When we eat food it gets broken down in our bodies into fats, proteins, and sugars. Our bodies then use these nutrients to either build tissues or create energy. Sugars are used to supply our bodies with energy. Our muscles use a large amount of that sugar as fuel for our movements. In order for sugar to get into muscle cells, insulin, which is made by the pancreas, is needed. When we eat a slice of bread, our body breaks it down and the basic sugar will enter our bloodstream. When our pancreas sees that sugar it makes insulin. Insulin will then allow the sugar to enter a muscle for energy.
When someone has diabetes that pathway of sugar combining with insulin to get to muscle cells is interrupted. There are two areas where the interruption can happen and therefore two types of diabetes.
Type-1 diabetes occurs when the pancreas is unable to make enough insulin. This usually occurs in children and young adults and the treatment for type-1 diabetes is to get insulin injections. Without these injections, muscles cannot use sugar and a type-1 diabetic would rapidly lose weight and die without insulin injections.
Type-2 diabetes occurs when muscle cells become resistant to the effects of insulin. Consequently, sugar cannot enter into muscle cells efficiently and the concentration of sugar in the blood goes up. The pancreas sees this high sugar and starts to make more insulin. When a person develops type-2 diabetes they have both high levels of sugar and insulin in the blood. Elevated insulin in the blood gets to the brain and triggers an increase in appetite and also a feeling of fatigue. A person with type-2 diabetes will tend to eat more and exercise less, further exacerbating the high sugar and insulin levels in the blood. Eventually, usually after years of having type-2 diabetes, the pancreas will get tired and stop producing insulin and then a type-2 diabetic will require insulin injections.
Over time high levels of sugar in the blood will cause permanent damage to the eyes, kidneys, heart, nerves, and blood vessels. Therefore, if left inadequately treated, diabetes will cause blindness, kidney failure (and the need for dialysis), heart attacks and congestive heart failure, painful neuropathy in the feet, and a lack of blood flow to the feet that may result in amputation.
Type-1 diabetes is typically caused by the immune system mistakenly attacking the pancreas and destroying the body’s ability to create insulin. While there is a hereditary component, it is not completely understood what triggers this autoimmune reaction.
Type-2 diabetes can also be hereditary. In addition to genetics, lifestyle factors can cause type-2 diabetes. The most important lifestyle trigger for diabetes is lack of exercise. When muscles are not exercised, they are not able to use insulin as they should. We call this insulin resistance. Overeating causes an overload of sugar in the system thereby encouraging muscles to ignore the sugar and insulin they see in the blood and this further worsens insulin resistance.
We have discussed the treatment of type-1 diabetes, which is insulin injections. The treatment of type-2 diabetes is multifactorial. The most important thing to do in treating type-2 diabetes is exercise! Exercise cannot be stressed enough. In order to solve the problem of insulin resistance, muscles need exercise. Diet is also important and a type-2 diabetic should limit the types of foods that can quickly be broken down into sugar by the body. Those foods that should only be eaten in small amounts include sweets, bread, pasta, white rice, potatoes, and fatty foods. Diabetics should especially avoid sweetened drinks like soda and juice! I tell my diabetic patients that the only calories they should drink are those found in milk. Diabetics should try and increase vegetables and fruits in their diet.
There are many medications used to treat type-2 diabetes. The most important medication is Metformin. It works by increasing the muscle cell’s sensitivity to the effects of insulin. Other medications work by increasing the production of insulin by the pancreas or increasing the amount of sugar that is eliminated by the kidneys.
Diabetes has become one of the most common diseases in the United States. Millions of people in our country suffer from some of the devastating effects of this disease. As discussed in this article, for most people diabetes is preventable with regular exercise and a healthy diet. For those that have diabetes, exercise and a good diet can halt the disease progression and help these people avoid the damage this disease can cause.
Marc Penrod, MD
Canyon View Family Medicine