A person today asked me: What exactly is Diabetes? “I know it is a problem with blood sugar levels, but what is the problem? And what does the medication do? And what can you not do as a result of having diabetes?”
Here is the long winded response I gave. (Hope you find it of some use):
Diabetes, in general terms, is a condition in which the body is unable to process glucose, either because the pancreas has stopped producing sufficient insulin, or because the insulin it produces is ineffective. Why is this a problem? It’s a problem because glucose is the fuel the body uses to perform all of its functions and all of the daily activities that we engage in. Glucose, contrary to popular belief, is not simply ‘sugar’ or eating sweets; glucose comes from ALL the foods that we consume, to some degree or another. 98% of all carbohydrates get turned into glucose, 58% of proteins, and 10% of fats.
Insulin is a special hormone produced by the Islets of Langerhans, within the Pancreas, and it’s main job is to sort of “open the doors” of our body’s cells, in order to let glucose in. When that glucose can’t get in, either because the insulin is ineffective (it won’t open the cell’s doors) or because the body is not producing enough insulin, the cells starve and start dying off. An excess of glucose in the body starts damaging the body’s organs, and slowly killing off the many small capillaries that take blood to the smallest and farthest parts of our bodies, like our extremities. When enough of these capillaries die, gangrene may set in, and internal organs may lose their ability to perform their functions well, leading to amputations, blindness, loss of bladder function, kidney disease, and heart disease, among some of the most critical issues.
There are many types of Diabetes, and these dictate the type of treatment we may need. The most common ones, however, are: Type 1 Diabetes, which is an autoimmune attack on the pancreas for reasons as of yet unknown, and Type 2 Diabetes, which is a metabolic imbalance that may be triggered by many, many possible factors, like genetics, lifestyle, other diseases, and medications, and even Agent Orange for Vietnam Veterans. Just being thin many not prevent a person from getting Type 2 Diabetes, if they have a family predisposition, or if for example, they take statins for high cholesterol or steroids for asthma, or even medications for bipolar disorder – medications which are known to cause Type 2 Diabetes as a side effect. Also, just being obese will not, in and of itself, cause a person to have Type 2 Diabetes. Millions of people all over the world are obese, and will lead their lives NEVER getting Type 2 Diabetes, even if they become slightly insulin resistant due to their obesity. The true causes for Type 2 Diabetes, are as of yet, also unknown.
Many Diabetics manage their Diabetes with just diet and exercise, while some may need oral medications, insulin, or both. Some of the medications work to make the pancreas produce more insulin, and with the liver (which also stores and saves a certain amount of glucose for certain key needs, like rushes of adrenaline, and to give us pep in the morning when we wake up) so that it doesn’t “dump” too much glucose in our bodies, while reducing some of the insulin resistance a person may already have. Metmorfin is one of these medications. Other medications, like Insulin, seek to either replace missing insulin, or to circumvent, so to speak, the amount of ineffective insulin that a person may have, with effective insulin. While all Type 2’s are insulin resistant, and may do well with diet and exercise alone, or with oral medications, or a combination of oral medications and insulin, most Type 1’s are not, and since they simply do not make enough insulin to live, oral medications are not an effective treatment for Type 1 Diabetes, on it’s own. Some Type 1 Diabetics, however, MAY become insulin resistant with time, and may also need to add an oral medication to their insulin regimen.
One of the biggest challenges with medications is that, for example, Type 2 Diabetes is a degenerative condition, which means that with time, the same medication dosage may not be effective, and newer and stronger medications may need to be added (some of which are very dangerous, and have very risky side effects not unlike the complications of high blood glucose themselves), usually leading up to needing to inject insulin. Type 1 Diabetics have to use insulin from day one, because their bodies are so deficient in insulin, that in about a week’s time they would die without it. It would be like a person not eating for 7 days or more. None of that nutrition from the glucose is getting into the body’s cells, and helping fuel it.
Managing insulin is particularly challenging, because it will NEVER be like a real pancreas. A real pancreas is a hard working machine, constantly producing around 1-2 units of insulin an hour, and 4-6 units for meals every day, in healthy people. It responds INSTANTLY to any slight change in our glucose levels, and it counterregulates any glucose dumping from the liver. Humans try very hard to replicate the process, how much to inject, and when, but it is far, far from a perfect science. Life gets in the way, like working, and sleeping… and food combinations, like fat and protein added to high carbohydrate meals, slow down digestion and oftentimes make reactions very unpredictable. (This usually happens with pizza.) Stress, and illness are also situations in which the liver will release more glucose into the body to help it deal with the “enemy,” and if a person is not aware of these, they may become high and not realize it. Too much injected insulin from a miscalculation will leave a person low, and in danger of a Hypoglycemia (too little glucose in the body), which may lead to coma and death; too little insulin may leave a person with high blood glucose numbers for hours and hours, especially if they are not diligent in testing often, and eventually may also lead to coma and death. Insulin may also lead to weight gain, as it is a fat storing hormone… Eating too many carbohydrates, and injecting insulin to deal with them causes this, as it does in persons without Diabetes, who are still producing their own insulin.
Most of the restrictions in dealing with Diabetes have to do with the dangers of medications like insulin, which may lead to lows and miscalculations. A person with Diabetes can do most anything that a normal person may do, but in some states a person with Diabetes who is insulin dependent is required to disclose this information and submit to yearly physicals to prove that they have their Diabetes under control, if they want to operate a motor vehicle. In some professions, such as truck driving and air piloting, a person may not even be employed because the simple risk of becoming low while on the job might be too much of a risk.
Diabetics need to take care to really manage their carbohydrate portion control, regardless of the type, so that they can reduce the margin of error when dosing for insulin, reduce the risks of weight gain, and prolonged high glucose. Portion control is the BEST way to do this, and each Diabetic needs to test frequently to see which foods are okay, and which foods are simply not that doable. Nothing is off limits, so long as we limit portions, dose accordingly, and react within reasonable blood glucose levels.
Thanks, very well done.
The only thing I would mention is there is ongoing debate as to what good control is and how tight of control one should have as a diabetic.
Additionally the debate carries into what exactly is pre-diabetic? This question often lands squarely on your Dr’s shoulder as he/she is the first one to let you know you are or are not.
Very well done.
You are fortunate to have people in your life that care about the details.
It wasn’t someone in my life. But lately I get a LOT of questions/messages from strangers about things. lol
i get the same thing these days. it seams the more in control i am with D, the more people ask about it. not sure how the two correlate.
I think the “open the doors” analogy is very good.
Wow, very nice summary Liz. 
I am glad you focus on how complex this disease is. It isn’t just obsese people that get it. It is combination of so many different factors and can trigger it off - and fat is just one of the possible triggers.
I am glad to be here at TuD -where there are so many different types of people that have this. I think this site alone should be evidence to the fact that diabetes is a very complex disease. The scientists should come HERE to do their studies! The people on this site are a perfect example of the complexity of this disease and there is no one answer or cause. I wish doctors and scientists would focus on that more - I know there is a lot of study and it takes time but I feel like only recently I am reading articles on dispeling the “you must be fat” sterotype. I am glad it is finally coming around but still irks me that it was seemingly ignored for quite some time.
Nice description. 
I’m curious where you got the info about a healthy pancreas producing 20 units of insulin an hour. I read in a book (I think this one) that a healthy pancreas produces about 0.5 - 1.0 units per kilogram of body weight per day. This is the same insulin dose a Type 1 with no insulin resistance who is not honeymooning/LADA would take, excluding adjustments for things like an athlete being extremely active. I also remember reading somewhere else that the pancreas produces about a unit an hour as basal insulin for people without diabetes (and then of course “boluses” would occur on top of that). If the pancreas produces 20 units an hour, then the average dose for someone who produces no insulin and does not have any insulin resistance should be almost 500 units a day, which is a massive daily dose of insulin.
It may be that no one really knows, but for some reason the amount of insulin a properly-functioning pancreas makes really fascinates me!
Augh, sorry… It’s supposed to be 20 a day, or so… I made it more specific for clarity.