While many understand that insulin is necessary for the control of blood sugars, few know about the rest of the endocrine system, and the role the liver, pancreas and bloodstream play in diabetes. This can lead to misunderstandings: some think that sugar causes diabetes, others that all forms of diabetes are alike, and some may even be afraid to give sugar to a relative with low blood sugars.
The first recorded cases of diabetes mellitus occurred in ancient Egypt, where it was called 'the wasting disease.' Egyptians noted that the urine tasted sweet and flies would congregate around the urine of those with this disease. "Mellitus" literally means 'honeyed urine' and is of Latin origin.
An endocrinologist should treat diabetes because it is a disease of the endocrine system. The endocrine system secretes hormones from glands into the bloodstream, which regulate the body. The pancreas and the liver are the two major glands involved in diabetes.
The pancreas, liver, insulin and glucagose
The Islets of Langerhans are cells within the pancreas that secrete the hormones insulin and glucagon. The pancreas secretes insulin into the blood stream at a constant low rate to keep the body stable. If blood sugars get too low, the body releases glucagon. When a person eats a meal, the food is broken down into glucose. The pancreas in a normal person then releases insulin to keep blood sugars at a normal level.
Extra glucose is stored in the liver. If a person eats more food than the liver can store as glucose, it is stored as fat. The insulin must enter the receptor cells in the blood stream in order for the body to use glucose. Glucose allows your brain, heart, lungs, kidneys and liver to work as they should. Without insulin, glucose cannot metabolize into the bloodstream and begins to build up. This condition is known as hyperglycemia, or high blood sugar.
Hyperglycemia or high blood sugar
When hyperglycemia occurs, and gets too high, the body starts to shut down. Because the body cannot use or store the excess glucose, it produces a product called ketones. Ketones are an acid, and damage to organs such as the heart, kidneys and lungs may occur. Prolonged uncontrolled high blood sugars cause permanent damage to the heart, and kidneys and eyes, and may cause delayed healing in arms and legs. One out of four diabetics has a heart attack; 65% die of coronary disease. Good blood sugar control may reverse damage done by hyperglycemia.
Diagnosis
Diabetes occurs when the body does not produce enough insulin, as in type I Diabetes, or cannot properly metabolize insulin, as in type 2 diabetes. Normal blood sugars range between 70 and 120 mg/dl. Certain conditions, such as pregnancy, illness or medication may cause normal fluctuations in blood sugar readings. If your doctor suspects diabetes, he will order a glucose tolerance test. This test is administered over a period ot time. The patient comes in fasting, and a sample blood sugar is drawn. Then he is given glucose, and more blood is drawn. The doctor checks to see if your body is releasing glucose and insulin to regulate itself.
Type 2 Diabetes
The majority of people newly diagnosed with diabetes have type 2 diabetes. Either their bodies are unable to utilize insulin properly, as in insulin resistance, or the body produces insufficient quantities of insulin. Insulin is a fat storing hormone: the more one weighs, the more insulin one needs. Some people get Type 2 diabetes when they gain weight. With close glucose monitoring, diets that restrict sugar and calories, and exercise, many manage their diabetes with the help of their doctor.
Sometimes, these patients may need shots of insulin, or oral medications to control diabetes. Type 2 diabetes usually occurs in older adults, and used to be found mostly in those over 40, although recent trends have shown an alarming increase in type 2 diabetes in children. This is not "juvenile" diabetes. It may be reversed, just as in adults by working with your doctor, and following diet and exercise rules. Sometimes type 2 diabetes in children is a precursor to type 1 diabetes.
Type I Diabetes
Ten percent of newly diagnosed diabetics are type 1. Type I diabetes occurs when the immune system attacks insulin producing cells in the pancreas. These children are insulin dependent - they cannot survive without insulin from shots or an insulin pump. This type of diabetes is not caused by obesity, and has nothing at all to do with the amount of sugar the child eats.
Gestational Diabetes
Another common type of diabetes is gestational diabetes. When a mother is pregnant her body requires more insulin, and she will acquire more body fat. Sometimes this triggers gestational diabetes, a form of type 2 diabetes. This occurs in about 8% of pregnant women, and usually goes away after pregnancy. A doctor will prescribe a diet and exercise regimen (not to lose weight, as this is dangerous to the baby), and insulin. Uncontrolled blood sugars during pregnancy can lead to complications that are dangerous to the health of both the baby and its mother. This type of diabetes may lead to type 2 diabetes in later life, or hang on as a form of type 2 diabetes.
Besides the three types of commonly found diabetes, there are other rare forms caused by tumors, genetic defects or illness.
Hypoglycemia or low blood sugar
Hypoglycemia occurs in diabetics because of pregnancy, hormones, certain medications, or excess insulin. Excess insulin is not always patient error. Causes of hypoglycemia are exercise, weight loss, pregnancy, a delay between insulin injections and meals, and a variety of other normal activities.
There are variations in opinion among experts regarding how low is too low, but most agree that any blood sugar under 70 mg/dl needs to be treated.
Likewise, symptoms of hyperglycemia may vary from patient to patient. Some may appear drunk, sweaty, have a racing heart, be shaky, have numbness in the face or body, or experience mental confusion.
When a patient experiences hypoglycemia, giving food with calories is crucial; always follow a doctor's advice as different patients may react better to some substances than others. The American Diabetes Association recommends the administration of low fat foods that digest easily, such as soda (not diet), candy, sugar, milk, or honey. If a diabetic loses unconsciousness, treatment with glucagon by a family member or friend is important. The brain is fueled by glucose, and when the brain is starved, hypoglycemia causes brain damage after 20 minutes of unconsciousness.
For more information:
American Diabetes Association
National Service Center
1701 North Beauregard Street
Alexandria, VA 22311
Phone: 1-800-DIABETES (342-2383)
Email: AskADA@diabetes.org
Sources:
Health InSite, Types of Diabetes (11/18/2010)
National Institute of Health, National Diabetes Information Clearing house (NDIC A service of the National Institute of Diabetes and Digestive and Kidney Diseases(NIDDK), National Institute of Health), Diabetes Overview,(11/18/2010)
American Diabetes Association, National Diabetes Fact Sheet , (11/18/2010)
John Hopkins University, "How the Pancreas Regulates Blood Sugars," johnshopkinshealthalerts.com (11/26/2010)
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