Diabetes Self-Management Blog

It’s no secret that having excess fat anywhere in the body isn’t so healthy. When’s the last time you took a good long look at your body in a full-length mirror? If you’re like many people, you probably don’t do this, and if you do, you might quickly glance away.

Yes, Americans are overweight and obese. In fact, just a couple of weeks ago, the Trust for America’s Health and the Robert Wood Johnson Foundation released their annual report, entitled “F As in Fat”, stating that obesity rates in a dozen US states have risen above 30%. To put that in perspective, four years ago, only one US state had an obesity rate above 30%.

So yes, being overweight or obese is a growing problem (no pun intended) and unfortunately, there is no one right or easy way to fix it. And no doubt, for those of you who struggle with your weight, you’re likely tired of hearing about obesity statistics and how important it is to reach a healthy weight. It’s hard and it’s discouraging.

Saddlebags vs. Spare Tires
If it’s any consolation, you might be able to feel a little bit better based on where most of your fat stores are located. Admittedly, you may never be thin and you may never lose those 50 or 100 pounds. But you can still do a lot to stay as healthy as possible and limit your chances of heart disease, high blood pressure, gallbladder disease, and some types of cancer. The type of fat you have also can affect your risk of developing Type 2 diabetes.

Go back to your mirror and take a long hard look. Where is most of your fat located? If you tend to carry your weight more in your hips and thighs (sometimes called “saddlebags” or being a “pear” shape), you can breathe a little sigh of relief. Carrying weight in these areas is what scientists believe to be less “harmful.” If, however, more of your weight is carried around your middle (known as a “spare tire” or having an “apple shape”), you may want to pay a little more attention.

Fat Facts
Everyone has two main types of fat in their body:

Subcutaneous fat: This is the layer of soft fat that lies just beneath the skin and makes up roughly 90% of the fat in our bodies. Of interest, if you inject insulin with a pen or syringe, you inject (or at least should be injecting) into this layer of fat.

Visceral fat: This type of fat that resides in your abdomen. Visceral fat is the kind of fat found deep within your abdominal cavity and that sneakily wraps itself around your internal organs like your liver and intestines. Visceral fat also lies in a layer under abdominal muscles and gets harder over time.

As many as 50% of people have too much visceral fat. A misconception about fat is that it’s a blobby, inert substance that just lazily lies there doing nothing. Nothing could be further from the truth. Fat is really like an organ, busy secreting hormones and other substances that affect the body in various ways. For example, visceral fat releases free fatty acids into the blood and into the liver that can affect the production of cholesterol and triglycerides (blood fats). It also releases various types of proteins that can trigger an inflammatory response, bumping up your risk for heart disease, and can boost blood pressure and insulin resistance (both in people with and without diabetes).

Subcutaneous fat, on the other hand, releases more beneficial chemicals, including leptin, a hormone that suppresses appetite and burns fat, and adiponectin, another hormone that protects blood vessels from damage and helps the body better use fat and glucose.

Why You Should Eviscerate Visceral Fat
To sum up, visceral fat is a problem. We all have it, but many of us have too much. Why is it such a problem? Here’s the damage that it can do:

  • Increases blood pressure and blood fats
  • Increases blood glucose
  • Increases risk of breast and colorectal cancer
  • Increases risk of asthma
  • Increases risk of dementia (including Alzheimer disease)

In other words, it pays to pay attention to visceral fat. There are things you can do to shrink it, even if you don’t get down to your high school fighting weight. How? We’ll look at that next week.

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Comments
  1. Interesting comment distinguishing type of body fat and its significance. Total weight is important but we need to pay attention to total visceral fat as suggested. Remember when you diet and exercise you may lose inches without losing weight because a pound of fat takes up much more volume than a pound of muscle. If you are working hard to lose weight and reach a plateau, follow your measurements as you may be making significant improvement in your body without seeing it on the sale. Don’t get discouraged.

    Posted by diabetic survial kit |
  2. I used tonnes of insulin per day and most of my fat is visceral. Makes one wonder if for people with a working pancreas if a very low carb diet would help in loosing belly fat. Less carbs = less insulin = less belly fat maybe ?

    Posted by calgarydiabetic |
  3. I think you are right. A low carb diet should help with weight loss and if sufficient protein is consumed it you should lose the right type of fat. If you used tons of insulin per day you were probably consuming too many carbs and used too much insulin to cover it rather than making appropriate changes in your diet. I would advise you to consult your health care provider and get on an appropriate diet. Good luck! Sybil

    Posted by Diabetic Survival Kit |
  4. My comment has to do with diabetics and insurance companies. Do you suppose there will be a day when the insurance company will charge more for policies of those overweight? They already ask if you have certain preexisting conditions. Another comment is related to the economy and how insurance companies contol our lives. In order for the insurance company to save money they have the right to take away our regular metformin that has worked for all those years and replace it with a generic substitute? A recent article contained a description of what are different “fillers” to be found in the generic types. An then there is the question about what country were they made! Like to hear a comment on this as I think it is happening more to us now with the downswing in the economy.

    Posted by Richard Shaner |
  5. Today we are seeing an explosion in type 2 Diabetes. I have had type 2 type Diabetes for over 30 years and the last 4 years cleaning up the mess and getting under control after a 4 year serious fight after a stroke on December 2007. The results after monitoring my disease first on over 30 finger pricks a day on a hand held glucose meter and finally a Continuous Glucose Monitoring System for 6 months have gotten me to a daily average of 140 on BG and an A1C of 6.4 In order to arrive at these results , I ended up having to achieve tight glucose control, regular hearty exercise, getting off actos and going on to accurate insulin injection boost assist and control rather than starlix, and fixing a leaky liver using metformin.
    The data and experience doing this have been extremely revealing. In addition, I consider myself to have the old hunter-gather gene set useful for eating and surviving on the food of years ago that would consist of low-nutrient food, game, fish and assorted leaves requiring lots of exercise just to rustle up that food to survive.
    Today, we have witnessed the great enlightenment of the United States where after the Second world war saw an enormous development in medical science, agriculture, computers, automation and of course home computers, 3D wide screens in the home, game boys and assorted other couch potato – low exercise entertainment and work.
    The concern I have is that at same time that enormous genetic and plant improvements were being made to improve grains, corn and rice growing and nutrient quality and nutrient content; tools and products that convert us to couch potatoes have been introduced reducing over all exercise and energy burn by the human body. Furthermore, if one has the old hunter gather gene set, there will be an explosion in the volume of glucose generated by such bodies from ingesting the modern high nutrient grains and carbohydrates which upon reduced exercise can lead to the condition of excess glucose in Blood – raised BG.
    The body uses glucose for energy generation, adding to fat stores and if the supply of glucose exceeds the cells need and ability to dispose or store ends up overloading the cells and backing up in the blood stream . My direct experience reveals that if there is insufficient exercise to burn off the glucose generated, one initially gets fatter and then failing that the cells begin to refuse to absorb any more glucose and then one has a condition known as insulin resistance. In conclusion, the body’s defense against too much glucose it cannot regulate is to ignore insulin – insulin resistance.
    Through my experience, I found I could stop that resistance by heavily exercising, stopping all excess insulin production due to diet choices, fixing medical conditions from leaky liver dumping in excess glucose and hearty exercise to literally burn down the glucose. It must be pointed out that only thru energy burn by body in running its processes, making heat and locomotion is it possible to clear out the excess glucose so that body cells can take on more. Insulin is simply a transfer enabling hormone that enables the cell to take on glucose assuming it is capable and able to take on more glucose otherwise it goes deaf.
    One thing I noted about the drug Actos is that it does enable the cells to take on more glucose when the cells have gone deaf on insulin presence in blood stream.
    My experience was very clear on this due to a leaky liver that would load up my body while I was asleep doing the dawn effect and hammering blood sugar up to 240 every am. During this time I would take 26 units of 75/25 Humalog in am when I wake up and watch it do nothing. I would then walk for 2 miles and then I would see BG drop back to 100. It wasn’t till most of excess glucose marched out by walking , I would finally see the insulin power from am injection kick in and work helping to push BG down faster. Prior to walking, the lowest I could get my BG down to was 185 and that was Actos doing it by itself too.
    This went on every morning for a year till I found power and timing of metformin doses to shut off errant liver.
    Today, I now watch the portion size and calorie content of all carbs I eat to ensure that bread, rice, grains, pasta, cookies, buns and cakes are literally cut back to small 100 calorie portions and eat larger potions of vegetables, cheese, yogurt, etc. It’s not that I cannot eat the carbohydrates , but I have to cut back portion size back very small. The other aspect of this is to consider your energy needs versus your age, job, activity very carefully. The body can only regulate glucose so far and so much. Exceed that balance and you will see insulin resistance and the BG climb out of control.
    The other important point lost in this fracas is that there are a number of organs from the gut, liver, pancreas, kidneys and brain all involved in a complex dance to regulate ones glucose level typically in non diabetic working system to 90 to 100. Depending upon any medical diseases, aging and degeneration, ones BG can be adversely affected and will require medical assistance to correct.
    To be clear; Type 2 Diabetes stated in its simplest indicates that your blood sugar is too high and out of recognized bounds for a normal operating body. Beyond that, it can caused by poor carbohydrate control, lack of hearty exercise, medical issues of one or more of the key organs from a simple problem to a complex issue where all organs are off slightly along with insufficient exercise and loose carbohydrate control.
    In summary and most importantly, the point of this essay is that we have in America improved the nutrient value of the foods, reduced the exercise with couch potato tools and entertainment and for the most of us are packing an old Hunter gatherer gene set optimized for the days of meager food and low nutrient value food and as such those of us on this old gene set have not seen our gene sets modified to match the new high test fuels and low exercise and as a result type 2 diabetes is exploding. For those of us aging and our key organ systems are degenerating face a critical regimene of carbohydrate reduction control, hearty exercise, medical attention and drug assists ( insulin and hormone boosts, metformin etc). In addition, in order to stop the “disease”, one needs to scale back all sorts of excessive glucose generation from diet issues and due to old gene sets, correct medical problems acerbating this issue from leaky livers on down and get strong hearty exercise of which 1 to 2 miles walking is an example will march out excess glucose and filter out completion products from the chemical process of cracking glucose.
    Most interesting after being on this regimene for over 6 month, I found my body start using my own insulin and causing excessive hypoglycemic lows requiring the removal of starlix/glyburide pills, actos and the potent 75/25 humalog insulin. After doing that and going onto reduced volumes of liquid Humalog Lispro standard insulin, I found my body working very nicely with the BG slowly moving like waves on placid lake as BG slowly moving up and down in response to gut output from 130 to 170. In fact, the weekly average appears to be gradually dropping lower. All on a 1200 calorie diet with grains and carbs carefully restricted and medical fixes. In the past during excessive glucose generation, adding extra insulin on top of the body’s insulin while genetically different from the body’s own release provides some temporary relief but does not solve the problem as the body is not fooled long and learns to throw up an insulin resistance to the new comer during the interval of excessive glucose generation overall.
    Today, I found Basil Insulin of Lantus – 15 units once a day and Humalog Lispro – 4 units at each meal and ½ unit at midnight most helpful in boosting body’s reduced insulin production most helpful. This is after years of blasting body on starlix pills and 75/25 liquid Insulin and now cut off. No, my pancreas and islets were not worn out or killed off.
    Folks, I am not interesting in assessing blame or silly conclusions. From current research, I would humbly offer that all the work to date is critical and examination of all edge cases of black box system operation critical to achieving a tool kit of medicines to solve the medical edge cases necessary to solving the huge variant of medical short comings leading to excessive blood stream glucose loading and hopefully we will arrive at a more complete overall medical assessment and proposed overall holistic better solutions to this vexing and difficult disease.

    James W. Snell

    Posted by jim snell |
  6. Yes, good article, except that we have EXACTLY NO CHOICE where our body lays down our fat. We are genetically programmed to be apples or pears, and I really resent the comparison that makes it look like I did something wrong for being a natural-born apple (all the women in my family are). I am at a normal BMI (24.3), but I still have a small “spare tire”, and likely won’t get rid of it. I appreciate ideas about blood sugar control, and how diet and exercise can help, but stop blaming the apples, because we DIDN’T ask for it!

    Posted by Natalie Sera |
  7. Hi Natalie,

    Thanks for your comment. You’re right — people can’t really help their body shape. But as you’ll read next week, there ARE things you can do to help shrink some of that harmful visceral fat. It’s not about blame, it’s about taking action steps to reduce risk.

    Posted by acampbell |
  8. Natalie:

    My apologies. The real point while not emphasized was to point out that these problems are not a personnal choice item.

    Far from it, my point is that until we get off that dime and properly research this fracas from a numerous perspectives, we are doomed for a continuous flood of this problem.

    I was on a 1200 calorie diet - restricting snacks booze etc. I could not loose an ounce till my liver stopped with metformin. I had gained weight to 330 pounds and kidneys, eyes and body breaking down.

    Diet alone was useless. Once liver stopped in its tracks, my weight finally started dropping and I am now down to 260 odd pounds.

    Rest assured I do not blame anybody for their problem having had all sorts abuse thrown at me by village which doctors that should know better.

    I apologize that my article gave cover to the blame game folks and was the furthest thought from my intent.

    Posted by jim snell |
  9. Hi Richard,

    I’m by no means an insurance expert, but I believe that some life insurance companies do boost their premiums for those who are overweight or obese. They take into consideration, as you said, preexisting conditions, and that includes weight. If anyone can shed more light on this topic, please share!

    Posted by acampbell |
  10. I’m a type 2..for 25 years. I never, ever had a problem with belly fat. My belly was always pretty flat. Then I had to have surgery, a bowel resection. From that day on, I have had belly fat. I don’t know why. I have done everything to get rid of it…diet, exercise, crunches, sit ups. The belly is still there. Low carb, low fat, you name it, I’ve tried…all with the help of my doctor. I’m not overweight, I never was, but danged if I can get rid of my belly fat.

    Posted by Sue |
  11. There really needs to be a limit on the length of some Comments…

    Posted by John_C |
  12. Natalie: You stated that:
    I could not loose an ounce till my liver stopped with metformin.

    Did you just stop taking Metformin?

    Posted by Amaze02 |
  13. By the way…using a lot of
    insulin can actually cause you to gain weight. (told to me by 2 different specialists) Especially something like Levemir. When I stopped taking Levemir, I dropped 10 pounds. It caused me to bloat up…probably water weight. A few hours after I took it, my face and hands would swell up. The doctors ruled out any kind of drug reaction.

    Posted by Sue |
  14. Hi Sue,

    I appreciate your comment, but would like to clarify that while some people gain weight when first starting insulin, not everyone does. Weight gain isn’t inevitable and you can take steps to limit this. Also, it’s important to distinguish between fluid weight gain and fat gain. Finally, some people actually lose weight when they start on insulin due to improved glucose control and if started early on, insulin may lead to weight loss due to a suppression of hunger.

    Posted by acampbell |
  15. Can you please tell me how to get rid of visceral fat. I am in a wheelchair and cannot walk or stand. I sure hope someone can tell me what to do.I have been confined to a wheelchair for 20 years.

    Posted by Virginia Fowler |
  16. Hi Virginia,

    A new study has shown that aerobic exercise (the kind that uses large muscles and gets your heart rate up ) can help decrease visceral fat. Even though you’re in a wheelchair, there are exercises that you can do in a sitting position. Visit the store on Joslin Diabetes Center’s Web site at and you can purchase an exercise DVD that allows you to do the exercises sitting down. Also, if you haven’t done so already, read my posting from August 8 on others ways to reduce visceral fat.

    Posted by acampbell |
  17. thanks for sharing! very interesting and informative. i think increasing fiber from veggies and fruits can greatly reduce the risk of having too much fat and to eliminate the excess fats

    Posted by Marty |

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