February 27, 2020
Type 2 Diabetes #1 INTRODUCTION

Type 2 Diabetes #1 INTRODUCTION

welcome to type 2 on this channel we’re going to discuss some things that I consider important to know if you’re dealing with
type 2 diabetes my name is Vladmir and I’m an endocrinologist what I will try to do
with these videos 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 every day 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 anyways 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 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 glucose and maybe fatty acids and amino acids and you know many
other things can come 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 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 that there is a traffic jam here
there is a traffic jam here 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… now
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 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 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 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 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 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 gluco 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 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 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 patient… they used to work in the same lab and one took this option the other one took this option and they both controled 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 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 patients 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

27 thoughts on “Type 2 Diabetes #1 INTRODUCTION

  1. Thank you very much Dr Vladmir, I'm learning a lot with your Videos, may god keep blessing you. One more time thank you for the help

  2. Love your videos please make more… I have a suggestion can you make a video on the different complications of diabetes, and the rationale behind each complication it symptom, for example a lot of people may know thatdiabetes can make you hungry or thirsty but what is the rationale why do these things physically happen.

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