The Who, What, and Why of Diabetes

Diabetes is one of our society's most widespread epidemics today and as a firm believer in prevention, this is something I think everyone should be knowledgable about, in some way. It's a complicated topic, so I'll try to keep it as non-science-y and simple as possible. X, this one's for you.

How Diabetes works:

There are 2 hormones that control the regulation of our blood sugar; insulin and glucagon. Both are produced in the pancreas. Beta cells in the pancreas produce insulin, which is secreted in response to high blood sugar. Alpha cells in the pancreas produce glucagon, which is secreted in response to low blood sugar. Both work to keep your blood sugar (blood glucose) levels consistent.

3 type of diabetes:

Type I: Autoimmune destruction of insulin-- your own body kills off beta cells, which produce insulin (~5% of cases of diabetes in the U.S.). More prevalent in children and young adults.

Type II: Insulin resistance/deficiency (~95% of cases of diabetes in the U.S.). Your body produces insulin but is not sensitive to it, which then, does not allow for blood sugar to enter your cells.

Gestational Diabetes: Women may become diabetic during pregnancy, most often in the third trimester (due to hormonal changes). However, if monitored closely, the incidence of diabetes can go away after giving birth and leave the child unaffected.

Now how do we apply alpha this and insulin that to real life?

When it's 4 p.m. and lunch seemed like it was many, many moons ago-- your body usually starts to crave a little pick-me-up. When blood sugar levels are low, your body will secrete glucagon in order to normalize blood sugar levels by increasing them.

On the flip side, let's say it's another late night at the Taqueria (clearly I love being back in S.F.). You order 2 a.m. nachos with the works and polish it off with a slice of cheesecake (true story from a few weeks ago, I like to recount personal experiences). With the ingestion of all this sugar and carbohydrates (which break down into glucose), your blood glucose levels increase. This is when insulin steps in to decrease the blood sugar levels and bring them back down to normal.

Now on a cellular level, this gets really interesting. When blood glucose levels are high, insulin goes to our cells and allows for their glucose channels to be opened so that these cells can take in the glucose. Insulin is the key to getting glucose from the bloodstream into the cells. Think of it like a bunch of Twittering Tweens (blood glucose) trying to get into the Jonas Bro's concert (the cell) and the concert gatekeepers (insulin) are responsible for letting in the vested and fedoraed masses into the concert.

With diabetics (type II), there is a decrease in cell sensitivity to insulin. This means the cells are not acknowledging insulin, which in turn, doesn't allow for the blood glucose to be let into the cells. At that point, the blood glucose stays in the bloodstream and accumulates. Too much glucose hanging out in bloodstream and not enough in cells can lead to several medical complications. So at the end of the day, you have more and more angry Tweens amassing outside the concert door, but the gatekeepers aren't responding to the signals that they need to let the Tweens inside. This overload causes traffic jams in the streets (bloodstream) which starts to put a strain on everything else.

* Eyesight. Glucose can accumulate in the capillaries of the eyes, leading to blurred vision.

* Nervous system. Accumulation of blood glucose affects capillaries, which weakens them and affects overall circulation. Peripheral nerves are highly affected (especially the feet and hands which have the lowest circulation, hence, why they get cold more quickly than other body parts). In more severe cases, wounds/cuts can lead to gangrene. Ex: when someone with diabetes gets a cut, the wound is more susceptible to infection because diabetics have sweet blood, and bacteria feeds on sweet. The healing time is also increased and in some some cases, can lead to amputation when the infection is too drastic.

* Kidneys / Excessive urination & thirst. The kidneys are strained, desperately trying to flush out the excess blood sugar, which causes lots of trips to les toilettes. Which then, causes more thirst. And so the cycle continues.

Treatment:

Type I: Diabetics can self-treat with injections of insulin shots. This involves monitoring blood glucose levels after meals to know how much insulin is needed (too much/too little can be harmful). When the body destroys its own source of insulin (beta cells), diabetics need to inject themselves with an external source in order for the glucose to be allowed into cells.

Type II: Diabetics are advised to eat 6-7 small meals throughout the day to maintain steady blood sugar levels, increase fiber intake, and exercise regularly.

While too much carbs/sugar can be detrimental to someone with diabetes, it's about eating the right things, in the right portion sizes, at the right times. 45-65% of the diabetic diet should be devoted to complex carbohydrates (whole grains, fruits, vegetables). Simple carbs (refined sugars) should be avoided. Fiber is essential because it slows the absorption of glucose into the bloodstream, which helps keeps glucose levels consistent (as opposed to the spikes one might face with simple carbs). Eating small meals throughout the day will also make it easier for your body to keep these levels consistent. Eating a big meal requires a lot of insulin and your body does not have the resources to handle that high spike in blood sugar.

And according to Dr. Trinh Tran, my nutrition professor, exercise can trigger a cascade of reactions at the cellular level that increases sensitivity to insulin, which opens glucose channels and allows for these channels to let glucose into cells. Medication can also be taken to stimulate the pancreas to produce more insulin.

Symptoms:

Now, don't get crazy with the self-diagnosis (I was convinced I had diabetes when I first learned about it in class). But, if you are concerned-- you go see a doctor who can check your blood sugar levels. Here is a list of common symptoms:

• Frequent urination
• Excessive thirst
• Extreme hunger
• Unusual weight loss
• Increased fatigue
• Irritability
• Blurry vision

Should you be concerned?

CBS news states that 24 million Americans have diabetes (about 8% of the population)-- the epidemics shows no signs of slowing down either. This is how preventative health and knowledge can save your life. A lot of diabetics simply don't know they have diabetes for quite some time and by the time symptoms are at full-blast, the situation could be very serious. Getting regular check-ups and being able to recognize symptoms can help you spot the disease in its early stages and prevent it from worsening.


Below is a list of populations who more susceptible to the disease (Type II):

1) Older people (40+). Diabetes can still affect people younger than 40, but research shows that with age, cells becomes less sensitive to insulin.
2) Obese and overweight individuals. The International Diabetes Federation states that "80% of people with diabetes are overweight."
3) Those with a family history of diabetes-- talk to your parents and see if it is genetic.
4) Those with IGT (Impaired Glucose Tolerance)-- whose blood sugar levels are higher than normal (healthy levels are between 70 and 110 milligrams of glucose / 100 milliliters of blood).
5) African-Americans, Hispanic Americans, and Asian-Americans and Pacific Islanders.
6) Those who do not exercise regularly.
7) Those dealing with another medical condition, such as renal (kidney) failure, cardiovascular (heart) disease, and/or stroke and nerve damage. It's important to look out for signs in the early stages so that these other medical conditions do not develop or worsen as a cause of the disease.


Conclusion (aka, you made it to the end!)

I know I presented a lot of information today, but this is a very serious topic and it will only become more relevant as we grow older. I hope you were able to take away something useful ....and please share your knowledge! You never know who might need to learn. Cheers and have a great week.