Article # 77. About Diabetes

Diabetes, known medically as diabetes mellitus, is a metabolism disorder. Metabolism refers to how the body uses and digests food for growth and energy. Most of the food we consume is broken down into glucose. Glucose is a type of sugar in the blood - it is the main source of food for our bodies (our cells).

When food is digested it eventually enters our bloodstream in the form of glucose. Cells utilize the glucose for growth and energy. However, without the help of insulin, the glucose cannot enter our cells.

Insulin, a hormone, is produced by Beta cells in the Islets of Langerhans, which are in the pancreas.

After eating, the pancreas automatically releases an adequate amount of insulin to transport the blood glucose into the cells, which results in lower blood sugar levels.

If you have diabetes, the glucose in the bloodstream does not enter the cells (at all or not enough), so glucose builds up until levels are too high, resulting in a condition called hyperglycemia. This happens for one of two main reasons:

·         The body is producing no insulin - as is the case in Diabetes Type 1

·         The cells do not respond correctly to the insulin - as occurs in Diabetes Type 2

Consequently, excessive amounts of glucose accumulate in the blood. This blood glucose overload is eventually passed out of the body in urine. Even though the blood has plenty of insulin, the cells of a person with diabetes are not getting their crucial energy and growth requirements.

In Diabetes Type 1 the body is not producing insulin, while in Diabetes Type 2 the cells are not responding properly to the insulin, and/or there is not enough insulin being produced.

Types of Diabetes

Diabetes Type 1 patients, who typically develop the disease as children or young adults, are unable to produce insulin. In this type of diabetes, the beta cells of the pancreas no longer make insulin because the body’s immune system has attacked and destroyed them. Their symptoms--high levels of sugar in their blood and urine, frequent urination, extreme hunger, thirst, and weight loss, weakness, and nausea--often develop quickly. Individuals with Type 1 diabetes control the disease with daily insulin injections, exercise, and diet.

Diabetes Type 2 formerly called “adult onset” diabetes is the most common type of diabetes, which constitutes the most common form of the disease with over 80% of diabetic patients suffering from this "adult onset" form. Type 2 Diabetes usually begins with insulin resistance, a condition linked to excess weight in which muscle, liver, and fat cells do not use insulin properly. In other words Type 2 patients do not produce enough insulin or are unable to make proper use of the insulin they do produce. Although certain symptoms are similar to Type 1 (tiredness, irritability, nausea, possibly increased appetite), Type 2 diabetes develops more slowly and thus can develop undetected for some time.

The precise causes of both types of diabetes are unknown, but in many patients, genetic factors seem to play a role in the manifestation of the disease.

Gestational diabetes is a type of diabetes that develops only during pregnancy. Gestational diabetes affects 2 to 10 % of all pregnancies.

The hormones produced during pregnancy increase the amount of insulin needed to control blood glucose levels. If the body can’t meet this increased need for insulin, women can develop gestational diabetes during the late stages of pregnancy.

Although this type of diabetes usually goes away after the baby is born, women who have had gestational diabetes are more likely to develop type 2 diabetes later in life. Research has shown that lifestyle changes and the diabetes medication, metformin, can reduce or delay the risk of type 2 Diabetes in these women. Babies born to mothers who had gestational diabetes are also more likely to develop obesity and type 2 Diabetes as they grow up.

Insulin resistance

Our body produces insulin, but its insulin sensitivity is undermined and does not work as it should do - glucose is not entering the body's cells properly. Consequently, blood sugar levels rise, and the cells are not getting their required nutrients for energy and growth.

The insulin resistance will reach a point in which the amount of insulin produced by the pancreas is not enough to make up for the cells lower response. At this point the person will have to take additional insulin.

Lack of physical activity, being overweight, and some genetic factors make it much more likely that the cells build up insulin resistance more quickly. It is important to remember that insulin resistance is not the insulin not responding properly, it is the cells not responding properly to insulin.

Unfortunately, insulin resistance can lock a patient into a vicious circle, because insulin resistance itself promotes weight gain. So, if people are insulin resistant because they are overweight, the excess pounds are harder to get rid of because of it.

Diabetes - Type I	Diabetes - Type 2
Usually appears before the age of 25	Patients tend to be older than 25, overweight, sedentary
Patient can quickly become very ill	Early stages don't necessarily produce symptoms
No longer able to produce insulin, so nutrients can't reach cells	Sometimes detected during routine blood screening
Blood sugar can skyrocket	Still produce insulin, but are "insulin resistant," so cannot use the insulin produced
Managed by insulin injection	Managed through diet, weight loss, oral medication, and possibly insulin injections
Goal of medical team: improve management of disease and life of patient	Goal of medical team: improve management of disease and life of patient