Understanding diabetes, in a nutshell

man doing blood sugar test to learn his diabetic reading
Courtesy: Photo by Artem Podrez, Pexels.com

The diabetes epidemic is upon us worse than we can imagine. Already more than 230 million people worldwide have diabetes and, according to the World Health Organisations, that number will increase to 333 million by 2025. The numbers for the UK alone are no less frightening, with approximately 3 million people diagnoses with the disease.

One of the most alarming features of the rising tide of diabetes is the fact that 50 percent of all those who have the disease do not know that they  have it. This is a potential time bomb and makes it doubly important that people become aware of the risk factors and how to prevent the disease.

What is Diabetes?

A person with diabetes has an excess of glucose and a deficiency of functioning insulin. Since insulin is the hormone that takes excess glucose out of the bloodstream, the net result of this imbalance is a high blood glucose level.

The two types of diabetes

There are two kinds of diabetes. Type-1 diabetes – the rarer kind – is primarily caused by the destruction of cells in the pancreas that make the hormone insulin. It is called an autoimmune disease because the body mistakenly makes antibodies that attack the cells in the pancreas. Once the majority of these cells are destroyed, a person cannot function without insulin. It used to be called ‘insulin – dependent diabetes’. This usually develops in childhood and hence was also called ‘child-onset diabetes’.

Type-2 diabetes accounts for over 90 per cent of all diabetes. Unlike people with type-1 diabetes, who have low levels of insulin, type-2 diabetics almost always have very high levels of insulin. The trouble is that the insulin isn’t doing its job of lowering blood glucose levels. This is because the underlying cause of type-2 diabetes is that insulin receptors in cells in the artery walls and in other cells in muscles and the liver shut down so that you become insulin insensitive or insulin resistant. The net result is a lack of functioning insulin, so the body tends to make more and more, but it doesn’t work, so blood glucose levels continue to stay too high.

Normally, your blood sugar level should stay pretty even. It goes up a little when you eat carbohydrates, which are broken down into glucose in the gut then absorbed into the blood. But insulin is then released, bringing it back down again.

Your blood sugar balance should look like a gently rolling landscape. Once it looks like hills or mountains, with higher peaks and deeper troughs, this shows you are losing blood sugar control-called dysglycemia- and that you are becoming increasingly insulin resistant. This can get worse and worse over years, and even decades, before you develop diabetes.

The symptoms of diabetes

Although there are tests to diagnose diabetes, there are also symptoms that some people suffer with. These includes:

  • Excessive thirst
  • Excessive hunger and carbohydrate or sugar cravings
  • Frequent urination
  • Unusual changes in weight (either way)
  • Increased tiredness
  • Blurred vision
  • Itchy skin or cuts and sores that take a long time to heal

But you can have none of these and still be diabetic.

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Diagnosing diabetes

There are two ways to diagnose diabetes. The first is by testing your blood glucose level. If it is often above 7mmol/l before you have eaten, that’s too high and you have diabetes. Ideally, it should be around 5. Your blood glucose level, however, does depend on what and when you have eaten.

You can take a fasting blood glucose test, taken with a simple pinprick of blood which is put onto a stick then inserted into a device. You can also have a urine test for glucose levels, because if glucose is not being filtered out of the blood by your kidneys you have got a problem.

You can also have a ‘challenge’ test. This involves ingesting an amount of sugar equivalent to what you would get in a can of a sweetened fizzy drink such as a cola. That’s about ten teaspoons of sugar. Then you wait two hours. If your insulin is working properly your blood glucose level shouldn’t go above 7. If it isn’t, you get a blood sugar spike: your levels rise significantly.

Diabetes is really hyper-glyc-aemia – high sugar in the blood.

Now, the problem with all of these tests is that they only tell you what’s happening the very second you test the blood. They don’t really tell you if you are generally in the hills (dysglycemia) or the mountains (diabetes).

A second way to test for diabetes is through a more long-term test that’s becoming increasingly popular, it measures glycosylated haemoglobin.  Technically, this is also called HbA1C, so that’s what you might see on your blood test results. You may remember that this is when your blood sugar goes too high so your red blood cells get sugar coated, or ‘glycosylated’. Sometimes this is called glycated haemoglobin – it’s the same thing. Now, red blood cells (called haemoglobin or Hb) live for about three months, and once they are glycosylated they stay that way. So, the greater the percentage of red blood cells that are glycosylated, the more sugar spikes you must have had over the past three months.

If  you have a glycosylated haemoglobin score above 7 per cent, the chances are you have diabetes or will soon develop it.

The consequences of diabetes are:

  1. Heart disease, including high blood pressure and high cholesterol, and an increased risk of thrombosis or stroke.
  2. Kidney disease
  3. Nerve disease, called neuropathy, leading to loss of feeling and coldness in the extremities, sometimes so severe that limb amputations are necessary.
  4. Eye disease, called retinopathy, and other problems, from glaucoma to macular degeneration and blindness
  5. Obesity
  6. Periodontal disease (gum and teeth degeneration)
  7. Memory loss and Alzheimer’s disease
  8. Depression
  9. Fatty liver disease
  10. Joint stiffness

Diabetes is a serious – and costly – disease

Many people mistakenly believe diabetes is a ‘bit player’ when compared to the big killer diseases such as heart disease and cancer, yet it is intimately connected with these diseases and implicated in a wide range of others. Cardiovascular disease is the most common complication for people with diabetes and also the leading cause of death in industrialised countries. Approximately 50 to 80 percent of deaths in people with diabetes are due to cardiovascular disease. Behind every four premature deaths in developing countries, you will find diabetes. The disease is also the leading cause of blindness and vision loss, disease-related amputations and chronic renal failure. Sadly, it does not stop there. Diabetes and obesity are associated with a greater risk for several cancers (including breast and colon cancer), osteoarthritis, migraines, psoriasis, asthma and other inflammatory disease. In addition, far more people with diabetes develop depression and Alzheimer’s disease.

And, of course, let’s not forget the cost. Worldwide, diabetes care costs between £100 and 180 billion annually – and that doesn’t include indirect costs due to disability and other such consequences. The price tag is paid by us all. Seventy per cent of drug costs are paid by the public – that’s you and me. Medication and insulin are big business – insulin is among the 20 bestselling drugs – so there is little incentive for the pharmaceutical industry to find a less costly solution. Thankfully, that solution already exists – and it doesn’t involve a new drug.

Food and exercise are better than insulin

A Norwegian study, conducted by Aker University Hospital and published in 2005, concluded that lifestyle change is better than insulin therapy for type-2 diabetics. Several international studies have come to the same conclusion. In the Norwegian study, one group with type-2 diabetes were treated with insulin injections, while another group was treated with dietary advice and exercise. the aim was to achieve weight loss and better insulin sensitivity and blood sugar control. The latter group lost 3kg of weight in 12 months and saw an improvement in blood sugar, blood pressure and triglyceride levels. The weight loss might not sound particularly impressive but the diet used was the more traditional low-fat and high carbohydrate diet – but low in sugar and high in fibre – and not a low glycaemic/low-carbohydrate diet, which can achieve much more impressive results. In contrast, the insulin group increased their weight by 4.9 kg and had worsened metabolic parameters such as triglyceride levels.

Given that heart disease is the biggest cause of death in type – 2 diabetics, and increased triglycerides increases the risk of heart disease, insulin treatment is obviously not the best choice! Nevertheless, the number of people with type-2 diabetes receiving insulin therapy has skyrocketed over the last two to three decades. The reason for this lies with the health-care system, which is simply not designed to help people improve their lifestyle and take care of their own health. It is a ‘sick-care’ system, not a health-care system. I believe most doctors and other health professionals would welcome the opportunity to raise awareness, convey knowledge and motivate diabetes patients to change their lifestyle habits, but they simply don’t have the time required to do this successfully.

Understanding diabetes, in a nutshell

Diabetes is the end result of eating a diet and living a lifestyle that repeatedly keeps your blood sugar at too high a level. As a consequence, the body produces a hormone, called insulin, which floods into the bloodstream to take the glucose out of the blood and into the liver and muscles. The glucose is first converted to glycogen, but when our glycogen stores are full it turns it into fat and stores it. High insulin increases fat storage both from dietary carbohydrate and fat. If your blood glucose levels keep going too high, over time, and if you are genetically susceptible, you become insensitive to insulin and develop what’s called insulin resistance. When that happens, you have even more blood sugar highs, and you produce even more insulin to cope. Too much glucose, and too much insulin, damage all kinds of tissues – arteries, eyes, kidneys, and brain to name a few. Your whole system tips into a state of inflammation, which means that you start experiencing more pain and more health problems – from heart disease to painful joints. Up goes LDL (‘bad’) cholesterol, triglycerides and blood pressure; down goes your energy, HDL (‘good’) cholesterol and your mood – and your memory suffers too.

This pattern of problems is called metabolic syndrome. I call this change in your body’s biology ‘internal global warming’ and I am going to show you how to cool down, not only for diabetes reversal but also to prevent a whole host of other common 21st-century diseases, from high blood pressure to low mood.

Author: Patrick Holford; Book Name: Say No to Diabetes