Thursday, April 22, 2010

What Causes Diabetes?

Type 1 diabetes usually develops due to an autoimmune disorder. This is when the body's immune system behaves inappropriately and starts seeing one of its own tissues as foreign. In the case of type 1 diabetes, the islet cells of the pancreas that produce insulin are seen as the "enemy" by mistake. The body then creates antibodies to fight the "foreign" tissue and destroys the islet cells' ability to produce insulin. The lack of sufficient insulin thereby results in diabetes.

It is unknown why this autoimmune diabetes develops. Sometimes it is a genetic tendency. Sometimes it follows a viral infection such as mumps, rubella, cytomegalovirus, measles, influenza, encephalitis, polio, or Epstein-Barr virus. It has been shown through studies that children who develop DM 1 have a higher number of life stress events than controls. Cow's milk has been implicated. Other less common (very rare) causes of type 1 diabetes include injury to the pancreas from toxins, trauma, or after the surgical removal of the majority (or all) of the pancreas.

The medical community still does not know the cause of DM 2, or what makes one person's cells become resistant to insulin and not another person. However, there are various factors that have been shown to increase the risk of getting DM 2.

The first risk factor is genetics. About 5 to 11% of people who have DM 2 have a family history of it. People who have DM 2 in their family history are 25% more prone to getting it than those who don't.

The medical community claims that eating sweets does not cause diabetes. They do admit, however, that if eating sweets leads to obesity, then eating sweets may be related to diabetes because there is a much increased risk of DM 2 when a person is obese.

Increasing age is another risk factor, as is smoking and drinking caffeine. Interestingly, using artificial sweeteners has also been shown to increase the risk of DM 2.

Race is also a risk factor. Native Americans, Eskimos, African-Americans, Hispanics, Asian-Americans and those of Pacific Island descent are at increased risk of DM 2.

High emotional stress has also been shown to be a risk factor, because elevated levels of cortisol which comes from chronic stress increase the insulin levels. Also, adrenaline from anxiety causes a rapid release of glucose into the bloodstream, causing chronic elevation of blood glucose.

My personal theory is that diet DOES play a very important role in creating the disease process of DM 2. The two problems in diet are 1) eating too much, and 2) eating too many refined carbohydrates. If a person has a family history or other risk factors, a poor diet can often “turn the switch” and start the disease process. It can also affect those without a family history.

Eating too much puts a strain on the pancreas in both digestive enzyme production and in insulin production. It increases fat cells which also cause impaired glucose uptake.

Eating too many refined carbohydrates (sugar, sugar sweets, processed foods with a lot of sugar and flour, eating a lot of bread—flour is a refined carbohydrate) causes a rapid rise in blood glucose. This causes an excess of insulin to be secreted.

Too much insulin drives the blood glucose down so quickly that often low blood sugar (hypoglycemia) results. When a person has low blood sugar they crave more refined carbohydrates, and there is a yo-yo effect of blood sugar and insulin levels bouncing up and down.

The brain doesn't like low blood sugar. The rest of the body has ways to make energy when glucose isn't available, but the brain doesn't. That's why we often feel tired and can't think straight when our blood sugar is low. If it goes too low, the brain shuts down and we can go into a coma (a diabetic coma is not caused by the blood sugar being too high, but by being too low because of medication or insulin usage).

Symptoms of low blood sugar can include (most people don’t have all of these but they do have some): anxious feelings, unusual tiredness or weakness, difficulty in concentrating, drowsiness, excessive hunger or cravings, headache, shakiness, nausea, anxiety and nervousness, blurred vision, cold sweats, confusion, cool pale skin, fast heartbeat, nightmares, restless sleep, slurred speech, and behavior change similar to being drunk. Blood sugar that drops too low can lead to complete unresponsiveness (coma).

So the body tries to compensate for the problem of low blood sugar by becoming resistant to the elevated levels of insulin. If the cells don't respond to the higher levels of insulin so easily, then the blood sugar doesn't drop as rapidly, saving the brain from problems.

However, the insulin resistance keeps the higher levels of glucose (from eating too much or from eating too many refined carbohydrates) in the bloodstream. This causes hyperglycemia, and leads to DM 2.

This theory explains the rapid rise in cases of DM 2 in the last fifty years, and why it is still rising. Up to 75 years ago, sugar was not as easily available. There were few processed foods with sugars and refined carbohydrates. People ate whole foods and cooked from scratch. Desserts were a treat, not a diet. The amount of high fructose corn syrup in sodas, drinks and other treats has dramatically increased in the last ten years. High fructose corn syrup has been shown to cause obesity, diabetes and heart disease even above table sugar.

Since that time, with an increase in sugar and processed food and drinks, children are eating sugar cereal (both the sugar and the cereal are refined carbs) for breakfast, sandwiches and chips and chocolate milk and desserts for lunch (bread and chips are refined carbs, and a hamburger, fries and a sugary or artificially sweetened caffeine soda for dinner (fries are also considered a refined carbohydrate). Even so-called “healthy” snacks like fruit snacks and granola bars are usually made with high-fructose corn syrup and other refined carbohydrates.

The diet of the modern first-world countries with an ever increasing amount of refined carbohydrate processed foods, high-fructose corn syrup drinks, chemicals and sweeteners is predisposing our population to a dramatically increased risk of insulin and blood sugar problems. Add to that the chronic, increased stress of our modern society and we have an excellent recipe for the creation of diabetes.

My next blog will be on how diabetes is diagnosed.

Until we meet again,
Dr. Judi

Saturday, April 17, 2010

What is diabetes?

We all like sugar. Our bodies are programmed to love the sweet taste because we need sugar in the form of glucose. Glucose is the sugar that the body uses to make energy. When we eat the body breaks down the food into glucose, which then enters the bloodstream to be taken to all of the cells in the body.

As the level of glucose rises in the blood, insulin, a hormone, is released from the pancreas, which is a gland that sits behind the stomach and also helps digestion. The insulin attaches to the body’s cells, which opens channels in the cell walls for glucose to enter. The cell then uses the glucose to make energy in the form of ATP in little organelles called mitochondria. The body needs this energy to be able to function.

Therefore, insulin lowers the glucose in the bloodstream by opening the cells so that the glucose can leave the bloodstream and enter into and help feed the cells. If we didn't have insulin, the glucose in the blood would remain high and the cells would starve.

Diabetes Mellitus (diabetes, or DM), is a group of metabolic diseases which is characterized by hyperglycemia (too much glucose in the blood). This happens when there either isn’t enough insulin (Diabetes type 1), or the cells become resistant to allowing the insulin to open the glucose channels (Diabetes type 2). When glucose can’t get into the cells, the levels in the blood increase, and the cells starve, being unable to make adequate energy for the body’s needs. The elevated levels in the blood vessels can then cause damage to those vessels.

Symptoms of high blood sugar can include: blurred vision; drowsiness; dry mouth; flushed and dry skin; fruit-like breath odor; increased urination; loss of appetite; stomachache, nausea, or vomiting; tiredness; troubled breathing (rapid and deep); and unusual thirst.

When insulin levels are too low and glucose levels too high, there is weight loss because the glucose can't enter the cells (type 1 diabetes). When the cells are resistant to insulin, the insulin levels rise. Insulin causes the body to hold onto fat, and there is weight gain (type 2 diabetes).

When the glucose is too high in the bloodstream, the glucose begins to “glycosylate,” or attach, to proteins in the blood and blood vessels, causing damage to the vessels. This is what causes the damage in the body related to diabetes. Over time, this glycosylation can lead to blindness, kidney failure and nerve damage (neuropathy). These types of damage are the result of damage to small vessels, referred to as micro-vascular disease.

Diabetes is also an important factor in accelerating the hardening and narrowing of the arteries (atherosclerosis), leading to not enough blood to the legs and feet, strokes, coronary heart disease, and other large blood vessel diseases. This is referred to as macro-vascular disease.

There are two main types of diabetes, simply named as type 1 and type 2. Diabetes Mellitus type 1 (DM 1) is generally a disease that starts in childhood, though more rarely it can start in adulthood as well. No one knows the absolute cause of DM 1, but it is characterized by a destruction of the beta cells in the pancreas that make insulin. There seems to be an autoimmune problem in which the body starts to destroy its own cells. Therefore, in DM 1 there is not enough insulin, and insulin shots are necessary for the patient to survive. If the patient does not have enough insulin, he/she will go into a condition called ketoacidosis, and will die without help. This is a very serious condition.

Symptoms of ketoacidosis that need immediate hospitalization include: flushed dry skin, fruit-like breath odor, ketones in urine, passing out, troubled breathing (rapid and deep) and possibly fever.

Diabetes Mellitus type 2 (DM 2) is much more prevalent. About 90% of the diabetes in the United States is DM 2. DM 2 is a condition in which the cells become resistant to the insulin, so that the glucose cannot get into the cell even when the insulin attaches to the cell receptor. Often the body makes more insulin to try and get the cells to open, so most people with DM 2 will have higher than normal levels of insulin. These patients will not develop ketoacidosis, and so do not die quickly if their blood sugars rise, but usually die from the long-term complications of glycosylation. The medicines for DM 2 are designed to either increase insulin or assist the cells to be more receptive to the insulin.

DM 2 has been considered a genetic disease, but recently many people have been diagnosed that do not have a family history. I believe that this disease is a disease of our modern lifestyle, and comes on much easier if there is a genetic tendency towards it.

In my next blog we will discuss the possible causes of diabetes.

Until we meet again,
Dr. Judi

Tuesday, April 13, 2010

Dealing with Diabetes

Blindness, amputations, kidney dialysis, chronic pain from neuropathy, heart attacks, depression and mental disease is more debilitating to so many people as is diabetes.

Two of my grandparents died of complications of Diabetes Mellitus type 2. Many of my aunts and uncles have suffered from the disease. I have a grandson who has Diabetes Mellitus type 1. A few years ago, my blood sugars were in the diabetic range, though they are now normal.

The next series of blogs are going to be on diabetes. They will be taken from my new microbook, "Diabetes: Don't Depend on the Medical System to Keep you Healthy." This e-book will be available on this site soon.

I learned about diabetes in medical school, but what we learned was, in my experience, inadequate. We were taught about medicines to help with the disease, and how to do bypass surgery and amputations when the arteries in the legs were blocked, and dialysis when the kidneys shut down, and do laser surgery for the eye complications, and how to treat the heart attacks that resulted.

But we were told that the disease was chronic and the patients would eventually die from the complications of diabetes. The only hope we had was to preserve their ability to function a little longer through medication, surgery and other interventions. We were not taught much about diet or any of the other major things that can have a tremendous impact on diabetes. There is a belief that the patient won’t stick to a diet, anyway. There was also a belief that there was nothing that could prevent the disease.

In 2007 the American Diabetic Association estimated that there were 17.5 million people in the United States that had been diagnosed with diabetes, and an additional 5.8 million that have not yet been diagnosed but still have the disease (for a total of about 8% of the population, or 10% of those 20 and older). The numbers are rising rapidly, and the age of onset is becoming younger. Almost 200 thousand teenagers are now suffering with Diabetes type 2, which used to be a disease of older adults.

From an economic perspective, the total annual cost of diabetes in 2007 was estimated to be over $174 billion dollars in the United States, a per capita cost of $17,750.00. 2.7 million days of hospital stay a year, and 28.6 million physician office visits were attributed to diabetes. Remember, these numbers reflect only the population in the United States. Globally, the statistics are staggering and growing rapidly.

Diabetes is the sixth leading cause of death in the United States; however, the first leading cause of death, heart disease, is often related to diabetes. Clearly, the medical mainstream has not found the answers to this rapidly growing and enormously expensive and deadly problem. The medications help lower blood sugar but often do not reduce the problems associated with diabetes. The medical community does very little to prevent diabetes and claims to not know the cause except for genetics. However, most people being diagnosed with diabetes today have not had it in their families.

Because this disease has personal implications to me, I have taken up a study of diabetes. I have learned a lot more than what I learned in medical school and I would like to share what I have learned with you: what diabetes is, what it does to your body, how to prevent it, and the many ways to treat it, some better than others.

I feel that it is tremendously important for people with diabetes, or who have diabetes in their families, to understand their bodies and to understand the disease, so they can take control of their own prevention and treatment, assisting the doctors who are treating them, rather than completely depending on the doctors to do it for them. I am not advocating that people with diabetes stop seeing their doctors. Medical care is important. But I am advocating that patients take a greater role in their own care, bringing things to their doctors’ attention so that their care can be improved.

My next blog will answer, "What is Diabetes?"

Until we meet again,
Dr. Judi