Type 2 Diabetes - Part I - What, How, and Why!

[@juliandonovan3068]

8:04 - I always thought that fatty acids were unlikely to be able to be made to glucose. Is this a new finding that you have made in the deep trenches of your research? Would be keen to be corrected on this.

[@juliandonovan3068]

A bloody excellent overview of diabetes though, thank you...looking forward to part 2 and 3

[@GreySteel]

I knew that this would get me in trouble, but I was trying to simplify, and this was a case where an attempt to simplify led me to say something that was clearly misleading. No, you are generally correct, and the way I presented this, in an attempt to simplify a complex process, gave a false impression, . Animals do not generally convert FAs DIRECTLY into glucose, although there are indirect routes to gluconeogenesis via 3-carbon ketone bodies. Triglycerides are oxidized in the beta oxidation pathway, but in the state of insulin resistance Acyl-CoA residues from oxidation can be shunted away from the citric acid cycle and into ketogenesis and you can get from there to lactate and pyruvate, and you can get from THERE to glucose. So you can in fact use C14 to label fatty acid and watch it show up in glucose (Weinman et al, 1957). Meanwhile, oxaloacetate from the cycle is diverted into gluconeogenesis instead--resulting in glucose production. So glucose production is ramped up by diversion of intermediates from the same pathway that SHOULD be oxidizing fat. And the fatty acid residues end up becoming ketone bodies, which in the state of insulin resistance is not necessarily a good thing (DKA). I held off on ketone bodies until Part III, so I glossed over that whole process in this video, and it bit me in the ass. Also, fat breakdown yields glycerol, and glycerol from triglycerides can be converted to glucose. It's not clear to me how much this contributes to hepatic glucose output in insulin resistance. In any event, your point is well taken. Lipolysis and increased hepatic gluconeogenesis are both present in IR, but the video strongly indicates that the glucose comes directly FROM the fat, and that is not correct. In fact it's even more complicated than all that. I didn't really have an opportunity to go into ketoacidosis or the development of hepatic steatosis, or the fat DEPOSITION that occurs during insulin resistance (because of insulin overproduction by beta cells and the differential effect of insulin on different tissues) . Oversimplifying always gets me in a little bit of trouble but its necessary. I'll be sure to revisit this issue and point out the error when we discuss keto in the Part III video. Good pickup. Please keep watching and keeping me on my toes.

[@juliandonovan3068]

@@GreySteel Roger that, I appreciate that it's super tricky condensing such an insanely complex topic into something that is watchable for any of us on KZbin and also as engaging as you manage to make them. Thanks very much for the caveat and explanation coach!

[@neptronix]

The term for this is 'gluconeogenesis', and people on ketogenic/low carb diets get the bare necessary glucose to run their brain etc through that process.

[@zaluq]

Look at people doing 50 years no NO carbs , liver make glucose on need basis , more than enough . Carbs are not needed to eat at all

[@jameswells7232]

Best explanation of diabetes I have seen since college.

[@GreySteel]

That is very gratifying to hear. Thank you, and thanks for watching!

[@paulgrant4720]

I have been a type 2 diabetic for over 6 years and hardly control my sugar levels. You’ve opened my eyes to how devastating this condition is. Thank you

[@GreySteel]

Thanks, Paul. Take control.

[@paulgrant4720]

@@GreySteel with your help I honestly feel like I have more tools to use. Thanks

[@mikefrizzell2532]

Thank you, Sir! Wonderful information.

[@GreySteel]

Our pleasure. Thanks for watching. Part 2 coming sooN.

[@apositiveattitude]

Excellent! I look forward to the next installments.

[@GreySteel]

Thanks, Ann!

[@robertmendelson7724]

Excellent information and presentation. This needs to be seen by younger people. I developed type II 20 years ago when I was 50. A combination of bad diet for 30 years and an unknown to me family history of Type Ii. Big effort since then, including losing weight, diet modification and meds. Looking forward to viewing the next 2 parts

[@martyryan7764]

One of the best (out of countless…) explanations of diabetes. The graphics were helpful, very complimentary to the presentation. Thanks for yet another non-nonsense, interesting educational video.

[@GreySteel]

Thanks for the kind word, Marty, and thanks for watching!

[@mikeseeley1042]

Outstanding, Doc!

[@GreySteel]

Thanks, Mike!

[@jasonseducationalscientifi9565]

Great Job! Eliyazer from India

[@neptronix]

I hope you mention low carbohydrate diets. I'm a type 2 that is medication and insulin free for 6 years due to low carb.

[@steiny3353]

neptronix...Now THAT is very interesting. I'm type 2 and putting on weight, again, and I have to get my head right,again, to get back on to my high protein/low carb diet. When I do, my sugar comes down, my weight falls off and I just generally feel better. I have progressed, (probably an inappropriate word) from diet controlled, tablet, and now insulin. That is awesome that you have managed to get off all medication. Congratulations. I'm determined to start losing weight. I got links to this guy from a mate of mine, but I haven't had time to watch it yet.

[@neptronix]

@@steiny3353 It's on you to figure out how to make a low carb diet into a lifestyle that perpetuates itself. The real trick I did a video on my channel recently about how i slipped over the course of 6 years, and what i did to fix that. Maybe it'd be of interest to you. At least you know what you need to do!

[@damianlang1855]

I keep accidentally learning things:)

[@GreySteel]

You'll have to be more careful, Damian.