Background Information and Statistics on Diabetes

The simple answer to the question of “what is diabetes” is that it means having high blood sugar or, more specifically, high blood glucose levels in the bloodstream. As you’ll find out, there are several types of sugar you can eat. Fructose, for example, is often called fruit sugar, because this is one of the main simple sugars in fruits. Lactose is generally called milk sugar because this is the sugar you’ll find in milk and other dairy products. Sucrose is table sugar, which is the kind found in most baked sweets and in the sugar you spoon into your coffee.

Regardless of the type of sugar you consume, all of it ultimately gets chemically transformed into glucose, which is the sugar all of your cells exclusively use as part of

their metabolism. Even the fat you and the protein you take in get funneled into the same metabolic pathways within the cell used to make cellular energy. That’s the real goal of cellular metabolism—to provide the necessary nutrients so that the cell can get the energy necessary to run all cellular processes.

Diabetics basically have too much sugar in their bloodstream and in the tissue spaces between the cells and not enough in the cells themselves. This is very bad for the cells, which must then rely on other types of nutrients to make cellular energy in chemical processes that simply aren’t as efficient as they would be if glucose itself was available to the cell instead. This is why some diabetics who haven’t yet been treated sometimes lose weight even though they’ve eaten enough. The body chooses to eat its own tissues in order to survive because the cells won’t be able to use the available glucose.

As we’ve already discussed, there are different types of diabetes that lead to the same high blood sugar problem. We’ll talk more about these later but, for now, let’s summarize the different types, including how they occur and why they cause high blood

sugar.

Type 1 diabetes is sometimes called juvenile diabetes because it mainly happens in young people, although it can happen in the older person less commonly. About 1.25

million people in the United States have this type of diabetes. Type 1 diabetes is partly hereditary and partly an environmental problem that isn’t completely understood. The type 1 diabetic develops autoantibodies, which are immune-related proteins directed at the cells of the human pancreas that are responsible for making the insulin hormone.

Insulin is crucial to blood sugar metabolism in the body. It is mainly through the pancreatic release of insulin in response to higher blood glucose levels that this sugar gets into the cells in the first place. In type 1 diabetics, insulin is no longer made because the pancreatic cells responsible for making it are permanently destroyed by the immune system. No drug or treatment besides giving the person insulin directly will help these people. This is a lifelong problem because the pancreatic cells do not regenerate themselves. The disease is manageable but not usually curable.

Most people with diabetes, however, have type 2 diabetes. Compared to the 1.25 million people with type 1 diabetes, more than 30 million people in the US have type 2 diabetes. This is between 90 and 95 percent of all diabetics. While it has traditionally been a disease of older persons, it is increasingly being seen in children, teens, and younger adults—mostly because of the epidemic of obesity in our country.

These are the people who have insulin resistance. For reasons we will talk about later, the cells themselves do not respond to insulin the way they are supposed to and glucose still doesn’t get into the cells. The pancreas responds to this problem by putting out even more insulin, which still doesn’t help much. High levels of insulin by itself are harmful to you, as you will see. Eventually, type 2 diabetics who aren’t treated essentially become type 1 diabetics, mainly because the pancreas simply burns out and can’t make insulin anymore. These patients also eventually need insulin. Take a look at figure 1 to see the basic difference between type 1 and type 2 disease:

Figure 1.

We will also talk about the complicated issue of a condition called prediabetes. Prediabetes is a true epidemic, affecting 84 million Americans or just about a third of

every one of adults in the US. The most difficult part of this problem is that 90 percent of prediabetics don’t know they have it. The second most difficult part is that, for those who know they have it, not enough is done to keep prediabetes from becoming true type 2 diabetes.

Prediabetes can be considered a “wake-up” call for everyone who has it. As you’ll see, this can be tested for in the doctor’s office and, when intervened on, it can mean the difference between remaining healthy and becoming diabetic. Prediabetes is a precursor disease to type 2 diabetes but not type 1 diabetes. There is probably nothing magical that defines whether you have type 2 diabetes versus prediabetes except that the blood sugar numbers are not as bad in prediabetes as they are in type 2 diabetes itself.

In fact, it might be argued that these two diseases are part of a long spectrum that goes from being healthy, through having prediabetes, and to finally having type 2 diabetes.

The main problem in prediabetes is the same one as with type 2 diabetes and that is insulin resistance. The main difference, however, is that, in prediabetics, the insulin being produced by the pancreas is effectively keeping up with the blood sugar problem so the blood sugars aren’t so bad. In fact, some prediabetics occasionally have the opposite problem of too low blood sugar after a high carb diet. The insulin overreacts temporarily to the sugar load and drives the blood sugar downward, leaving the person with temporary symptoms of low blood sugar.

Some women will have what’s called gestational diabetes, which is diabetes that only occurs in the last part of pregnancy, sometimes leading to birth complications, including stillbirth and having an infant that is too large to fit through the birth canal. About 6 to 9 percent of all pregnancies are complicated by gestational diabetes. This involves so many pregnancies that this is tested for in every pregnant woman sometime during the pregnancy in order to intervene on those who test positive for the disease.

Part of the problem is that pregnancy itself is a temporary state of insulin resistance in every women but only some of them have this issue bad enough to be called gestational diabetes or to require treatment. In most cases, the high blood sugar conditions during the pregnancy go away after the delivery of the baby but it can come back with subsequent pregnancies. Women with gestational diabetes also have a higher risk of later developing type 2 diabetes unrelated to being pregnant.

There are less common types of diabetes that most people have never heard of that are largely hereditary. Maturity Onset Diabetes of the Young or MODY is one of them,

though it sometimes goes by other names. It involves a genetic defect in one of eleven

known genes that control glucose metabolism in the body through different mechanisms. Up to five percent of all diabetics have MODY rather than type 2 or type 1 diabetes. Many don’t know they have this form but most will recognize that diabetes exists in many members of their immediate family.

You do not have to be overweight or obese to have MODY and many develop what they think is type 2 diabetes but at a younger than expected age. Most of these are called autosomal dominant inherited diseases, which means that the affected person has a fifty-fifty chance of passing it onto each of their children. This adds up to having people with diabetes in every generation for the most part and to a lot of people in the family who seem unlucky enough to be diabetic.

Some people with MODY require pills or other medications to control their high blood sugar, while others need some form of insulin therapy to manage their condition. Of all types of diabetes, MODY is probably the least understood and the hardest to identify, although newer genetic tests have become available to diagnose those who have it early in the course of the disease process.