About Diabetes and Its Many Faces

Diabetes comes in many shapes and forms. People with diabetes have one thing in common – they have (or would have) high blood glucose levels without intervention. But let’s see why this happens:

Glucose (a type of sugar) is the main fuel for cells in our body. It needs a hormone called insulin to cross the border, to be able to get inside a cell. In the absence of insulin, or if the insulin available is not working properly, the glucose stays in the bloodstream (and leaves the body with the urine), while the cells are lacking in fuel. The name, diabetes mellitus comes from Latin, it means sweet urine.

The inability of the glucose to cross over can happen for various reasons

Type 1 Diabetes

In Type 1 Diabetes (T1DM) the body lacks insulin. The insulin producing cells (beta-cells) in the pancreas stop working. This is usually caused by an autoimmune reaction, when the immune system of the body destroys its own beta-cells. We don’t know yet, why exactly this is happening, but possibly there is a genetic susceptibility, and a viral infection can act as a trigger, but there are still unknown components. When the beta-cells stop functioning, there is nothing else to be done (yet), you have to become your own beta-cell and provide the body with insulin. The insulin is a protein, so it cannot be taken by mouth, as it would get digested along with the other proteins. It has to be given as a shot. And you really have to think like a pancreas, and balance the insulin dose with the insulin requirements, determined by what you eat, what exercise you do, and many other things. With the artificial pancreas on the horizon, there is hope that it will not always be so.

Type 2 Diabetes

Type 2 Diabetes (T2DM) is accountable for the majority of the diabetes cases, and can be quite different from person to person. The main problem here is usually not the lack of insulin (although that also might happen during the course of the disease), the problem is that the insulin is not able to do its work properly. This is called insulin resistance. The pancreas tries to overcome this problem for a while by synthetizing more and more insulin, but after a while the blood sugar starts to rise.

The insulin resistance happens due to many things. There can be genetics behind it, but usually it is the lifestyle that is the main culprit. Eating unhealthy, being a couch-potato, not sleeping enough, smoking, and of course that extra weight around the waistline – these all help the insulin resistance develop. This means, that the most important thing is to move towards a healthier lifestyle. Of course we have drugs to decrease insulin resistance, but without proper food, exercise and sleep they are less than half as effective. As time goes on, you might need more medication, maybe even insulin shots, but keep in mind, these are not instead of eating, moving and sleeping healthy, they are to supplement this!

With insulin resistance the metabolic changes can lead not only to high blood sugar, but also to abnormal lipid levels and high blood pressure. These in turn may clog your arteries, so if you have Type 2, you should take care of these also.

Diabetes related to other diseases

This is a big group with various disorders, most of them extremely rare. There two types that are a bit more common than the others, and it is good to be aware of them

Steroid diabetes – If you need to take steroid tablets or injections on the long term, this might raise your blood sugar, so you need to check it from time to time, and you might need treatment for it. After stopping the steroid the blood glucose usually decreases again.

Pancreatic diabetes – If you have had pancreatitis (inflammation of the pancreas) many times, or a part of your pancreas has been removed, you might develop diabetes. In this case the insulin producing cells are missing, so this usually means insulin therapy.

Gestational diabetes

Gestational diabetes is any diabetes diagnosed during pregnancy. In pregnancy some degree of insulin resistance is normal, due to the hormonal changes, but in susceptible people it might lead to diabetes. It is important to detect and treat it, as it might lead to complications. The blood glucose levels usually are back to normal after the baby is born, but it means a higher risk for later T2DM.

Now the classification of GDM is changing, and so do the numbers. According to the new WHO guidelines you could have either Diabetes in Pregnancy, when you fall into non pregnant diabetes criteria, or you could have Gestational Diabetes if you have any of those below:

– fasting plasma glucose 5.1-6.9 mmol/l (92 -125 mg/dl)
– 1-hour plasma glucose ≥ 10.0 mmol/l (180 mg/dl) following a 75g oral glucose load
– 2-hour plasma glucose 8.5-11.0 mmol/l (153 -199 mg/dl) following a 75g oral glucose load

I personally find Diabetes in Pregnancy a bit confusing as there are those who were living with diabetes even before pregnancy (either type 1 or type 2), another totally different set of issues.

But never mind, a rose by any other name would smell as sweet. If you have higher blood sugar values during pregnancy, that can increase all sorts of risks. But again it is a good time to make some lifestyle changes that can last. And healthy lifestyle early on has the greatest impact on your baby’s future health.

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