Diabetes: Understanding the Disease
We are what we eat
The human body is powered by energy that is derived from the sugars we eat. During digestion, these sugars are converted by the liver into glucose. The glucose is passed into the blood stream and transported to cells throughout the body. In a healthy individual, the pancreas responds to the increased level of glucose in the blood stream following a meal by releasing a hormone called insulin. The insulin is distributed to cells in the body to activate cell receptors to accept the free glucose in the bloodstream. Once the glucose enters the cell body, it is processed through a series of reactions to generate energy (in the form of Adenosine Triphosphate, or ATP) for the cell.
The difficulty presented in diabetic patients is there is a breakdown of the system that allows for sufficient levels of glucose to reach its final intracellular destination, depriving cells of the needed ATP energy. This occurs either due to the destruction of pancreas beta cells, leading to no insulin production (type 1 diabetes), or the development of insulin resistance (type 2 diabetes). In both situations the body is left to cope with heightened blood glucose levels that degenerate into symptoms and complications.
Diabetes can present in three basic forms
The three pervasive forms of diabetes that exist in the US are gestational diabetes, type 1 diabetes and type 2 diabetes.
Pre-gestational and gestational diabetes (GDM): a somewhat common but transitory disease
• Pre-gestational diabetes: Women who have an existing diabetic condition are categorized as having pre-gestational diabetes upon conception. This patient is not always aware of her diabetic condition, as it only begins presenting as a result of the pregnancy. Failure to diagnose and properly manage pre-gestational diabetes during the first trimester increases the risk of miscarriage while also placing the child at risk of developing hypoglycemia (lower than normal blood glucose levels) and birth defects in vital organs.
• Gestational diabetes (GDM): Presents in 2% -5% of all pregnancies, is temporary and treatable, and can improve or disappear after delivery. GDM develops during pregnancy, and involves a combination of inadequate insulin secretion and responsiveness, as is experienced in type 2 diabetes. The two types of GDM (A1 and A2) can be managed with as little as diet modification or require as much as insulin or other medication. Failure to properly manage a diabetic condition during pregnancy can result in health issues for the mother and child. The mother is at risk of developing hypertension, preeclampsia (hypertension and protein in the urine), and type 2 diabetes. The child faces the risk of developing hypoglycemia, jaundice, respiratory distress syndrome (RDS), childhood and adult obesity, and type 2 diabetes.
The National Institutes of Health notes that after pregnancy, 5-10% of women are found to have type 2 diabetes. Additionally, women that develop GMD have a 20-50% chance of developing type 2 diabetes within 5-10 years.
Type 1 diabetes
Formerly known as insulin-dependent diabetes mellitus (IDDM) and juvenile-onset diabetes, type 1 diabetes is the result of the body attacking and destroying the insulin producing beta cells in the pancreas. There are no known preventative measures that can minimize the onset of type 1, and the only treatment for type 1 diabetes is by delivery of insulin via multiple daily injections (MDI) or continuous subcutaneous insulin infusion (CSII, also known as insulin pumps). Though it is not clear what triggers the onset of type 1 catalyzed by a viral infection coupled with certain environmental factors (stress, chemical agents, weight, ect.) Researchers hypothesize that sufferers are genetically more susceptible to the viral infection but seem to require the environmental trigger to instigate disease presentation.
Symptoms can present at any age, and often are severe with a rapid onset. These symptoms include polyuria, polydipsia and polyphagia, weight loss, fatigue, nausea, abdominal pain, vomiting, and absence of menstruation in women. In type 1 patients, excessive eating coupled with weight loss is explained by the body deriving its energy from the breakdown of fat (a process known as ketosis), rather than from the glucose available in the food being consumed.
When the disease goes untreated, patients can suffer from severe and potential deadly complications. The high blood glucose levels experienced in type 1 diabetics can degrade the body’s vascular system, eyes, kidneys and nerves. Damage to any or all of these systems present an immediate negative impact to an individual’s overall health and quality of life. Additionally, type 1 diabetics who do not properly regulate their disease are at risk of Kussmaul breathing (deep, rapid breathing) and diabetic ketoacidosis (DKA). DKA is the result of a build-up of dangerous levels of ketones (acids) in the blood as a by-product of ketosis, and if not immediately treated it can lead to a DKA coma and potentially death.