Diabetes: First the Basics

It’s a new year with new resolutions and I’m sure none of us have been perfect, but trying is what matters.  I’m a firm believer that knowledge is power and the best way to succeed is to know as much as you can.  Diabetes is a very big issue.  Projections have showed that 52% of the population could have diabetes or pre-diabetes by the year 2020!  That’s only eight years away folks.  Now, I’m not here to judge anyone.  Trust me, I understand that sometimes genetics is a beast that looms over your shoulder and sometimes you just want to give up.  There are at least three generations of late onset type I diabetics in my family and the odds are not on my side.  Depending on the kind of diabetes you see in your family there are tests that can be run and things that you can do to prevent the diabetes (or at least slow it down).  If you are already a diabetic and you are wondering how these new year’s diets all fit into your life it’s time to touch on that too.  This is waaaaaaaaaaaaaaay too much information to do in one blog.  I don’t want your eyes to glaze over and I promise it’s going to be good stuff so I really want you to take it all in.  So this is the first blog in the series.  Let’s talk about diabetes, the difference between Type I, Type II, and the emerging definition of Type III.

Diabetes Mellitus (DM), no matter what type you have, is a dysfunction of a hormone, insulin, in the body.  Insulin is the hormone that helps your cells absorb glucose (a sugar your body needs to function).  The best way to think about insulin is that it is the taxi that delivers glucose into the cell.  Depending on what is going on with the taxi, this helps you understand what the difference in the kind of diabetes you have.

Type I DM is often known as juvenile diabetes because the majority of patients diagnosed with Type I are between the ages of 4 years of age and in their early 20’s.  This term, however, is not being used any longer because there are patients with Type I that are diagnosed in their 30’s and 40s (and sometimes later).  Also, in the current state of affairs, just because a child has diabetes, does not necessarily mean that they are Type I diabetics.  So, what really distinguishes a Type I diabetic from the other types?  This is a autoimmune mediated disease where antibodies attack the pancreatic beta-cells and, sometimes, the insulin hormone itself.  Okay, WHAT?  Now in plain ol’ English:  Type 1 diabetes is caused when the body decides it doesn’t like the cells that make insulin in an organ called the pancreas and sometimes doesn’t like the insulin either.  This is equivalent to the body’s antibodies blowing up the taxi station and the taxis so that glucose cannot get inside the cells.  Now that’s what I call bio-terrorism.  Now, here is the good news: if you know that this type of diabetes runs in the family there is a very simple lab test that can be run to test for the antibodies.  This can sometimes help catch the disease before it gets ugly, but not everyone produces these antibodies, just the majority.  Sometimes you can’t predict if you’re going to get Type I DM.  It can be caused by genetics, but also environment, a virus, or even poor eating.  And remember what I mentioned before.  Just because you are over 30 doesn’t mean you’re out of the woods.  LADA, or Latent Autoimmune Diabetes of the Adult, occurs in people over the age of 30!

Type II DM is more often than not associated with obesity and poor eating.  This is true, but individuals at a healthy weight can also get Type II (although their chances are much less likely).  Type II diabetes is caused by peripheral insulin resistance and by the beta cells inability to make enough insulin to cover the high glucose that is already present in the body.  All overweight individuals suffer from insulin resistance, but only when a person’s beta cells are unable to produce enough insulin does the patient have Type II DM.  So in English:  The body is unable to absorb the sugars into it’s cells and the pancreas just can’t spit out enough insulin to overcome the resistance.  This is equivalent to the taxis not being able to get the glucose into the cells and the taxi station not being able to supply enough taxis to meet the  demands of the body.  Type II diabetes does have a genetic link (some of the mutations can be screened for), but there is more than just genes involved.  People who do not do some sort of exercise, are overweight, have high blood pressure, polycystic ovarian syndrome, or just eat meals high in simple carbohydrates put themselves at high risk for Type II diabetes.  Unlike Type I diabetes there is usually a way to prevent the onset or to simply get rid of the Type II DM altogether (more on that later).

Type III DM is not truly recognized, but people studying the occurrence describe it as a mix of Type I and Type II DM.  Not only has the body destroyed it’s ability to make insulin it is also resistant to absorbing the insulin injected.  This means the patient must use super high doses of insulin to moderately bring down their blood glucose.

If you already have diabetes or pre-diabetes (no matter the type) the words you most likely hear from the doctor are “blood glucose levels” and “A1C.”  I suspected since these numbers are thrown around so much that the average patient would at least be able to tell me what their goal is or what those numbers mean, but in my experience only a few patients actually understand the numbers and the acronyms and tell me what they mean.  This means there is a distinct lack of communication going on between the patient and the doctor, so let me clear some of this up for you:

Blood Glucose Levels:  These are measurements read from the blood by a laboratory or by your glucose monitor to tell you how sugar is in your blood and much insulin to inject or what foods to eat less of.  For example, if your blood sugar is reading 200 it is probably not the right time to have a burger or eat some ice cream.  A fasting blood glucose level (the level taken after not eating for 6 hours) should be less than 125.  If it is between 100 and 125 then pre diabetes is a concern.

A1C:  Your A1C is measured, normally, by your laboratory although there are machines available to the general public for home monitoring.  This lab helps figure out an approximate 3 month average of blood sugars.  Most people have a goal of less than 7, but if you are 65 or older the American Geriatric Society suggests an A1C of less than 8.  Testing your A1C more than once every 3 months is not recommended (and to be honest the home test kits are kind of expensive and not as accurate at the lab).

I know this is a lot of information so take it in.  Ask questions.  Read the article a few times and remember that another blog will be appearing soon to discuss more about risk factors and prevention.  And just remember, Mixtures Pharmacy doesn’t just compound, we also take care of your regular medications, including your diabetic supplies so if you have questions about your diabetes and treatments just call or stop by and let us know!

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