You have probably heard quite a few things about "Diabetes," mostly as a general umbrella term thrown around by the mass media, from news articles, to well-intentioned television hosts. Based on what these folks say, you probably have a very basic, limited understanding of the disease, and it's probably in alarmist terms: Something along the lines of... "335 million people, worldwide, have it, with around 2% of Americans walking around, undiagnosed, not knowing they have high blood "sugar" (with little explanation of what blood "sugar" is)... and oh, my god, the obesity epidemic is skyrocketting, and seriously, you people need to lose weight, and yadda, yadda, yadda, yadda... Stop eating sugary food, and McDonald's... because in the 'near future', estimated figures "predict" as much as 75% of people will be developing "Diabetes"." What's worse is that these alarmist outlets leave you with the impression that a.) There's only one type of Diabetes, b.) all Diabetes is the same, c.) Diabetes is very straightforward and easy to understand, d.) all people gave themselves this disease (or gave their kids this disease) because they're slackers, or poor parents, e.) if they weren't such slackers, they could cure themselves with diet and exercise, gastric bypass, or some miracle supplement or special raw diet being promoted online, and f.) if people aren't diagnosed, it's their own fault for not paying enough attention.
There are SO MANY things that are wrong with this scenario!
1. Diabetes is NOT straightforward. Diabetes is a very complex spectrum of diseases, with many etiologies, and a variety of treatments... It is attended to by many EXTREMELY uneducated medical 'professionals'! (This is why so many people run undiagnosed, by the way... It should bother you. A LOT. http://www.phlaunt.com/diabetes/14046782.php It is NOT the patient's fault. This kind of situation would be unacceptable in any other disease field... but we'll talk about that, some other day.) Diabetes has MANY types. The most commonly known are Type 1, and Type 2; however, there's also Gestational, Latent Autoimmune Diabetes in Adults, Maturity Onset Diabetes of the Young, and the many, MANY subtypes that each of these has! Here are just SOME of the etiology classification types: http://care.diabetesjournals.org/content/27/suppl_1/s5/T1.expansion.html.
2. Diabetes is NOT caused by a poor diet and a lack of exercise. Look around you... Does every obese person you know have diabetes? No... they DON'T.(http://www.phlaunt.com/diabetes/14046739.php)
While most Type 2 Diabetics are obese, most obese people will NEVER get diabetes. Most Type 1 Diabetes is caused by an autoimmune response from the body, attacking it's own pancreas' beta cells (which are the ones responsible for producing insulin), while Type 2 Diabetes is a host of complicated metabolic malfunctions and comorbidities. The causes for these two types of Diabetes are UNKNOWN. There are only some correlating factors known, or suspected... but they do not equal to causation. (In Type 1, for example, some studies have pointed to a pre-mature exposure to proteins in infants, such as those found in infant formulas, as well as exposure to ozone and sulfate in ambient air, and exposure to second hand smoke. http://www.ncbi.nlm.nih.gov/pubmed/16629713)
3. Diabetes is NOT caused by eating too much sugar! In its most basic of explanations, "Diabetes" is a condition in which the body cannot use glucose properly. Glucose is NOT table sugar! When Diabetics talk about "controlling their blood sugar," they do not mean avoiding soda and ho-hos. (NO, they DON'T!)
Glucose is the fuel our bodies use to be able to move, exercise, and perform all of our body's daily functions, just in the same way gasoline may power our cars. (It is NOT, simply, an overload of sugary foods!) Our bodies take ALL the food we eat (whether it's lettuce, or a ho-ho), and turn it into glucose. About 98% of carbohydrates get turned into glucose, 58% of proteins, and 10% of fats. What does this mean? It means that, for a diabetic, consuming rice has just as much potential for raising blood glucose levels as eating too many sweets. Now, this does not mean diabetics can pig out on sweets... it simply means that in moderate servings, diabetics can enjoy desserts, and treats, so long as they effectively manage their carbohydrate portions, take their medications, or inject their insulin. Then again, WHO should pig out on sweets? NO ONE. Diabetic, or not.
4. All Diabetes does not behave the same! This does not make one type "worse" than the other, just different, and challenging in its OWN unique way. Diabetes is NOT a disease of little children, and old people; if you have the markers or the predisposition for it, it can strike you at ANY time of your life. Children can NOT outgrow it, and there is no 100% full proof method of preventing it. Diet and exercise do NOT mean you will not get Diabetes.
There are three main ways in which a diabetic fails to use glucose properly: either insulin resistance, insulin deficiency, or both. Insulin is a hormone which, in healthy individuals, is naturally produced by the body to help glucose enter our red blood cells and muscles, and get that energy and nourishment they so need; it is the 'bouncer at the club,' if you would, controlling glucose access into our cells.
- Most insulin resistant diabetics are Type 2 Diabetics. Insulin resistance means our body's red cells and muscles are starting to have trouble recognizing insulin's instructions, and not letting it let blood glucose in. Now here's something you may not have known... EVERYONE is insulin resistant from one degree, to another, and this is largely dependent on gender, periods of life with high hormonal fluctuations like periods, teenage years and menopause, weight, height, and age. The difference is that in a normal person, the pancreas will overcompensate by just making a little extra insulin and getting over whatever resistance there might be. In an insulin resistant diabetic, however, this overcompensation is NOT enough: the pancreas will keep producing, and producing insulin, in an effort to reduce blood glucose levels, without much success... and with time, becomes less effective at it's job. If one is a Type 2 Diabetic, this constant work by the pancreas can lead to beta cell exhaustion, and failure... leading to an eventual, and significant loss in insulin production. Thus, Type 2 Diabetes is a progressive disease, and the overwhelming majority of Type 2 Diabetics will need insulin within their lifetime to attain proper blood glucose control (http://www.diabeteshealth.com/read/2009/03/20/5564/insulin-for-type-2-diabetes-who-when-and-why/) Another major issue with insulin resistance is that insulin is a fat storing hormone. (Oh, yes it is.) This doesn't mean that fat is normally a bad thing... It means that insulin takes extra nourishment from your body, and saves it as 'energy stores' for a rainy day. If you have too much insulin in your body, though, from having high and uncontrolled levels of blood glucose that just won't go down, this means you will gain weight. Whatever the body can't utilize, or release through urine, it will put on as weight. While a non-diabetic, overweight person, may have a bit of insulin resistance from being overweight, a diabetic person will gain a lot of weight from being very insulin resistant. See the difference there?
- Most insulin deficient diabetics are Type 1 diabetics. Insulin deficiency happens when the pancreas' insulin producing beta cells have been attacked by a person's own immune system, thinking it's a 'foreign agent,' and completely destroying the production of insulin. This near complete destruction means that a person will need insulin injections, for life, in order to live or to preserve health. Near insulin deficiency may also occur when a person has exhausted their beta cells from insulin resistance, as noted above, or sometimes... for completely unknown circumstances (as in Idiopathic Type 1 Diabetes).
- Having both insulin resistance AND insulin deficiency means that when a diabetic MUST inject insulin, they must find ways to overcompensate for the red cells and muscles NOT being able to let glucose in -- this may happen by a.) increasing daily dosages of insulin to help overcome the resistance issues (and risking weight gain), or b.) treating with oral medications to deal with the resistance (such as Metformin), on TOP of insulin injections. This type of condition is often labeled as "Double Diabetes,"
Risky procedures such as islet cell transplants, and gastric bypass are NOT cures. They are, for some, temporary solutions and ways to alleviate issues. For most, they are potential causes for even greater problems than the diabetes itself ever was. You should be highly suspicious of ANY article that claims anyone, ever, was 'cured' from any of these procedures as they a.) do not resolve autoimmune attacks and subject a patient to the horrible side effects of immunosupressant drugs, and b.) create issues of malnutrition, and malabsorption, as well as dumping and hypoglycemia unaware, respectively... And that's just to sum it up, succinctly.
What DO we know about Type 1 and Type 2 Diabetes? A lot more than 20 years ago, but still not nearly enough!
- Type 1 Diabetes can occur for two main reasons: an immune mediated reaction (meaning the body's immune system overreacted to some kind of trigger, and it confused the pancreas' beta cells with a foreign agent, and destroyed them, causing complete, or near complete insulin deficiency), or it can be idiopathic. What does idiopathic mean? According to the American Diabetes Association, it means "Some forms of type 1 diabetes have no known etiologies. Some of these patients have permanent insulinopenia and are prone to ketoacidosis, but have no evidence of autoimmunity. Although only a minority of patients with type 1 diabetes fall into this category, of those who do, most are of African or Asian ancestry. Individuals with this form of diabetes suffer from episodic ketoacidosis and exhibit varying degrees of insulin deficiency between episodes. This form of diabetes is strongly inherited, lacks immunological evidence for β-cell autoimmunity, and is not HLA associated. An absolute requirement for insulin replacement therapy in affected patients may come and go." (http://care.diabetesjournals.org/content/27/suppl_1/s5.full) In less fancy words, it means WE DON'T HAVE A FRIGGING CLUE! Hmmm, for as misinformed as she is... this kind of reminds me of Halle Berry. Aside from these, many persons, though not officially considered "Type 1 Diabetic," by the standard etiological definitions, have absolute insulin deficiency due to other illnesses, such as Pancreatitis, Pancreatic Cancer, etc. or were born with congenital abnormalities such as having part of their pancreas missing. (See above link, previously referenced for a lengthy etiological listing.)
- Type 2 Diabetes can be triggered for as many reasons as you have hairs on your head, and there's quite a few subtypes which I will not go into detail listing. This list of triggers or facts about Type 2 Diabetes is by no means exhaustive. The fact is we are still discovering associations and potential Type 2 triggers:
- It is very evident that fat plays a key role, and it's truly not exactly because of quantity. While weight loss may bring SOME benefit and improvement in control to some Type 2 Diabetics, this is NOT a cure for their condition. A thin person with 'impaired' or 'toxic' fat is just as likely to get Type 2 Diabetes as an obese one, and this is more evident when more serious 'triggers' are applied.
- In a human body, fat has many functions that are like those of an organ: fat produces AND communicates with hormones that control hunger, satiety, energy expenditure, and metabolism, etc. It communicates with our brain as well as our pancreas, and other organs. Scientists are STILL discovering the many roles some of these hormones play (http://www.sciencedaily.com/releases/2007/10/071001171752.htm). In a type 2 diabetic, fat doesn't behave like it should... and many of these delicate balances of communication are impaired (for example, some persons do not receive satiety signals as a result of this).
- Another one of they key ways in which there's an impairment, is in the way the body STORES fat. In persons with Type 2 Diabetes, fat is stored around the liver, or midsection of the body. This fat storage is not the normal way in which a person without diabetes would store fat, and is unbalanced, putting pressure on the body's main organs, exacerbating the already complicated cycles of insulin resistance, and opening doors for other potential illnesses like fatty liver. It's really hard to tell how much fat is around your liver, without some blood protein tests, so BMI is not really a good indicator of risk. A thin person with a little "pouch" may be just as at risk as a heavy person, if they have a lot of fat stored around their liver, strong genetic markers, or an ethnic predisposition for the disease.
- Fat STORES and keeps pollutants and toxic substances, within our body. Two new studies have identified pollution, such as from pesticides, or from toxic substances found in plastics, like BPAs (http://jcem.endojournals.org/content/early/2011/09/22/jc.2011-1682.abstract?sid=6a5c7cd6-6020-4b8c-8200-e76fad8d96ad), as two major contributors to Diabetes. Pollution, such as that from pesticides, has been identified as a stronger risk factor than obesity for developing Type 2 Diabetes (http://health.howstuffworks.com/diseases-conditions/diabetes/toxic-fat.htm).
- Internal, low grade inflammation plays a role... but not in the way in which we thought it did. Inflammation is actually responsible for activating two different proteins that play key roles in keeping blood sugar levels stable. These switches are not being turned on, for some reason. In other words, it is NOT the inflammation in itself which is causing insulin resistance, but the body's inability to turn on these switches, as it normally would when it becomes inflamed. (http://au.ibtimes.com/articles/211621/20110910/inflammation-may-not-be-the-root-of-type-2-diabetes-according-to-a-new-study.htm)
- An autoimmune reaction also plays a role. Type 2 Diabetes is currently in the process of being redefined as an autoimmune disease. "Scientists at the Stanford University School of Medicine and the University of Toronto have showed that Type 2 Diabetes could derive from an autoimmune reaction from within the body. It is hoped the breakthrough will lead to new therapies for treating the condition. The research, published in the journal Nature Medicine, found that an antibody called anti-CD20 was effective in treating laboratory mice with Type 2 Diabetes . Although more work is needed to test it on humans, the anti-CD20 can pinpoint and eliminate mature B cells, which could prevent the development of Type 2 Diabetes in those prone to the condition, as well as helping to replenish their blood sugar [glucose]. A human version of anti-CD20, which is already used for treating some blood cancers and autoimmune diseases in humans, is called rituximab, is available under the trade names of Rituxan and MabThera. It is thought that insulin resistance comes about when the B cells and other immune cells react against tissues in the body." (http://www.diabetes.co.uk/news/2011/Apr/autoimmune-reaction-and-type-2-diabetes-linked-in-breakthrough-study-98668844.html)
- Factors such as:
- Not enough Vitamin D. Researchers at Melbourne Pathology tested the blood of 5,200 people and established that for every extra 25 nanomoles of vitamin D in the blood the chance of getting diabetes was reduced by 24 per cent.
- being on certain medications (thyroid medication, antipsychotic or mood altering medications, statins, steroids, blood pressure medications, etc.)
- having certain illnesses such as some cancers, Polycystic Ovarian Syndrome, and even Depression (http://indiatoday.intoday.in/story/depression-invites-diabetes-say-doctors/1/155239.html)
- a family history, as well as being Latino, Asian, or African American.
- Dietary factors, such as High Fructose Corn Syrup which has been shown to cause damage to tissues (http://www.sciencedaily.com/releases/2007/08/070823094819.htm).
- Etc, etc.
The development of Diabetes, of any type, is really not a straight forward situation. Besides the complicated etiological factors, many diabetics live with the psychological factors of guilt, or may develop eating disorders driven by the amount of guilt heaped upon them by society, the media, and simplistic guidelines by some advisory board organizations. We are a silent, misunderstood disease... And we deserve respect.
Think about that the next time you say to someone "if only you'd go on a diet..."
Spread Diabetes Awareness, and Compassion... Not Diabetes Type Myth.
