Lifestyle factors and type 2 diabetes

Type 2 diabetes results from genetic and lifestyle factors. The great news is, lifestyle can be changed. Changes to diet, physical activity and weight (especially body fat) levels prevent and reverse type 2 diabetes. This article covers the key lifestyle factors that contribute to type 2 diabetes and tips on how to start changing them.

Insulin resistance

For most individuals, insulin resistance is central to type 2 diabetes, with insulin resistance occurring 1-2 decades before the onset of the disease (1). The relationship between insulin resistance, high levels of insulin and high levels of blood sugar (glucose), exacerbate one another. Insulin resistance contributes to the dysfunction of insulin secretion which determines the onset of type 2 diabetes. Also having continually high levels of blood glucose becomes severely damaging and results in further health complications such as cardiovascular disease and neuropathy.

Tip: start reversing insulin resistance now and increasing insulin sensitivity! Movement, exercise, optimal nutrition and losing weight are all proven ways to improve insulin sensitivity (2). Check out 10 tips to improve insulin sensitivity and Improve insulin sensitivity with these exercise tips for lots of great ideas for you to try today!

Stress

The stress hormone, cortisol, functions to increase blood glucose levels to generate energy for survival during stressful times. It has been shown that Individuals with type 2 diabetes have significantly higher cortisol levels than people who are healthy (3).

A chronic stress response can result in elevated levels of blood glucose, called hyperglycaemia. Chronic hyperglycaemia is harmful, damaging blood vessels, contributing to insulin resistance and contributing to the dysfunctional secretion of insulin which results in type 2 diabetes (4). Exposure to chronic cortisol results in high blood sugar, high levels of insulin and insulin resistance (5,6).

Stress also contributes to type 2 diabetes through its impact on weight gain. Cortisol assists fat stores to grow and develop, especially around the organs, which is associated with insulin resistance and type 2 diabetes (7). Cortisol also interacts with appetite signals, affecting hunger levels and subsequent eating behaviours which can result in weight gain, increasing risk for type 2 diabetes. Check out Stress and weight gain to learn more.

Tip: check in with yourself about your stress levels and identify the sources of stress in your life. Research shows it’s far more effective to be prepared for stress than to wait to deal with it, so create a plan to mitigate stress or look for support in this area. We have a great team of associate practitioners that work with our clients, particularly in the area of stress and past trauma management.

Try introducing daily opportunities to do what you enjoy – whether that’s a nice bubble bath, playing the piano, or reading a book, talking to a loved one. Check out Learn how to manage stress and chill out like a pro for some quality tips.

Excess weight

Excess weight is a high risk factor for type 2 diabetes (7). Weight gain substantially increases the risk of developing type 2 diabetes and even modest weight loss significantly reduces the risk. For someone who is overweight, each kg of weight gained yearly over a 10-year period is associated with a 49% increase in risk of developing type 2 diabetes in the subsequent 10 years. However, each kg of weight loss annually over 10 years is associated with a 33% lowered risk of type 2 diabetes in the subsequent 10 years (9).

Weight reduction along with diet and exercise intervention, reduces the incidence of type 2 diabetes by 58% (10). A 5-10% reduction in body weight significantly reduces blood glucose levels, decreases use of diabetes medication and improves a variety of factors: overall fitness, depression symptoms, sleep quality, cardiovascular risk factors and reducing use of blood pressure medication use (10).

Weight reduction is the only proven strategy to reverse type 2 diabetes (11).

As well as excess fat, visceral fat, the type of fat that covers the organs around the abdomen area, is especially associated with insulin resistance and type 2 diabetes (7). Therefore, people may appear a ‘normal’ weight but have stores of visceral fat, be metabolically unhealthy and at risk for developing type 2 diabetes (12). Check out Insulin resistance and weight gain to learn more.

When working with our clients we include body composition analysis that allows us to determine your visceral fat levels, body fat levels, muscle mass, water weight and so forth. This helps to set goals and see the impact of nutrition and lifestyle interventions as well as correlate the data with any blood tests that we may also run associated to type 2 diabetes and insulin resistance.

Tip: to lose weight, energy balance needs to be negative. This can be achieved through either diet or exercise/physical activity, or a combination. If you want to lose weight, choose a daily habit that you can implement today to begin you on your weight loss journey. At the same time, be aware that you can be at risk of type 2 diabetes without being overweight!

Diet

Long-term consumption of refined grains, processed foods and sugar-sweetened drinks promote weight gain and increase risk for type 2 diabetes risk (13). Diets low in fibre and vegetables and high in red and processed meats also increase type 2 diabetes risk (13). Long-term excess energy becomes an overload and stress to the body, contributing to insulin resistance and dysfunctional insulin secretion in type 2 diabetes (14).

Independent of excess energy, quality and type of food also influence risk for type 2 diabetes: foods higher in trans fats, found in many bought baked goods (cakes, cookies, pies), dough, fried foods and margarine are associated with a much greater risk (15).

Specifically, diets high in carbohydrates, the macronutrient that raises blood glucose levels the most, have the greatest risk associated with developing type 2 diabetes (15). The toxicity of high blood glucose levels and excessive insulin secretion from a diet high in refined carbs promotes the insulin resistance and dysfunctional insulin secretion that occurs in type 2 diabetes (16, 17). High carbohydrate loads are associated with an inflammatory state, also associated with type 2 diabetes (16).

Tip: replace refined foods that are high in sugars with real whole food that include a range of vegetables. Cook from scratch when possible and keep it simple. Feel free to make use of our ever-expanding recipe section and recipe books to help.

Inflammation

Individuals with type 2 diabetes have elevated levels of inflammatory biomarkers in comparison to those who are healthy (18). Many lifestyle factors are associated with an inflammatory response, such as excess weight, diet, stress, smoking and sleep disruption. The reversal of type 2 diabetes is associated with a significant reduction in inflammatory biomarkers (19). Check out Inflammation and type 2 diabetes to learn more.

Tip: consider the types of fat you eat and include omega-3 fats such as fatty fish (salmon, mackerel, sardines, trout), eggs and walnuts instead of a diet rich in vegetable and corn oils. Where possible, include a diet rich in phytonutrients. If in doubt, try and make your diet as colourful as possible from natural wholefood ingredients.

Sleep

A review of multiple studies over 3 years concluded that quantity and quality of sleep consistently and significantly predict the risk of developing type 2 diabetes (20). The lowest risk for developing type 2 diabetes is associated with 7-8 hours per day of sleep and there is an increased risk of 9% for each hour of sleep lost per day per year (13).

Tip: blue light from mobile phone screens, iPads/tablets, computers all interfere with sleep. Ideally stop using any device 1-2 hours before going to bed. If this isn’t possible, ensure your devices are on night mode, download a blue light filter and work to introduce more time between device use and bed time.

Physical activity

Being inactive, overweight and having type 2 diabetes are all strongly associated with one another. Each hour spent watching television has been shown to increase the risk of developing type 2 diabetes by 4% over 3 years (13). High versus low total overall physical activity is associated with a reduction in relative type 2 diabetes risk by approximately 30% (13).

Exercise and planned periods of physical activity significantly enhances insulin sensitivity. It enhances glucose uptake into the muscle, increases blood flow to the muscle, resulting in growth of muscle mass, and reduces levels of fat mass (21). It also improves mood, well-being, sleep and general stress levels, all important in affecting the development of type 2 diabetes (21).

Tip: Most phones have a step count on them, challenge yourself to 10,000 a day or just look at what your average step count currently is and increase it by 20% to start with. Then, additionally add in your exercise – so a daily walk/ run / dance class/ high intensity session. You want to be both physically active AND exercising. Check out Exercise and type 2 diabetes to learn more.

Take away message

Lifestyle factors influence the development of type 2 diabetes: not only excess weight, diet and reduced physical activity, but stress, inflammation and sleep. They all interact with one another and when you start improving one, the others improve too.

Changing lifestyle habits can prevent, reverse and delay type 2 diabetes: the combination of diet, physical activity and weight loss is tried and tested and nothing beats it!

Understand the tools you need for success: set yourself up for the success you deserve and start believing in yourself now. You can do this. Be logical about the tools you need to assist you on your journey. Make a plan. Reach out to supportive friends/family or consider working with one of our Nutritionists and Health Coaches to get professional guidance and support.

If you enjoyed this article, you may also enjoy the following related articles:

• 10 tips to improve insulin sensitivity
• Improve insulin sensitivity with these exercise tips
• Insulin resistance and weight gain
• Stress and weight gain
• Learn how to manage stress and chill out like a pro
• Inflammation and type 2 diabetes
• Exercise and type 2 diabetes

References

1. Defronzo et al. (1992). Pathogenesis of NIDDM. A balanced overview.
2. Wilcox et al. (2005). Insulin and insulin resistance.
3. Chiodini et al. (2007). Cortisol secretion in patients with type 2 diabetes.
4. Ogawa et al. (1992). Roles of insulin resistance and beta-cell dysfunction in dexamethasone-induced diabetes
5. Di Dalmazi et al. (2012). Glucocorticoids and type 2 diabetes: from physiology to pathology
6. Nicod et al. (2003). Metabolic adaptions to dexamethasone-induced insulin resistance in healthy volunteers
7. Eckel et al. (2011). Obesity and type 2 diabetes: what can be unified and what needs to be individualised?
8. Epstein (2011). Fight the Fraz
9. Resnick et al. (2000). Relation of weight gain and weight loss on subsequent diabetes risk in overweight adults.
10. Wing et al. (2011). Look AHEAD research group. Benefits of modest weight loss in improving cardiovascular risk factors in overweight and obese individuals with type 2 diabetes.
11. Hallberg et al. (2009). Reversing type 2 diabetes: a narrative review of the evidence.
12. Rhee et al. (2013). Metabolic health is more closely associated with coronary artery calcification than obesity.
13. Kolb et al. (2017). Environmental/lifestyle factors in the pathogenesis and prevention of type 2 diabetes.
14. Fung et al. (2016). Hyperinsulinemia and Insulin resistance: scope of the problem
15. Korat et al. (2014). Diet, lifestyle and genetic risk factors for type 2 diabetes: a review from the Nurses health study, Nurses’ health study 2 and health professionals follow-up study.
16. Cordain et al. (2005). Origins and evolution of the western diet: health implications for the 21st century.
17. Willett et al. (2002). Glycaemic index, glycaemic load, and risk of type 2 diabetes.
18. Donath et al. (2011). Type 2 diabetes as an inflammatory disease
19. Athinarayanan et al. (2019). Long-term effects of a novel continuous remote care intervention including nutritional ketosis for the management of type 2 diabetes: a 2 y-ear non-randomised clinical trial.
20. Capuccio et al. (2010). Quantity and quality of sleep and incidence of type 2 diabetes.
21. Colberg et al. (2010). Exercise and type 2 diabetes. The American college of sports medicine and the American diabetes association: joint position statement.