With Diabetes in Mind

Having a basic physiologic understanding of what diabetes is and how it’s caused is a key stepping stone in diabetes management, supporting your loved ones with diabetes, and supporting the diabetes community as a whole. If you are someone currently living with diabetes, understanding the why can empower the what and the how of diabetes management. If you are not currently living with diabetes, understanding the what of diabetes will allow you to support your loved ones with diabetes by having an understanding of the condition they are living with and/or speaking in correct terms in relation to diabetes to provide better support to the diabetes community.

Let me start off by saying, diabetes is NOT caused by eating too much sugar. If that is what you think, please take a moment to clear, wipe, and remove that concept from your mind and let’s get started on what diabetes actually is…

Most simply put, diabetes is a metabolic disorder characterized by a lack of insulin production or the insulin produced is not enough or working as it should.

What is Insulin?

Keep it simple for me! definition: Insulin is a hormone produced in the pancreas, a small organ located near the stomach. It serves as a key that opens a lock in cells. When this lock is open, glucose (or sugar) is able to enter the cell where it can then be used for energy. Without insulin, the body is deprived of the energy source it needs to execute its functions and glucose will build up in the blood.

Nerd alert! definition: Insulin is a hormone produced in the pancreas, a small organ part of the endocrine system responsible for hormone and enzyme production. It is produced in the islets of Langerhans within the beta cells of the pancreas. These cells can sense when the glucose concentration in the blood is too high and will then release insulin which serves as the key to open a channel in a cell’s membrane to allow the glucose to enter the cell and be used for energy. Without insulin, the body is deprived of the energy source it needs to execute its functions and glucose will build up in the blood.

If diabetes is focused on the absence of insulin, why does everyone think it has to do with too much sugar?

Too much glucose (or sugar) in the blood stream is a result of there not being enough insulin available for glucose to enter the cells so the presence of too much glucose in the blood raises awareness to the fact that there is not enough or no insulin available. This is why the amount of glucose in the blood is a key factor to defining, recognizing, diagnosing, and managing diabetes. If there is one thing you take away from reading this, let it be this: blood sugar is what diabetes revolves around, but it is not the cause of diabetes itself.

What is Blood Sugar?

The term “blood sugar” is most often referring to a numeric value that represents the amount or concentration of glucose in the blood at a point in time. A person without diabetes maintains a blood sugar level of less than 140 mg/dL or 7.8 mmol/L. When we eat anything containing carbohydrates, those carbohydrates are broken down during the digestion process into individual sugar molecules which are glucose. Those glucose molecules are then absorbed into the blood stream to be carried throughout the body and provided to cells as an energy source (with the help of insulin of course).

What causes diabetes and what are the different types?

Now that we have discussed insulin and blood sugar, let’s get into the causes and types of diabetes. There are different causes for diabetes which is why there are different types. However, most experiences of diabetes are the same in living with and managing it regardless of type or origination of diabetes. Our culture and society likes to divide the experience of diabetes based on type and stereotypes of that type where you hear things like “you don’t look like you have diabetes” or “is that the bad kind?” when in reality everyone with diabetes faces similar struggles and experiences in diabetes management. This review of the types of diabetes is meant to help provide insight into the physiology behind diabetes to further understanding of what diabetes is.

Type 1 Diabetes Mellitus (TID or T1DM)

• T1D is caused by inherited risk factors from both parents and triggered by environmental factors such as cold weather, viruses, or even early diet [1].
• The combination of inherited risk factors and environmental triggers result in antibodies that have “gone bad” and end up attacking the body’s own tissues (i.e. the beta cells producing insulin) instead of foreign substances as they are intended [1]. This is what classifies T1D as an autoimmune disorder.
• T1D can develop over many years, but eventually all insulin production is stopped in the pancreatic beta cells. Those newly diagnosed may have what is called a “honeymoon” period where some insulin production is still occurring as not all insulin producing cells have been attacked yet, but eventually all insulin production will cease.
• Those with type 1 diabetes do not produce any insulin and are completely reliant on an external source of insulin from injections or an insulin pump.
• T1D can only be managed and not treated as it cannot be reversed and no cure exists yet. That’s right, cinnamon is not going to do anything for you, and diet and exercise will not reverse it.
• There is no one size fits all treatment plan for type 1 diabetes so understand what may work well for one person may not work well for someone else. However, every treatment plan must include insulin.

Latent Autoimmune Diabetes of Adulthood (LADA)

• LADA is a subset of T1D that is developed late in life, usually after the age of 30 [2].
• People with LADA are clinically similar to type 2 diabetes at time of diagnosis where they do not require insulin. However, LADA is characterized by highly variable beta cell destruction rate where eventually insulin production will cease and the person will be insulin dependent [2]. At this point, the person is clinically similar or basically the same as those with type 1 diabetes.
• The main differentiation between LADA and type 1 diabetes is older age of onset and slower progression towards insulin dependence [2].

Type 2 Diabetes Mellitus (T2D or T2DM)

• Type 2 is caused by inherited risk factors and has a stronger link to family history and lineage than type 1, but also depends on lifestyle factors like obesity [1].
• Those with type 2 diabetes are still producing insulin, but have insulin resistance where the insulin is not able to do its job or not enough insulin is being produced to meet the body’s demands so the process of glucose entering the cell is impaired.
• Type 2 diabetes is managed through an emphasis on a healthy diet, weight management, and physical activity. Some people with type 2 diabetes can maintain their target blood sugar range with exercise and diet alone, but many also need an oral medication (there are many varieties) and insulin as well [3].
• There is no one size fits all treatment plan for type 2 diabetes so understand what may work well for one person may not work well for someone else.
• A common stigma with type 2 diabetes is that someone “brings it upon themselves” due to lifestyle choices. While lifestyle choices can contribute to risk for diabetes, no one asks for diabetes or purposely brings diabetes upon themself. Those with type 2 diabetes deserve the same empathy, respect, and attention as any other type of diabetes.

Other Types of Diabetes

• Gestational Diabetes: a temporary form of diabetes in pregnant women where insulin resistance is brought on by the hormonal changes that occur during pregnancy [5]. Insulin resistance means the amount of insulin produced is not as effective as it needs to be in maintaining a normal blood glucose range. Gestational diabetes goes away at the time of birth.
• Type 3C (Secondary Diabetes): damage or removal of the pancreas brought on by other diseases, medical conditions, or medications [5]. For example, the pancreas or a portion of it is surgically removed due to pancreatic cancer.
• MODY (Maturity Onset Diabetes in the Young): defects in pancreatic beta cell development that impairs insulin secretion and is an inherited genetic condition. There are multiple subtypes of MODY based on the gene involved. MODY is different than T1D as there is still some insulin production and there are no pancreatic autoantibodies [7].

Why is blood sugar control important?

Excess glucose on the blood vessels and nerves can lead to long term complications such as:

• Increased risk of cardiovascular disease, high blood pressure, heart attack and stroke [6]
• Eye problems: retinopathy, cataracts, glaucoma, and blindness in extreme cases [6]
• Nerve Damage: neuropathy, foot complications [6]
• Kidney Disease: nephropathy [6]
• Skin Complications: various skin conditions such as bacterial or fungal infections or dermopathy among others [6]

What are the signs of diabetes?

• Excessive Thirst and Frequent Urination – Since glucose cannot enter the cell in the absence of insulin, the glucose builds up in the blood where the body attempts to remove the excess through urination. Excessive urination leads to excessive thirst.
• Fatigue and Extreme Hunger – With the cells deprived of glucose, they are not receiving they energy they need for the body to function leading to fatigue and hunger as the body feels deprived of fuel.
• Unusual Weight Loss and Ketosis – With the body not able to use it’s primary energy source of glucose for fuel, the body taps into it’s secondary energy source for fuel which is fat causing the weight loss. A byproduct of using fat for fuel is the creation of a ketone. While ketones are normal, a ketone is an acid and too many ketones can disrupt the body’s pH balance and lead to ketoacidosis where the body is in a toxic state and essentially “poisoned” by all the ketones. Diabetic Ketoacidosis is what usually lands people in the emergency room with a diagnosis of diabetes if the earlier signs are not picked up on.
• Other symptoms can include blurred vision, slow healing wounds or sores, and frequent infections.

Well, friends, that’s wrap on, What is Diabetes? Hope you found this informative!

References:

1. American Diabetes Association. (n.d.). Learn the genetics of diabetes. American Diabetes Association, https://www.diabetes.org/diabetes/genetics-diabetes.
2. Pozzilli, P., Pieralice, S., (2018 June). Latent autoimmune diabetes in adults: current status and new horizons. Endocrinology and Metabolism, 33(2), 147-159. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6021307/
3. Mayo Clinic. (n.d.). Type 2 diabetes: diagnosis & treatment. Mayo Clinic, https://www.mayoclinic.org/diseases-conditions/type-2-diabetes/diagnosis-treatment/drc-20351199
4. Hallberg, S.J., Gershuni, V.M., Hazbun, T.L., Athinarayanan, S.J., (2019 April). Reversing type 2 diabetes: a narrative review of the evidence. Nutrients, 11(4), Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6520897/
5. McGuire, M., Beerman, K.A., (2018). Nutritional sciences: from fundamentals to food (3rd ed.). Cengage Learning
6. American Diabetes Association. (n.d.). Complications. American Diabetes Association, https://www.diabetes.org/diabetes/complications
7. Hoffman, L.S., Fox, T.J., Anastasopoulou, C., et al. (2022 August). Maturity Onset Diabetes in the Young. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan. Retrieved from: https://www.ncbi.nlm.nih.gov/books/NBK532900/