June 12 - What is Diabetes? - 47 ABC - Delmarva's Choice

June 12 - What is Diabetes?

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GOOD MORNING DELMARVA – We begin our Diabetes series with looking at the disease itself. We are joined by John Motsko, RPh, CDE, with the Apple Diabetes Center to discuss.

What is diabetes?

Diabetes, in general terms, describes a condition where the body cannot use its normal nutrition source or fuel (sugar/glucose) to run the millions of cells in our body.  Sugar or, the technical name, glucose is needed for cell function.  We get glucose from the digestion of foods called carbohydrates.  Carbohydrates include grain products such as bread, pasta and rice; starchy vegetables such as potatoes, corn, peas, lima beans; Fruits as fructose, some dairy products (lactose) and sugar containing products such as sodas and fruit drinks.

Glucose, after entering the blood stream following the  digestion of carbohydrates, needs the help of a hormone called INSULIN to help the glucose move from the bloodstream into the cell to be used as fuel.

If the body does not make insulin, the diabetes is referred to as Type 1-This is usually seen in children, but not always and absolutely requires the use of insulin injections for the individual to survive. Before the discovery of insulin in 1922, people with this type of diabetes died within months of developing the disease. Type 1 diabetes represents about 5-6% of the total cases of diabetes

Type 2 diabetes  is almost a completely type of disease and can occur for one or all of any of these conditions:

 (1) the body is not making enough insulin

(2) the insulin the body is making is not working as well as it should (this is called insulin resistance)  I call this "low octane insulin".

(3) We are consuming too many carbohydrates for our body to use in a day and/or  inactivity

 (4) the liver is not managing its stored sugar reserves properly and releases too much at the wrong time.

(5) Heredity.  Something we cannot control, but definitely a complicating factor in the development of type 2 diabetes.

 Unfortunately in many situations, type 2 diabetes is caused by several of these factors, if not all of them.  The older a patient becomes and the more overweight and less active they become, the more at risk they become for developing diabetes

While Type 1 diabetes does absolutely require insulin therapy and lifestyle management, Type 2 diabetes can usually be managed by oral medications and life style changes.  Note the phrase "lifestyle changes". However, the severity of Type 2 diabetes can progress over time.

In type 2 diabetes, the patients themselves play the most important role in controlling the disease. In fact, the education classes are actually titled "DIABETES SELF-MANAGEMENT EDUCATION AND TRAINING".  The patient plays the most important role in keeping the disease under control through medication compliance, healthy eating, weight management and staying active.

Why is blood sugar/glucose control so important?

High blood glucose levels over time can increase the risk for cardiovascular (heart and blood vessel) disease, including  heart attack and stroke. This is referrer to as the macorvascular effect ( large blood vessels).   In  the small blood vessels of the eyes, kidneys, etc.( microvascular disease) damage can cause these cells to die

HOW?

The buildup of glucose in the blood affects the lining of the artery walls. Arteries carry blood from the heart to the rest of the body. When arteries are healthy, the linings are smooth. But when you have high blood glucose the lining becomes damaged over time. This allows the buildup of plaque (fatty materials such as cholesterol) in the arteries.

This buildup of plaque narrows arteries.  This means that any blockage, such as a blood clot, can cut off blood flow.  When this happens in the heart or brain a heart attack or stroke happens.  When this happens in the small blood arteries of the eyes, kidneys and nerve endings, the cells below the blockage do not receive blood flow/nutrition and eventually die off.  These cells DO NOT regenerate and if enough die off complications such as blindness, kidney failure or neuropathy can occur.  The narrowing also causes increase in blood pressure which in itself is a risk factor for stroke and heart attack.

The Bottom Line :

Keep your blood sugars as close to normal as possible; because you cannot "feel" high blood sugar, people think controlling it is not important. However, uncontrolled diabetes is a time bomb.  Fortunately with the patient taking responsibility for their blood glucose control , complications of diabetes can be prevented.   It's not always easy work, but well worth it.

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