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Central obesity -- the big belly characteristic of the typical type 2 diabetic -- has been of interest to me since I began learning about diabetes after my diagnosis in October 2005. For me, central obesity began developing very very slowly, almost imperceptibly over a few years immediately preceding my diagnosis of diabetes. At diagnosis, I had a respectable pot belly which I had attributed to my march into middle age. Diet control and exercise eventually led me to make new holes in my belt and to donate my pre-diagnosis pants to the old-clothes-collection drive of the local diabetes association. But to say the truth, to this day my recalcitrant central obesity refuses to go away completely. There is still a little excess fat around (or rather within) my belly

As I understand it, the large amount of insulin that circulates in the blood stream of the average insulin resistant T2 diabetic (as compared to a non-diabetic) drives blood glucose into the belly as fat. Insulin resistance of the typical T2 diabetic forces his/her pancreas to produce several times the amount of insulin that it used to produce before the diabetic developed insulin resistance. Normal amounts of insulin help blood glucose enter cells to produce energy. Insulin resistance of the cells coupled with abnormally high amounts of circulating insulin cause the glucose in the blood (derived from the food consumed) to be converted to fat. Why does this fat go to the belly? Blame it on our genetic programming. As I understand it, the fat is first stored as subcutaneous fat in the belly. As more fat gets driven into the belly, it turns into the more vicious visceral fat.

What happens if and when the diabetic becomes insulin deficient, i.e., the pancreas produces much less insulin as compared to when the diabetic was non-diabetic and non-insulin resistant? Will the body of the diabetic stop converting blood glucose into fat? I think yes, and the diabetic will begin losing fat not only from the belly but from all over the body. Not just fat but muscle too. But before this happens or by the time this happens, the diabetic may already be on drugs that stimulate pancreas to produce more insulin or the diabetic may have started injecting exogenous insulin. Because of insulin resistance, this additionally generated insulin (from the stimulated pancreas or from injection of exogenous insulin) will be capable of driving glucose as fat into the belly. Central obesity then remains.

In my understanding, the only practical way for the insulin resistant T2 diabetic to reduce central obesity is either to get most of the energy that the body needs from the metabolism of ketone bodies (which the body obtains from ingested fat) or to reduce insulin resistance to such a degree that blood glucose is metabolized for energy and not converted to fat. (In either case, one has to ensure through diet control not to supply the body with more energy than it needs because any food additional to that needed to meet the body's energy requirements will be converted to body fat irrespective of if it is taken as fat, carbohydrates or protein.) For people like me who consider that their quality of life will be seriously compromised if they adopt the first option, the only option left is to reduce insulin resistance. I think the only way I can reduce insulin resistance is through regular exercise. I believe I have reduced my insulin resistance significantly through exercise. I have to reduce it still more to completely get rid of all the excess belly fat. I remain optimistic that I will eventually get there through regular exercise and diet control.

Regards,
Rad
 

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Hi Rad,

I think lots of people start out as IR and after many years of diabetes also become Insulin Insufficient. I don't think that means the IR goes away. In fact many T 2's who go on insulin may need a lot more insulin than one who is not IR. So I think it has more to do with the signaling process than just the over production of insulin. I think when we produce too much insulin for too long or as you said take sulfyurea drugs that do the same thing we may burn out beta cells. The question out there is , "Can we regenerate some of those cells". I think exercise is good and I try to do something every day. Some days I count my housework or yard work as exercise. I think those of us who are IR have to be aware of what different foods due to our bgs. Over the past 4 years I have found I have had to change my diet several times to get the balance that works for me. Right now it seems I am managing the IR pretty well without any of those spikes. It is funny though if I gain a few pounds even though I am still thin, it always comes on my belly, first.
 

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I have no doubt that I am both insulin resistant & insulin deficient. I have read studies that say by the time most T2D are diagnosed, there is already some level of beta cell regeneration deficit. That is, we can continue to make beta cells, but fewer & more slowly than we need them.

Belly fat was not an issue for me at diagnosis; it has been since I began using insulin. I am still not overweight, but I have a tummy bulge that I'd really love to get rid of. I am almost resigned to it, however, because due to my age & my insulin use, no amount of exercise seems to budge it.

Good luck, Rad, keep us posted!
 
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