Diabetes means siphonHealing Handbook for Persons with Diabetes

Chapter 1: What is Diabetes?

Origins 

Mellitus means sweet like honey.The medical name for diabetes, diabetes mellitus, comes words with Greek and Latin roots.

Diabetes comes from a Greek word that means to siphon . The most obvious sign of diabetes is excessive urination. Water passes through the body of a person with diabetes as if it were being siphoned from the mouth through the urinary system out of the body.

Mellitus comes from a Latin word that means sweet like honey. The urine of a person with diabetes contains extra sugar (glucose). In 1679, a physician tasted the urine of a person with diabetes and described it as sweet like honey. 

Anyone can get diabetes. In fact, 14 million Americans have diabetes, including famous entertainers, athletes, and political leaders. Although they must carefully control their diet and medication, most people with diabetes lead full, active lives.

A History of Diabetes

Time

Event

1500 BC

Ebers Papyrus first describes diabetes

400 BC

Susruta records diabetes symptoms and classifies types of diabetes. Charaka refines this work in 6AD.

10 AD

Celsus develops a clinical description of diabetes

20 AD

Aretaeus coins the term diabetes.

1869

Langerhans describes clusters of cells (islets) in the pancreas.

1889

von Mering and Minkowski observe that diabetes develops when an animal's pancreas is removed.

1921

Banting and Best obtain and purify islets of Langerhans from an animal pancreas, inject the material (insulin) into a diabetic animal, and find a fall in blood sugar level.

The Role of Insulin 

Your body's cells need sugar for energy. Insulin funnels sugar into cells.Insulin is a hormone produced in the pancreas to regulate the amount of sugar in the blood. In persons with diabetes, the pancreas produces no insulin, too little insulin to control blood sugar, or defective insulin. To understand how this affects you, you need to understand more about how insulin works in your body.

Think of each of the billions of cells in your body as a tiny machine. Like all machines, cells need fuel. The foods you eat are made up of carbohydrates, proteins, and fats, which are broken down to provide fuel for the cells. The main fuel used by the cells is called glucose, a simple sugar.

Glucose enters your cells through receptors. Receptors are sites on cells that accept insulin and allow glucose to enter. Once inside, glucose can be used as fuel. But glucose has difficulty entering your cells without insulin.

There needs to be enough insulin to put sugar in every cell.Think of insulin as the funnel that allows glucose (sugar) to pass through the receptors into your cells

Excess glucose is stored in the liver and muscles in a form called glycogen. Between meals, when your blood sugar is low and your cells need fuel, the liver glycogen is released to form glucose. 

 

 

 

 

The Pancreas, Islets of Langerhans, and Beta Cells 

Beta cells make insulin.The pancreas is located in the abdomen, behind the stomach. It is attached to the small intestine and the spleen. Inside the pancreas are small clusters of cells called Islets of Langerhans. Within the islets are beta cells, which produce insulin. 

In people who do not have diabetes, glucose in the blood stimulates production of insulin in the beta cells. 

Beta cells "measure" blood glucose levels constantly and deliver the required amount of insulin to funnel glucose into cells. 

They keep blood sugar in the normal range of 60 mg to 120 mg. 

Also, when there is not enough insulin, excess glucose cannot be stored in the liver and muscle tissue. Instead, glucose accumulates in your blood. 

This high concentration of glucose in the blood is called hyperglycemia or high blood sugar. 

When the insulin funnel breaks because of diabetes, blood sugar goes high.Insulin keeps blood sugar between 60 and 120.

 

 Where Does Blood Sugar Come From 

Everyone knows that eating sugar can put sugar into the blood. And every person with diabetes knows that one of the key parts of controlling blood sugar is paying attention to the diet (See Chapter 6).

But what many people do not know is that not all the sugar in the blood comes from sugar that we eat. Because sugar in the blood is so important to our bodies, we have a backup source of sugar to use when we are not eating. The main source is the liver. The liver is like a big factory that makes many of the things that we need to live. One of those things is blood sugar.

During the day, when we are eating, the liver puts some sugar into storage. (Doctors call this stored sugar "glycogen.") During the night when we are asleep and not eating, the liver puts that sugar into the blood. And if we skip breakfast, the liver may actually make new sugar for us to use. It makes this new sugar from proteins that are taken away from our muscles!

The sugar that comes from the liver (and to a smaller degree from our kidneys, too!) explains why persons with diabetes can have a high blood sugar even when they are not eating!

Diabetes Symptoms

People with diabetes experience different symptoms. You may experience all, some, or none of the following:

  • Frequent urination (even at night)
  • Excessive thirst
  • Dry skin
  • Itchy skin
  • Slow healing of cuts
  • Blurry eyesight
  • Always being very hungry
  • Feeling tired and weak
  • Weight loss
  • Skin infections
  • Numbness or tingling in feet

Diabetes Symptoms.

 

The Kidney Dam 

When blood glucose rises above a certain level, it is removed from the body in urine. Picture the kidney as a dam: when there is too much glucose in the blood, the excess "spills" out. The maximum blood glucose level reached before sugar spills out is called the kidney threshold (usually about 180 mg/ml).

The Kidney Dam in most people can't hold back blood sugar levels over 180. 
If diabetes has hurt the kidney dam, blood sugar may have to go very high before it spills into the urine. 

Some people with long-term diabetes or kidney disease can have a very high kidney threshold. Sugar will not " spill" into the urine until the blood sugar is very high.

Glucose cannot be passed out of the body alone. Sugar sucks up water so that it can "flow" from the body. The result is polyuria or excessive urination. People with excess glucose in their blood, as in uncontrolled diabetes, make frequent trips to the bathroom. These people also have sugar in their urine; the medical term for sugar in the urine is glycosuria.

Sugar passing into the urine takes water with it. 

Loss of water through urination triggers the brain to send a message of thirst. This results in a condition called polydipsia, or excessive thirst. This symptom is not always pronounced, however; you may notice nothing more than a dry mouth.

Excessive urination can result in dehydration, leading to dry skin.

When the insulin funnel is broken, cells can't get sugar for energy.Blurred vision can be caused by fluctuations in the amount of glucose and water in the lenses in your eyes during periods of dehydration.

When there is no insulin to funnel glucose into the body's cells, or when the insulin funnel is not working to pass glucose through the receptors, the cells get no fuel and they starve.

This triggers the brain to send a message of hunger, resulting in polyphagia or excessive hunger. Because the glucose that should be fueling your cells is flowing out in urine, the cells cannot produce energy, and without energy, you may feel weak or tired. Weight loss may occur in people whose bodies produce no insulin because without insulin, no fuel enters their cells.

Insulin also works to keep fuels inside the cells. When insulin is low, the body breaks down the fuels, and rapid weight loss results. The breakdown of fat cells forms fatty acids which pass through the liver to form ketones. Ketones are excreted in the urine. The medical term for ketones in the urine is ketonuria.

When there is no insulin, lots of ketones get into the blood and urine.Skin infections sometimes occur because excess sugar in the blood suppresses the natural defense mechanism like the action of white blood cells. And sugar is an excellent food for bacteria to grow in.

Numbness and tingling in feet and night leg cramps may result from nerve damage due to prolonged high glucose levels that cause changes in the nerves.

Types of Diabetes 

Almost all people with diabetes have one of two major types. About 10% have Type I or insulin dependent diabetes mellitus (IDDM). Their bodies produce no insulin. When diagnosed, most people with Type I diabetes are under 40 and usually thin. Symptoms are often pronounced and come on suddenly. Because their bodies produce no insulin, people with Type I diabetes must obtain it through injection. If you've been diagnosed with Type I diabetes, you'll want to pay special attention to Chapter 3, which describes IDDM.

About 85% of persons with diabetes have Type II or non-insulin dependent diabetes mellitus (NIDDM). Their bodies produce some insulin, but it is not enough or it doesn't work properly to funnel glucose through the receptors into their cells. When diagnosed, most people with Type II diabetes are over 40 and usually are overweight. Symptoms are usually not pronounced and appear over a long period of time. Type II diabetes can sometimes be controlled with a carefully planned diet and exercise, but oral medications or insulin injections may be necessary. If you have Type II diabetes, you can find information about NIDDM in Chapter 4.

The following table highlights some of the differences between Type I and Type II diabetes.

  Type I (IDDM) Type II (NIDDM)
Age at onset Usually under 40 Usually over 40
Body weight Thin Usually overweight
Symptoms Appear suddenly Appear slowly
Insulin produced None Too little, or it is ineffective
Insulin required Must take insulin May require insulin
Other names Juvenile diabetes Adult onset diabetes
 
 

 

 

 

 

 

Other Types of Diabetes

People whose blood contains more glucose than normal, but less than occurs in diabetes, may be diagnosed with a condition called impaired glucose tolerance (IGT).

Some women experience a rise in their blood glucose level during pregnancy. These women have a condition called gestational diabetes mellitus (GDM). Their blood glucose levels usually return to normal after their babies are born. Other types of diabetes may occur as a result of diseases of the pancreas or the endocrine (gland) system, genetic disorders, or exposure to chemical agents.

Causes of Diabetes 

Two factors are especially important in the development of diabetes:

Heredity: If you have a parent, grandparent, brother, or sister, or even a cousin who has diabetes, you are more likely to develop diabetes yourself There is about a 5% risk of developing Type II diabetes if your mother, father, or sibling has diabetes. There is a higher risk (up to 50%) of developing Type II diabetes if your parent or siblings have Type II diabetes and you are overweight.

Diabetes sometimes runs in families. 
Being overweight can lead to diabetes. 

Obesity: Eighty percent of people with Type II diabetes are overweight when diagnosed. Diabetes symptoms disappear in many of these obese patients when they lose weight.

Other Factors Can Cause Or Trigger Diabetes, Including: 

  • Age: As people age, their bodies may have fewer insulin-producing beta cells.
  • Viruses: Certain viruses may destroy beta cells in susceptible people.
  • Faulty immune system: Scientists now believe that there is not one cause of diabetes, but multiple factors that may trigger the immune system to destroy beta cells.
  • Physical trauma: An accident or injury may destroy the pancreas, where insulin is normally produced.
  • Drugs: Drugs prescribed for another condition may unmask diabetes.
  • Stress: Hormones released during periods of stress may block the effect of insulin.
  • Pregnancy: Hormones produced during pregnancy may block the effect of insulin.
Other factors can trigger diabetes. 

Controlling Diabetes 

There are no easy cures for most cases of diabetes. Some persons with diabetes can be cured by a transplant of insulin producing cells, but there are significant risks associated with the surgery and with the immunosuppression-type drugs that need to be taken.

But even if diabetes cannot usually be cured, it can be controlled. Control of diabetes means balancing the amounts of glucose and insulin in your blood. To achieve this balance, your diabetes nurse educator or doctor will prescribe a regimen of diet, exercise, and possibly insulin injections or oral medications. Sticking to your regimen helps keep you healthy and greatly reduces your likelihood of developing diabetes complications.

People with diabetes are vulnerable to a variety of complications over time. Health-care providers all agree that strict control of blood sugar makes complications less likely. This was shown clearly by the Diabetes Control and Complications Trial. Control of blood sugar is the best way to minimize the risk of complications.

If you're feeling fine, you may wonder whether you really have to stick to your regimen. Remember that not everyone who has diabetes experiences the same or any symptoms, but even if you notice no symptoms, you still have diabetes and keeping your blood glucose in control is still important. High blood glucose is a toxic condition. Over time, it can result in damage to your blood vessels, kidney, eyes, and nerves. Although your body may adapt to a high glucose level, and you may feel fine, the closer your blood glucose level is to normal, the healthier your body will be.

For More Information 

Keep informed about diabetes. The more you know, the better you will be able to take care of yourself. By joining the organizations listed below, you gain access to a network that can provide the latest information on diabetes research and treatment.

You may also want to subscribe to some of the following publications

  • Countdown (subscription included in JDF membership fee)
  • Diabetes Forecast (subscription included in ADA membership fee)
  • Diabetes Self-Management P.O. Box 51125 Boulder, CO 80321-1125
  • Diabetes in the News P.O. Box 3105 Elkhart, IN 46515

Finally, you may want to consult some of the growing number of Online Resources for Persons with Diabetes. The list is expanding and frequently being updated.

This handbook probably won't answer all the questions you have about diabetes. In several chapters, you'll find references to other books you may want to look at for more information.

REMEMBER: The care of diabetes is a team effort involving you, your physician, and the diabetes education staff where you receive your medical care. This handbook cannot-and was not meant to-replace this team effort. 

This handbook embodies the approach of the diabetes care team at the University of Massachusetts Medical School. Different diabetes care teams may approach some aspects of diabetes care in ways that differ from those in this handbook. While most teams are in close agreement regarding the GENERAL PRINCIPLES of diabetes care, they may differ in the DETAILS. There can be more that one "right" way to approach a specific issue in diabetes management. 

Always remain in touch with your diabetes care team, and bring any questions you may have about the materials in this handbook to their attention! 

Copyright 1995-1999 Ruth E. Lundstrom, R.N. and Aldo A. Rossini, M.D. All rights reserved.
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 Dr. Aldo Rossini