Diabetes mellitus is an affliction recognized since ancient times. The first term comes from a Greek term referring to excessive urinary output; the Latin term “mellitus,” (meaning honey) was added to describe the sugary sweet nature of this abundant urine. Early civilizations could reliably diagnose “sweet urine disease” by its taste, or by observing the attraction it held for ants! Until recent times this illness was a death sentence. Now, great advances in understanding its development and treatment have made diabetes mellitus a truly manageable condition. Unfortunately though, the lifestyle made possible by our enlightened modern society has led to a dramatic increase in the number of cases; damage and death due to diabetes is a greater health concern now than ever.
Diabetes is caused by a problem with insulin. Insulin is a hormonal protein normally produced and secreted by the pancreas. Insulin enables cells to absorb, or take in and use, glucose(aka sugar). When the amount of insulin is inadequate, there is too much sugar in the bloodstream and not enough sugar in the body’s cells. This “sugar allocation error” is the root of the disease process. Important cells are starved due to lack of glucose fuel. And the excess sugar stuck in the blood stream causes all sorts of problems, including dehydration due to its potent diuretic effect. This serious imbalance yields the three classic signs of diabetes: excess hunger, excess thirst, and excess urination.
There are two types of diabetes. Type 1, previously called “juvenile diabetes,” is caused by a total lack of insulin; thus the ONLY treatment that works is to provide this missing hormone via insulin administration. While it is the more serious type of diabetes, it comprises only about 10% of the diabetic cases in the Western world. The other 90% plus cases of diabetes mellitus are termed Type 2 (adult-onset) diabetes. Individuals with Type 2 diabetes DO make insulin, but not enough for the abnormally high demand of their systems. Their bodies have come to require more insulin than usual to function normally due to the development of insulin resistance. Sometimes insulin resistance is an inherited tendency, but the vast majority of times it is fostered by obesity. Every person who is more than 20% over their ideal body weight develops some element of insulin resistance. Additionally, genetic factors, other illnesses, or chronic use of certain drugs such as steroids can lead to this predisposition. With any of these folks, if their pancreas cannot keep up with the ever-increasing demand for insulin secretion, they will develop diabetes.
Diabetes is diagnosed by measuring the level of sugar, or glucose, in the blood. Normal blood sugars are less than 100. Fasting blood sugars of more than 130 or so are felt to indicate diabetes. But many factors, such as stress, medications, hydration status or the carbohydrate content of the preceding meal, can make simple glucose measurements misleading. Another test, the Hemoglobin A1C, is able to determine not just one’s sugar level on that day, but what the average sugar level for the last 3 months has been! This is possible because red blood cells survive for over 90 days in the circulation and during their lifespan accumulate an exterior layer of glucose (a sugar coating). If this “sugar coating” makes up more than 6% of the cells diameter, the Hemoglobin A1C will be reported as more than 6% and the diagnosis of diabetes will be assigned. Individuals with borderline glucose and hemoglobin A1C levels are labeled as “pre” or “early” diabetics. For these people, any worsening of insulin resistance, most commonly brought on by gaining weight, virtually guarantees the transition into overt diabetes mellitus. Excess body weight is now deemed the source of over 90% of diabetic cases in Western civilizations.
The health impact of diabetes is dramatic. In the United States it is the leading cause of kidney failure and the most common reason for non-traumatic amputation. Additionally, over 20,000 new cases of blindness per year are attributed to this illness. Having diabetes more than triples one’s risk of heart attack and stroke, and also makes cancer and depression more likely to occur. It is now estimated that over 11% of adult Americans have diabetes; a total of 26 million cases are currently reported. And experts feel there are currently another 80 million people who have “pre-diabetes” and so are on the verge of being diagnosed unless they are able to change their eating and exercise patterns dramatically. The economic numbers mirror these dismal health statistics; studies show that the average per capita health care costs of a person with diabetes is over $13,000, compared with about $2,500 for a non-diabetic, and utilization of that very expensive arena of medical care, the emergency room, is twice as high in diabetic populations.
Scientists refer to the “diabetic lifestyle” as excess food intake coupled with inadequate exercise and the resultant obesity. Regrettably, this lifestyle has become the “default setting” in our modern world. In order to reverse the alarming trend of ever-increasing numbers and severity of diabetic cases, we need to replace this diabetic lifestyle with affordable and agreeable strategies to make healthy food and enjoyable physical activity perpetually accessible to every member of society. This is a formidable task, and one that is only tepidly embraced by government and actively undermined by the companies that profit from unhealthy food sales. Yet the ability to avoid diabetes is a real option for most of us, and the health and economic benefits of doing so are enormous! Hopefully, the growing knowledge of this illness’s nature will help individuals, and society, contain this terrible epidemic.
Listen to Dr. Passidomo:[audio:http://www.pawlingpublicradio.org/wp-content/uploads/2012/04/5-3-dr-p-diabetes.mp3|Titles=Diabetes – Dr. Patrice Passidomo]