bloodstream out of nowhere you know just talking about glucose.

My blood sugar my a 1c this and that but we need to understand that glucose is always in your bloodstream glucose is always there because it's coming from the food that you eat going to different cells let's say this is the food that you eat and then comes not just glucose and maybe fatty acids and amino acids and you know many other things can come.

Basic Introduction to Type 2 Diabetes
A basic introduction to type 2 diabetes

Now later we can talk about the other ones because they also play a role in this process but let's say that you take glucose from the food right and then this glucose has to go to different places in our body to produce energy, for example, you have this place let's imagine that this is a city and there are different cars on the road
going to different places... and for them to know when they should go straight or turn left or turn right they need to have some signals and we have traffic lights different traffic lights on the road.

So that they can signal the cars when they should go straight when they should turn left when they should turn right ... the same thing is happening in our body we also have traffic lights and the traffic lights are beta cells of the pancreas... inside your pancreas, there are some cluster of cells called islets and in inside the islets we have some cells called beta cells... let's take one outside... and they produce the insulin they produce insulin and insulin is actually the one that directs the glucose to different places to tell the glucose you should go straight oh sorry not a car to tell the glucose if they should go straight and be used as energy or if they should your turn left and be stored as glycogen or if they should also turn right and be stored as fat so the same thing is happening in our body.

Now let's imagine.

Pathophysiology of type 2 diabetes
Pathophysiology of type 2 diabetes

That there is a traffic jam where there are too many cars what do you think that could be the problem there are three things that we need to look at.

  • The first one is if the traffic lights are working if they're not working... let's say they all turn red these cars will just stop here and not go anywhere.
  • The second one is how many cars are coming here the third one how many cars are leaving very easy... now if the traffic lights are not working we just replace them and this is the pathophysiology of type 1 diabetes because when it comes to type 1 diabetes the traffic lights oh... in our case, the insulin... the beta cells that produce insulin are destroyed by your immune system by mistake which means that these patients do not produce any insulin.

So we need to replace it that's why everyone with type 1 diabetes no matter where you're from... if you're tall short white black green you'll always have to take insulin... this is number one reason why you see all the patients with type 1 diabetes taking insulin simply.

Because they do not have the traffic lights they do not have the beta cells that produce insulin and we need to replace the insulin... very easy to understand but those people their lives are not easy because beta cells are very highly sophisticated cells they work really well and we can never match that however it's easy to understand no traffic lights we put the traffic lights back even if it's... you know a bad one but we still put the traffic lights back and they keep going with their lives.

The main difference between type 2 and type 1

So now that we have type 1 diabetes out of the way we'll look at type 2... now for type 2 diabetes most of the patients with type 2 diabetes still produce insulin still have functional islets and with enough beta cells to produce enough insulin that someone would need however the amount of glucose that is coming into the blood is more than the glucose that is living the blood... now this has to happen for a long time that's why most people with type 2 diabetes more than 80 percent are obese or overweight simply because there's more glucose coming into the blood then the glucose that is living this has to happen for a long time because if it's just for a day or two or a week or a month even one year we have a backup we can store the glucose somewhere we can store them in other places.

But eventually, we will run out of place to store them and they will stay in the blood... this is why when it comes to type 1 diabetes we have one way to deal with it... replace the insulin that is missing now for type 2 diabetes you hear a lot of things you hear people talking about fasting right with this understanding what do you think they're trying to accomplish reducing the glucose that is coming... easy do you think it's going to work do you think fasting, for example, would work of course it will work... however, getting patients to fast is another story right we'll talk about that later.

Now others talk about low carbs diet what are they trying to accomplish... less glucose coming into your bloodstream some will talk about keto diet Keto Keto Keto sounds cool but what it means is just less glucose coming into your bloodstream because that dye has almost no sugar and no carbs maybe I don't know 5 10 20 %.

So what they're trying to accomplish is just less glucose coming into your blood... now I can do that I can invent a diet right now... let me I'll call it a stone diet right a diet that you eat stones and you drink water do you think it's going to help you with type 2 diabetes... of course a stone has no sugar... less glucose coming then the glucose that is leaving.

But the stones will kill you though so don't try this at home that's why even the drug companies pharmaceutical companies try to tackle this problem.

We know drugs like metformin right first-line therapy for type 2 diabetes do you know what metformin does one of the things that metformin does is decreasing your glucose absorption.

So less glucose will be coming here into your blood if you take metformin even the glucose that that should be produced by the liver metformin... let's say your liver is trying to produce some glucose metformin will reduce it
it also increases insulin sensitivity and some other stuff but what metformin is trying to accomplish is having less glucose coming here and more glucose going by for example increasing insulin sensitivity okay let me think about another drug.

There is one called the name is long so I think I need to write it it's called alpha-glucosidase inhibitors I don't know if you can see it glucosidase inhibitors... inhibitors... do you know what drugs like alpha-glucosidase inhibitors do... drugs like acarbose... when you eat food with a lot of cars they are mostly complex carbs and inside your small intestine there are some enzymes that will break them down into simple carbs.

So that your body can absorb them... now what these drugs will do they will block those enzymes so even though you eat two pieces of pizza only one is getting into your bloodstream because these drugs can block those enzymes in your GI tract that are supposed to break the complex carbs into simple carbs so that the body can absorb them... by blocking them only a few of them will be working and less glucose will be getting into your blood.

so why am I telling you all this?

Because I believe that if you know what's going on you will be able to make better decisions for example in this case of alpha-glucosidase instead of eating two pieces of pizza you can change this one to vegetables... that will lower the sugar in that food and it will also decrease the absorption of glucose it will have almost the same effect of this one. But with no side effects without buying the drugs and this will probably be cheaper.

So if I give you these two options someone might say oh, of course, I'll take this one but some other patients
might say wait... are you saying that if I have this drug this glucose something I can keep eating my carbs... all my rice and things.

That I love and I don't need to worry about blood sugar too much and we'll go like yeah... kind of and they'll go like that's what I want but at least you know what you're doing right.

What I think is not right is if I just tell you okay take these drugs and they'll help your blood sugar but I don't tell you how but after you know how you will make your decision... now let me give another example we have a drug called S G L T 2... sglt2 inhibitors do you know how they work... your kidneys the way they filter blood they let everything go out.

And then they pick what they need there is a transporter of glucose that will reabsorb the glucose into your bloodstream back to your bloodstream and these drugs will block them so less glucose will be taken back into your blood more of them will go to your urine... at the end of the day there will be less glucose coming into your bloodstream and more glucose going... going into your urine, in this case, there are many examples.

The main difference between type 2 and type 1
The main difference between type 2 and type 1

But I just want you to understand the idea behind all these things when you have your own understanding you can make better decisions I... I had two patients... they used to work in the same lab and one took this option the other one took this option and they both controlled their blood sugar... this one was happy because the blood sugar went down with no drugs.

But she had to change something this other one didn't change anything but added some drugs... but continued with her happy life... so at the end of the day I'm not saying one is better than the other I'm just saying that you should know what is going on and choose wisely that's why many people say that type 2 diabetes is possible to be reversed is possible to be cured.

The idea behind different approaches to treatment

But not type 1 diabetes and the idea behind that is that if we fix this issue of more glucose coming than glucose going for a long time we can actually get the body back to normal but there's one thing that we need to look at first... it's the state of your beta cells of the pancreas even though I told you that for type 2 diabetes most of the patients still have beta cells functioning some patients do not have a lot of beta cells especially at the end of type 2 diabetes, the beta cells will be mostly destroyed.

And for these patients, they would be almost like type 1 but normally if you are in the beginning or middle stage of type 2 you probably have enough beta cells.

And if you are thinking about reversing your type 2 diabetes you need to check the function of your islets... if they're still functioning if the beta cells are still okay... if they're okay it's possible if they're not okay you'll probably need some help.

that's why some patients with type 2 diabetes take insulin but not all the patient's patients with type 2 diabetes that still have functional beta cells should not take insulin unless there are some specific cases that we will discuss on other videos.

No matter what you do you can't let all this sugar stay in your blood because they will lead to all sorts of complications that we'll talk about when we talk about complications of high blood sugar.

  • I think maybe I should just stop here and make another video next week.
  • I think it's going to long... I'll probably talk about insulin resistance...

thank you so much for staying this long and I'll probably see you next week when I make other videos... I will make videos on everything related to type 2 diabetes have a blessed week bye.

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