Type 2 Diabetes and Regrowing Beta Cells

At the beginning of June, in The Journal Diabetes, S.V. Zhyzhneuskaya et al. demonstrated regrowth of Beta cells in vivo in subjects who maintained diabetes remission for over two years. Presumably, if you’ve made it to this unassuming corner of the internet, you’re as excited about this as me, but if not, let me break it down.

My Story

My journey into Health Optimization began in earnest two years ago. My family has a history of heart disease and stroke, so I’ve always been worried about heart health. But for most of my life, it felt like I was on the right track. I was an athlete in University and continued to work out through my early adult years. In addition, I believed that I ate reasonably well. I’d gained weight during some key high-stress moments in my life but had always managed to lose it again quickly.

I’d known that I had high-ish blood pressure but always attributed it to a high-stress work environment. It was easy to ignore and think, “Nothing underlying is wrong. I’m just working hard. I can turn it off at any time.” Instead, I was listening to my doctor tell me my cholesterol was high, and I had a fasting blood glucose of 114, which indicated pre-diabetes. My grandfather had Type 2 Diabetes, but it had always felt like a foreign thing that would never affect me.

It was a kick in the butt. Blood pressure felt like a temporary problem, but blood glucose felt somehow different. It was something that didn’t feel like it could be fixed with breathing exercises or meditation. On my way home from the doctor’s, I stopped at CVS to buy a glucose monitor. I didn’t need to wait until my next doctor’s appointment to understand how I was doing; I could measure my morning glucose at any time. Then I got to work.

• No Snacking, so I wasn’t feeding my body a diet of constant insulin.
• Glycogen depletion workouts, so my muscles we always hungry for glucose.
• Eat low glycemic food with lots of fiber to slow down glucose absorption.
• Lose the extra ten pounds the last round of stressful work nonsense had caused me to gain.
• Track the calories to never create any days of significant hypercaloric to never

It worked, and my morning glucose settled at a comfortable ~100, with an A1C of 5.3. All okay, but knowing the pathology of Type 2 diabetes, it felt like a defeat. I could definitely manage, but would I ever get to eat dessert guilt-free again, or sit down to a stack of blueberry pancakes for breakfast without worrying about sugar?

Why?

Glucose control in our bodies

Glucose is the basic fuel of all life. It powers every cell in our bodies, and if our glucose levels were to drop too low, we’d die. On the flip side, at high concentrations, glucose is toxic. In our day-to-day lives, glucose damage is probably a critical factor in aging. If glucose levels significantly exceed normal daily levels, the rate of damage substantially increases. This range of glucose is very narrow. At any given time, there will be anywhere from 4 to 7 grams of glucose in a healthy person’s blood. That’s the sugar in 1/5 of a candy bar.

When sugar goes up, a set of cells in our pancreas called beta cells secrete insulin telling our cells to remove the sugar from our blood. As sugar drops, the beta cells produce less insulin until our cells use less glucose and our liver starts to secrete it. This dance repeats every time we eat, and is critical in maintaining energy levels that allow us to function without taking on unsustainable damage from too much sugar.

Pathology of Type II Diabetes

On the other hand, for many North Americans, this system stops working. Our glucose control system going from slightly dysfunctional to totally broken is what we call Type II diabetes. Over 10% of Americans have Type 2 diabetes, but over half of Americans on their way. There’s no consensus on exactly how it develops, but everyone agrees it follows a path that looks roughly like this:

1. The patient somehow becomes insulin resistant. This means our cells stop taking up as much glucose as they see insulin. (I’ve written about how this may happen elsewhere.)
2. Because the patient can’t clear sugar as fast as they used to, after big meals glucose spikes higher than it did before. This increased glucose creates damage, and one type of damage it does is to our beta cells. Repeated exposure eventually causes the cells to become nonfunctional before they eventually die.
3. Beta cells never grow back. We’re left in a state where we can’t clear glucose because we don’t respond to insulin and can no longer make as much insulin. We’re on a vicious cycle of deterioration, eventually leading to completely uncontrolled glucose. This further leads to cancer, heart disease, nerve damage etc.

Why this is exciting?

The key here is #3. If beta cells truly never recover, once they’re damaged, we must remain hyper-vigilant for the rest of our lives. We can probably avoid diabetes, but we can only do it by living an ascetic life. Fairly depressing.

And so, the idea that with enough discipline, beta cells will regrow and reactivate is extremely exciting. For the over half of Americans (myself included) who’ve kicked off down the road of insulin resistance, there is an alternate path to a slow spiral into infirmity or a life of ascetic pleasure denial.