What is diabetes?

The first thing I wanted to do when diagnosed was to understand the disease. I found out later that understanding is essential to management. Type2 diabetes is normally progressive, that means it gets worse. The longer you can stall it the better. One day I hope to find something that will cure me, until then I have to live with it and not let it interfere with my quality of life.

Our food is composed of proteins, fats and carbohydrate. Each of these is a complex entity in its own right and our body deals with them differently. For now, I shall tell you a little about carbohydrate.

Carbohydrate is broken down in the digestive tract into types of sugar. Some are simple sugars (or monosaccharides), such as glucose, fructose and galactose, and others are disaccharides: commonly know as sucrose, lactose and maltose. Once absorbed into the bloodstream, the liver converts sugars to glucose to use as energy for the cells.

Your brain runs on glucose and it must have a constant supply to keep it going. Therefore, there is always a minimum amount of glucose needed in the bloodstream and the body carefully regulates its concentration. When you do exercise, you burn fuel. As the cells burn fuel, they call upon the blood to supply more glucose. The “preferred” fuel is glucose, although there are other types the body can use. When the cell needs more fuel, it creates (expresses in medical jargon) receptors at the cell surface, which take the fuel into the cell. The more fuel it needs, the more receptors are created. However, it is not quite that simple. These receptors have to be “activated” and to do that they need the hormone insulin in the blood. This a mechanism the body has for “sharing out” its glucose throughout the body and making sure energy goes to where it is needed. Diabetes occurs when this mechanism functions incorrectly. The effect is to leave too much glucose in the bloodstream. This has many consequences, which we shall examine later.

There are two main types of diabetes, but they are both characterised by glucose not being able to enter cells. The first form of diabetes discovered is now termed type1 diabetes. This is when the pancreas, the organ responsible for making insulin, stops making any, or is unable to make sufficient for the body needs.

In 1922, a team headed by Frederick Banting discovered and isolated insulin.
http://inventors.about.com/library/inventors/bldiabetes.htm

Before this discovery people with type1 diabetes lived at most for six months following diagnosis. This discovery of insulin changed that and now people can live for many years. It has to be injected into the fat stores (not into the veins) and depending on the type of insulin, its effects last for eight or so hours. Ingesting insulin is ineffective because stomach acid destroys it, although scientists are now finding ways around that.

Today, insulin insufficiency accounts for only 5% of the cases of diabetes. Type2 diabetes accounts for nearly all of the remainder. Type2 diabetes was once called “late-onset” diabetes or non-insulin dependent diabetes mellitus (NIDDM). However, we are now seeing the disease in children as young as 12 and so the more precise name. Type2 diabetes is insidious and creeps up on you without you noticing. It occurs because as in tye1, glucose cannot enter the cells, at least not quickly enough, but the reason is different. There is not a shortage of insulin; it is just that the insulin cannot activate the receptors in the cells. There are many theories about why this happens, but the causes remain elusive.

Therefore, whatever the type of diabetes, it leaves glucose in the bloodstream, but for different reasons. High levels of glucose in the bloodstream are damaging to all organs. Future health depends on keeping levels as low as possible.

There are many strategies to help avoid high blood glucose, and I shall be looking at them in future instalments.