What Is Diabetes?

(Originally posted on bcotoronto.com on May 16th, 2013)

This week is the 4th Annual Diabetes Blog Week so I thought that it would be apropos for me to throw my hat into the ring even though I am not a diabetic myself. So I’m not going to talk about living with diabetes or the emotional struggle involved. For stories like that I would recommend my good friend Ilana Lucas’ blog Diaturgy where her amazing writing talent will have you laughing and crying with every post.

For my part, I’m going to try to do what I (try to) do best: Educate. We’re going to dive deep into what diabetes is so that those of us lucky enough to not have this condition can understand a little more of what it is to live with it.

In a nutshell, Diabetes is our body’s inability to regulate our blood sugar levels. This leads to complications throughout the body which we will get into in a bit. There are two types of diabetes. Type 1 is where the pancreas is unable to produce the insulin necessary to control blood sugar. This can happen because of genetics or environmental exposure to some kind of toxins and usually develops prior to birth or around puberty but can develop later in life. Type 2 is where the body’s regulatory systems which trigger insulin production and release become deficient. This generally develops because of frequent spikes in blood sugar and consistent over production of the hormones associated with decreasing hunger signals.

People living with Diabetes need to constantly measure their blood sugar levels by pricking their finger with a needle and testing a drop of blood. Type 1 Diabetics will also need to inject themselves with insulin to regulate blood sugar after meals. Type 2 Diabetics can monitor their blood sugar levels and manage them through diet and activity without the need for injections.

So far this just sounds unpleasant but not a huge problem right? Well, this is where the picture gets a little darker. To those of us living without diabetes, a dip in blood sugar brings on lethargy and hunger and a spike causes a little bit of mania and maybe the jitters. For someone living with diabetes a low or high blood sugar level can be life threatening.

Insulin is required to push glucose across the cell membrane and into our cells for use. So when we don’t have the insulin to perform this essential component of life glucose builds up in the blood and our cells need to look for alternative energy sources. Muscles begin to breakdown protein which creates urea (a toxic chemical) that needs to be filtered out by our kidneys. Also if glucose is not being pushed into our cells it is staying in the blood and so ends up being filtered out by the kidneys as well. This leads to a drop in blood volume as water is pushed into the urine in the filtration process. A drop in blood volume like this is bad for the brain and causes stupor and confusion. To add to all of this fat is being utilized as an energy source by the body and the processing of fat into usable energy by the liver produces something called Ketones which as toxic if they build up. The build up of Ketones and the drop in blood volume can lead to coma and possibly death. This whole process does not take long to occur.

The other side of the coin is when there is not enough glucose in the blood which is very bad because our brains can only use glucose as an energy source and nothing else. So without sufficient glucose our brain starts to shut down and can lead to coma and death.

So keeping a regulated blood sugar level is very important and very difficult. Our blood sugar fluctuates wildly throughout any given day depending on our needs. This is not a big deal and kept in check by our bodies for people without diabetes but those living with this condition it is a daily struggle. Even a diabetic with well controlled blood sugar can have spikes and dips sometimes.

There are long term consequences to blood sugar levels that are uncontrolled as well. With higher levels of glucose circulating in the blood (not high enough to cause a coma as we talked about before) the glucose ends up sticking to things, mainly the red blood cells (used as a measure of ~3 month blood sugar stability, “A1c”) and the walls of the arteries and veins. This process is called, “Glycosylation” and it causes the tissues it happens to become stiff. This is not a huge problem for the red blood cells but is an issue for the blood vessels which need to respond to different situations by expanding and contracting. This stiffening causes them to be more susceptible to damage which is where the long term consequences come in.

Damage to the walls of the blood vessels increase the risk of the development arterial plaquing which leads to heart disease. Glycosylation has also been shown to lead to the development of Macular Degeneration (a disease of the retinas leading to blindness) as well as putting strain on the kidneys and the filtration of the blood.

Glycosylation can also happen to the nerves of the body which can cause pain along those nerves and can lead to the loss of all sensation along that nerve. This is generally associated with areas of heavy glycosylation in the blood vessels and so a decrease in oxygen reaching these areas of the body (generally the feet and hands) and so the degeneration and death of these tissues. This degeneration is not reversible (although there is some interesting leads in laser therapy to prove this wrong) and the tissue will need to be amputated.

Diabetics also have a higher risk of being diagnosed with cancer because tumors feed off of glucose hungrily. So when tumors are very small and have a chance of dying off on their own due to lack of nutrients they have no end of nutrients in the blood of people living with diabetes because they do not require insulin to grab the glucose up out of the blood while the cells around them are still waiting for the insulin to feed them.

So now you have a little more knowledge about what this condition entails and the burden it can be. A little understanding can go a long way. Diabetes is not something to be feared or shunned. It is a physiological process that can be influenced by our activities and habits. The people I know who have diabetes are some of the strongest characters I have ever met. They struggle and strive to conquer this mountain daily.

Thanks for reading,
Dr. Ben


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