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I am trying to understand the various effects of Type 2, but I cannot seem to find a direct statement about this:

Are all the various symptoms/problems of Type 2 - neuropathy, heart health problems, etc. - caused specifically by the high blood sugar that results from Type 2, or are there some effects that are caused independent of sugar levels simply because you have this condition?

The base of what I'm trying to get as is whether or not a properly controlled sugar level will eliminate all problems from developing, or are there effects that occur over time that are caused simply by having Type 2, even if it is "perfectly controlled"?

Maury Markowitz
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    In some cases, diabetes type 2 can be reversible. A person who has diabetes 2 due to bad diet and obesity can improve diet and lose weight and can thus not only "control" diabetes but get rid of it. Unlike diabetes type 1, diabetes type 2 is not necessary a disease "on its own" but can be a result of something other. – Jan Jul 04 '19 at 07:52
  • Diabetes type 2 is not already metabolic syndrome. Anyway, one of the main factors for both diabetes 2 and metabolic syndrome is obesity and the next one could be genetic predisposition. – Jan Jul 04 '19 at 08:33

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No, blood sugar control is not 100% of the battle for complications from diabetes, but it IS the majority of it. Although a lot of the sequelae are related to elevated glucose levels, diabetes is a complex metabolic dysregulation that has many other factors involved. The pathogenesis of diabetes differs between types, they are really quite different diseases, so I will focus primarily on type 2 diabetes (the most common and the most metabolically complex).

Some things to consider that will help frame your understanding:

  • Look at the association between dysfunction in insulin resistance, blood pressure, cholesterol and fat metabolism, protein metabolism, and inflammation in the spectrum of endocrine dysfunction in metabolic syndrome. It is clear that it's not just sugar that's out of balance in the process of type 2 diabetes / insulin resistance.

  • Look at the complexity of the pathophysiology of renal dysfunction in diabetes, and how much is involved beyond just glycosylation from elevated glucose.

  • Consider insulin: the pathophysiology of type 2 diabetes centers on insulin resistance, and often individuals have elevated fasting insulin and high spikes in insulin. The insulin molecule has fairly broad metabolic activities on its own - from fat metabolism to inflammation to protein turnover to vasodilation... so persistently elevated or high spiking insulin levels have metabolic consequences that are independent from glucose levels.

But from what we know in studies, a healthier a1c (the indicator of average blood sugar) correlates with better outcomes. Maintaining normal levels of blood sugar (not just a1c which looks at the average BG but true normal including normal range postprandial levels etc) brings the risk of most macro and microvascular complications down to near what it would be if you didn't have diabetes. Again, it appears that although much of that is due to the blood glucose levels, a good part is that the other metabolic dysregulations improve along with improving blood glucose levels.

DoctorWhom
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