Have any questions about diabetes but are too afraid to ask? Well, today's your lucky day. Here is the first part of three in a series I wrote about diabetes. I did my best not to make it boring and dry :)
“A Touch of the Sugars: Why America Needs to Care About Type II
Diabetes”
Amy Falk, MS4
Part One
Diabetes: it’s a disease we hear a
lot about and maybe know a lot of people who have it. But have you ever thought about what it really means to be diabetic?
Or how it happens? Or what
someone can do to prevent it or even make it go away?
Before coming to medical school, of course I knew diabetes
was a big problem in this country.
You can’t turn on the TV or flip through a magazine without seeing an
advertisement or story about diabetes.
What was really shocking to me, though, was that many diabetic patients
I cared for this year as a third year medical student didn’t understand that a
“touch of the sugars” would ultimately have devastating consequences for their
health.
One day in clinic, I was taking a
medical history on a gentleman who came in for some viral syndrome. I asked him about his past medical
history, and he tells me, “I’m pretty healthy. I just have a touch of the sugars, I guess.” This takes me by surprise; a touch of
the sugars? What does that
mean? I quickly figured out that
he is trying to tell me he has diabetes, and with further questioning, he
divulges that no, he doesn’t take any medication, no he doesn’t see a doctor,
and no, he doesn’t check his blood sugar.
He feels fine, so he doesn’t think it’s important. We checked his blood sugar and it was
super high, somewhere in the 300s (a normal, random blood sugar reading is
between 70-140), and his hemoglobin A1c, a fancy, sneaky measurement
that indicates the average blood glucose over the past three months, is through
the roof, indicating that indeed he hasn’t been taking care of his
condition. Don’t worry about the
numbers and tests, I’ll tell you all about them in a bit, but the point is that
this man, like so many Americans, has a serious condition that will have
adverse effects on his ENTIRE body, but isn’t taking proper measures to prevent
the adverse events. I truly feel
that almost everyone will take better care of themselves if they understand why they are doing it. My mission regarding diabetes in this
“Stethoscopes to the Streets” series is to educate you about how blood sugar,
insulin, and diabetes works, and how this horrible illness can be prevented or
even cured! What great news! But first a disclaimer: I’ll be discussing Type 2 diabetes, the
“preventable and (maybe) curable” kind.
Type 1 diabetes is an entirely different entity (but with similar
consequences) that we’ll save for another day. Now lets get to work.
How your body works:
sugar and insulin
Before
we can talk about how diabetes causes so many medical problems, we need to
review what happens to the food you eat.
No, we’re not going to take a swim in the deep end of biochemistry here
(I’ve done that already), we’ll just kind of float on the surface. Let’s say you just ate lunch. Your GI tract (stomach, intestines and
all those great parts) will digest what you have eaten, thus allowing your body
to use it. Carbohydrates like
fruits, crackers, and cookies will be broken down to single molecules of sugar,
called glucose. Glucose is small
and can be absorbed into your bloodstream where it will float around and attach
to cells that need it. Glucose is
useless just floating in the blood, though (all it is there is just bloody
syrup, yuck). It needs to get
inside cells for energy to be produced.
So, glucose is taken up by every cell
in your body, but muscle and fat cells (about 2/3 of your whole body mass) need
using special transporters that are sort of like doors that can open to the
inside of the cells, letting glucose in.
Simple enough, but here’s the trick; in muscle and fat cells, glucose
can only get through those “doors” and into those cells if insulin unlocks those doors.
Insulin is a small protein molecule made by the pancreas (an ugly but
important organ in the middle of your belly) that convinces those muscle and
fat cells to let the glucose floating around in the bloodstream in, allowing
energy to be produced. Insulin has
other functions too, mainly anabolic or “building up,” increasing the synthesis
of more muscle and fat. Insulin
makes your liver store up energy in the form of glycogen (available for a rainy
day when those cookies are out of reach). Insulin also tells various cells in your
body to please stop using up those energy stores like glycogen, protein and fat
(how counterproductive would that be, if insulin is working to store energy
away?). So, you eat, carbohydrates
get broken down and glucose gets absorbed. Glucose gets into cells because insulin unlocks the doors,
thus insulin helps your body to build up and maintain energy stores.
Metabolic syndrome
and insulin resistance: Things are getting out of control!
Now
that we know how the body is supposed to respond to insulin, let’s look at what
happens when it doesn’t respond.
Have you ever heard of the metabolic syndrome, or Syndrome X? You probably have, since by some
accounts about 25% of Americans meet the criteria of the disorder. I’ve always thought of metabolic syndrome
as the culmination of too many unhealthy food choices and not enough exercise
which causes a person to inch towards full-blown diabetes and heart
disease. Here are the criteria for
metabolic syndrome:
- · Increased waist circumference
o More
than 40 inches for a man, 35 inches for a woman
- · High triglycerides: over 150 mg/dl
- · Low HDL (the good) cholesterol
o Men
less than 40 mg/dl, women less than 50mg/dl
- · High blood pressure: over 130/85 or needing to be on a blood pressure medication
- · High fasting blood sugar: over 100 mg/dl
People who fit this profile tend to have “insulin
resistance:” their pancreas is “kicking out” plenty of insulin to get all that
extra sugar they are eating into their cells, but the cells just aren’t
listening! Like a good organ, the
pancreas tries to secrete MORE insulin to make the cells listen and take up the
glucose that is floating in the bloodstream, but because of a variety of
factors, the cells become more resistant to insulin, and eventually the
pancreas isn’t able to keep up.
Hello diabetes.
Remember how I told you that
insulin is responsible for getting glucose into cells and making sure that the
liver, muscle, and fat cells are building up energy stores, not breaking them
down? Well, since those cells
stopped listening to insulin, the body is in a relative state of starvation,
despite the ridiculously elevated blood glucose level. Think about being super hungry, trapped
in a room with a window, and just on the other side of that window is a
wonderful meal…but you can’t get at it no matter what you do. That’s what the cells of a person with
Type 2 (insulin-resistant) diabetes feel like. Furthermore, high blood glucose ultimately leads to kidney,
eye and nerve damage, but we’ll deal with that in part two.
End of part one
Tune
in next time for the continuation of the “Touch of the Sugars” article, where
we will (finally) define what diabetes is, what it does to the body, how it is
treated once diagnosed, and what people can do to prevent or reverse the
disease.
No comments:
Post a Comment