Storage of liver fat can only occur when daily calorie intake exceeds expenditure. Sucrose overfeeding for 3 weeks has been shown to cause a 30% increase in liver fat content (37). The associated metabolic stress on hepatocytes was reflected by a simultaneous 30% rise in serum alanine aminotransferase (ALT) levels, and both liver fat and serum ALT returned to normal levels during a subsequent hypocaloric diet. Superimposed upon a positive calorie balance, the extent of portal vein hyperinsulinemia determines how rapidly conversion of excess sugars to fatty acid occurs in the liver. In groups of both obese and nonobese subjects, it was found that those with higher plasma insulin levels have markedly increased rates of hepatic de novo lipogenesis (2,38,39). Conversely, in type 1 diabetes the relatively low insulin concentration in the portal vein (as a consequence of insulin injection into subcutaneous tissue) is associated with subnormal liver fat content (40). Initiation of subcutaneous insulin therapy in type 2 diabetes brings about a decrease in portal insulin delivery by suppression of pancreatic insulin secretion and, hence, a decrease in liver fat (41). Hypocaloric diet (42), physical activity (43), or thiazolidinedione use (23,44) each reduces insulin secretion and decreases liver fat content. Newly synthesized triacylglycerol in the liver will be either oxidized, exported, or stored as hepatic triacylglycerol. Because transport of fatty acid into mitochondria for oxidation is inhibited by the malonyl-CoA produced during de novo lipogenesis, newly synthesized triacylglycerol is preferentially directed toward storage or export. Hence, hepatic fat content and plasma VLDL triacylglycerol levels are increased.
Other drugs are on the horizon as well, as scientists work to improve the variety of medications to treat type 2 diabetes. Frequently physicians will prescribe one type of oral medication and discover it isn't really helping to control blood glucose that much. In the past, this would have meant that the patient would likely be put on insulin. Now, physicians can try another type of medication to see if it helps correct problems. Physicians often notice that a particular medication works well for a period of time and then begins to work less well for a patient. Now they can mix and match medications that work on different aspects of the diabetes problem to see if that will improve blood glucose control.
Diabetes is a group of diseases characterized by elevated blood glucose levels due to defects in insulin secretion, insulin action, or both. According to the American Diabetes Association (ADA), type 2 diabetes usually begins with insulin resistance. For those people whose bodies resist insulin, the pancreas secretes extra insulin to maintain normal glucose levels. As the condition progresses, insulin production gradually decreases and eventually reaches a level of deficiency that can no longer maintain blood glucose in the normal range. But how type 2 diabetes presents and progresses can vary considerably, as noted by the ADA, and methods of treatment can vary from patient to patient.
You should have no more than three of these “feeding times” per day. The reason limiting the number and duration of your meal times is so important has to do with staying out of the vicious cycle of increasing insulin resistance. To get smart on insulin resistance — the cause of both type 2 diabetes and obesity — read Dr. Jason Fung’s book, The Obesity Code: Unlocking the Secrets of Weight Loss, or watch his free lecture on YouTube.