Defining Diabetes

Diabetes is becoming more and more prevalent.  If you do not have diabetes, I am sure that you know someone who does.  As of yet, there is no "cure" for diabetes.  However, diabetes can be prevented and controlled.  Patients with controlled diabetes can live a normal life span.  The key to controlling and possibly preventing diabetes is to understand its cause.  With proper understanding it becomes easier to adhere to the practices and treatments that will keep diabetes in check.

In our body, sugar or glucose is used by our cells, especially muscle cells, for fuel.  This is the main reason why we eat, to provide fuel for our body.  Glucose is delivered to our cells by way of our blood vessels.  Elevated levels of sugar in the blood stream cause damage.  Since we have blood vessels going to every organ system of the body, diabetes can adversely affect them all.  I like to think of Insulin as a key that unlocks and opens the doors from the blood stream to the cells.  This allows glucose to exit from the vessels to be used for fuel.  Diabetes occurs when there is too much sugar in the fuel lines instead of in the cellular engine.  There are two types of diabetes, type I and type II.  Patients with type I diabetes have an absolute lack of insulin.  This is usually due to a destructive immune response.  It is felt to be triggered by a viral infection and it results in the destruction of all the cells that make insulin.  A patient who has had their pancreas removed surgically would functionally have the same disease.  These patients must take insulin.  I will not discuss this type any further but will now focus on type II diabetes.

This is the type of diabetes that is taking our country by storm.  It is truly reaching epidemic proportions.  It is closely related to being overweight.  It is caused by a resistance to the effect of insulin initially and then a gradually increasing lack of it as the disease progresses.  The problem originates because of abdominal fat stores.  These stores release short fatty acids, which like glucose can also be used for fuel and enters the cells through the same doors.  It is like a bus load of students who have arrived at a museum.  Once they are in line to enter if another bus load arrives and mixes with them it will take much longer for them to all get inside.  The only was to get them in quicker is to open up twice as many doors.  If you have equal amounts of glucose and fatty acids competing to get into a cell it will take twice as much insulin to open enough doors for the glucose to exit out of the blood vessels.  For a time the pancreas just spits out more and more insulin to keep the blood glucose level normal.  Over time, though, the pancreas is no longer able to produce a sufficient amount of insulin to keep up with the demands and the blood sugar begins to rise.  When the pancreas completely burns out, it becomes functionally like type I diabetes.

Diabetes does not begin when the blood sugar rises but many years before that.  If you have more than an inch or two extra around your waist, you are putting stress on the pancreas and increasing your chance for diabetes.  Though there is no cure for diabetes, most of type II diabetes can be prevented.  It is all about the supply and demand for blood sugar.  What we eat greatly influences how much sugar is delivered to the blood stream.  How much we exercise is the major determinant in how much sugar the cells use up for fuel.  In a person who is prone to diabetes the proper diet and adequate amounts of exercise during the time when blood sugars are still normal will completely prevent diabetes for developing.  Waiting until the blood sugar rises may be too late.  We all need to be concerned with this whether or not we have been told that we have a problem.  With this definition in mind, stay tuned as I discuss the treatments for diabetes in more detail next week.