<br><h3> Chapter One </h3> Diabetes Explained <p> <p> People tend to think of diabetes as the presence of high blood sugar levels in the body, which requires people to follow a strict diet and take insulin shots. But just what exactly is diabetes? Why do people say it is one of the enemies of good health? Take a deeper look into what experts call the "illness of the rich." <p> Diabetes used to be known as <i>insulin dependent diabetes mellitus</i> (IDDM) and <i>noninsulin dependent diabetes mellitus</i> (NIDDM). These terms are not used as commonly today because of the possibility of confusion for those who aren't familiar with the medical jargon. Instead, we now use the terms <i>Type 1</i> and <i>Type 2 diabetes</i> (Arabic numerals are preferred over Roman numerals to avoid any possible confusion). <p> Being metabolic (that is, involved in breaking down consumables and converting them into energy), diabetes is an outcome of the processes that take place when the body digests food. When we eat, food is changed into glucose, the form that sugar takes when it is "active." This serves as the main source of fuel for our bodies. The glucose then goes into the bloodstream and passes through the rest of the body for energy and growth. For glucose to reach the cells, the body uses insulin, a hormone secreted by the pancreas. The pancreas is the large gland found at the back of the stomach. <p> Statistics show that 5 to 10 percent of diabetics have Type 1 diabetes, in which beta cells do not produce enough insulin, thus requiring insulin injections for the patient. Type 1 diabetes is like the hijacking of immune processes whereby the body's own cells attack themselves. These destructive autoimmune processes eventually lead to illnesses like diabetes mellitus and other autoimmune disorders (e.g., Crohn's disease, Goodpasture's syndrome). Type 1 diabetics are usually diagnosed before the age of thirty. Type 2 diabetes occurs gradually, meaning that it has a slow onset, and approximately 90 to 95 percent of diabetics have this kind. This form of diabetes happens due to insulin resistance or sensitivity. It can cause impaired functioning of the beta cells which leads to reduced insulin production. <p> At first, Type 2 diabetics are prescribed common remedies, such as diet and exercise. When blood glucose levels continue to escalate, physicians may prescribe oral hypoglycemic agents. <i>Hypoglycemia</i> means low sugar in the blood. In some individuals suffering from sudden stress, the medicines don't work, which leads to a serious need for insulin injections. Type 2 diabetes typically afflicts people who are obese and over the age of thirty. <p> Complications occur not only for those who take insulin. Whatever the type of diabetes, the patient's condition can unfortunately spiral out of control once the individual's body is affected by different factors that lead to complications. With proper management of the symptoms and avoidance of factors that trigger specific symptoms, diabetics can steer clear of life-threatening complications. <p> Type 2 diabetics may have the impression that they do not actually have diabetes simply because they don't take insulin injections. They believe they have "borderline" diabetes, but this idea is potentially harmful for them. Diabetics must take their conditions seriously, follow the doctor's advice, and learn alternative means for preventing symptoms and avoiding complications. <p> If you are a health care provider, you must be committed to educating your patients about the real picture. In doing so, you must urge them to work for their own wellness and help them to understand that what they have is not "borderline" diabetes but the real deal itself. Type 2 diabetes is also referred to as insulin resistance, impaired glucose tolerance (IGT), or impaired fasting glucose (IFG), a state wherein blood glucose levels act like an elevator and go up and down between average levels and those of a true diabetic. <p> <p> HISTORY OF DIABETES <p> For centuries, people have studied diabetes and the underlying factors that lead to the illness. Today, much advanced research goes into the prevention and treatment of the disease. Insulin has been used to manage diabetes only since 1922. <p> Diabetes can be indicated by the occurrence of glucosuria, or the condition of having glucose in the urine. Ancient Hindu writings told of black ants and flies that were found lingering around the urine of those with diabetes. Sushruta, an Indian doctor who lived around 400 BC, wrote about the urine of diabetics and described it as a sweet substance. Later on, physicians believed that sweet urine was a sign that a person had diabetes. <p> In 250 BC, the term <i>diabetes</i> was coined. Diabetes in Greek means "to siphon," as the disease was believed to drain an individual of fluid. The Greek physician Aretaeus explained that diabetics were being drained of their body fluid because they urinated more often than usual, and he vividly described the disease as the "liquefaction of flesh and bones into urine." In 1674, King Charles II's personal physician, Thomas Willis, coined the term <i>diabetes mellitus</i>, with <i>mellitus</i> meaning "honey." Willis also believed a diabetic's urine was sweet or "imbued with honey and sugar." <p> In the 1800s, many different treatments were suggested for diabetics, including bloodletting and opium. Different diets were also suggested. In the early decades of the century, starving oneself was said to be an effective therapy. Sufferers were said to enjoy a longer life span through these practices. The treatment of diabetes took a major step forward in the late 1800s, when two German physicians, Joseph von Mering and Oskar Minkowski, removed the pancreas of several dogs and discovered that the dogs gradually developed diabetes. Through this discovery, the physicians tried to link the pancreas to diabetes and aimed to isolate a pancreatic extract that they hoped could treat the disease. <p> In Canada, Dr. Frederick Banting was eager to isolate the extract in spite of skeptics who didn't believe it could be done. In May 1921, Dr. Banting, together with his assistant Charles Best, a medical student, began experiments at the Toronto laboratory of Professor John Macleod. Banting tied off the pancreatic ducts of dogs to observe the behavior of insulin. The pancreatic cells, which release digestive enzymes, degenerated, while the cells that released insulin did not. After a few weeks, the pancreas disintegrated into sediment to the point that insulin could be isolated and retrieved. In July 1921, a dog with its pancreas removed was injected with extract obtained from another dog with tied ducts. As a consequence, the canine's blood glucose level dropped. Following this experiment, another dog with its pancreas removed was injected with the extract for eight days. The scientists observed the same results and called the substance "isletin." The isletin studies caused the dogs to have lower blood glucose levels, thus improving their overall condition and causing their urine glucose levels to go down. It was observed that as long as the dogs received isletin, they survived. Later on, different animals were experimented on, with many experts now experimenting on cows rather than dogs. The animals could survive without a pancreas for a period of seventy days. This breakthrough led to improved diabetic research. <p> Following these experiments, Dr. James Collip, a biochemist at the University of Western Ontario, tried to develop a new extract with longer-lasting effects. On January 11, 1922, a fourteen-year-old boy named Leonard Thompson was the first to receive insulin injections. However, these injections produced only a slight decline in glucose levels and caused protruding abscesses at the site of the injection. Because of these unsatisfactory results, Dr. Collip worked on refining the insulin extract. After several weeks, the same boy was given the purified extract, and soon his health improved. His blood sugar levels were now up to par. He gained weight and managed to live another thirteen years, dying at twenty-seven from pneumonia. <p> During the spring of 1922, Charles Best continued to produce insulin to help in the recovery of patients at the Toronto clinic. For almost sixty years, insulin was manufactured to produce long-lasting, positive effects and became a flexible therapy for diabetic patients with evolving needs. In 1978, a change came about with the creation of recombinant human DNA insulin; instead of using animals, the substance could now be replicated from insulin produced by human beings. This was a major medical milestone. <p> In 1923, Macleod and Banting were awarded the Nobel Prize in Medicine for the discovery of insulin. They maintained that insulin was not actually a cure for diabetes but rather a treatment. Due in part to their experiments, it is now known that insulin helps metabolize carbohydrates and other nutrients that provide the body with energy for everyday activities. <p> <p> TRACKING THE RATES OF DIABETES <p> According to the International Federation of Diabetes, the number of diabetics has grown from 30 million twenty years ago to more than 246 million today. Based on their statistics, seven of the ten nations with the largest number of diabetics are developing nations, with two of the nations being China and India. Most countries with a striking density of diabetics are located in the Middle East and the Caribbean. <p> The Centers for Disease Control and Prevention (CDC) suggests that 21 million Americans, or 7 percent of the total U.S. population, have diabetes. The big news is that, astonishingly enough, one-third of them don't have a clue that they have the disease. About 41 million Americans are currently prediabetic or are at high risk for contracting the disease. When prediabetes is left unmanaged, it can mature into Type 2 diabetes, and possibly cardiac disease. <p> In 2006, as determined by the International Diabetes Federation, diabetes was announced as the sixth leading cause of death in America. They also reported that 21 percent of those aged sixty and above are close to developing diabetes. Among twenty- to thirty-nine-year-olds, 2 percent are likely to develop the disease, followed closely by 10 percent of forty- to fifty-nine-year-olds. <p> According to the American Diabetes Association, at least 23 million people in the United States today suffer from diabetes. Of this number, about 17 million have already been diagnosed, while approximately 5.7 million have not. <p> The United States spends around $132 billion for this disease, with $92 billion being direct medical costs and the rest being in productivity losses and other costs. <p> As overwhelming as U.S. diabetes statistics are, compared to Third World countries, the situation is still manageable. In African and Asian countries, where insulin is very difficult to come by, diabetics may live only for two years or less following diagnosis. <p> Factors that lead to diabetes include unhealthy lifestyles, poor diets, and heredity. People nowadays exercise less and perform fewer physical activities, which prompts obesity. This causes stress on the system and the organs and makes the body unable to produce insulin. <p> If you have diabetes, you will slowly realize that, apart from the health predicaments you face, you could also be confronted with considerable economic hardships. There are treatment expenses and other health care costs, such as hospitalization, which is common in diabetics aged sixty-five and above. Diabetics are also more prone to life-threatening complications. The overall estimated costs incurred by diabetics in the United States, including direct and indirect expenses, may reach up to $100 billion each year. The aim of treatment regimens is obviously not a financial one, but is rather to bring down sugar levels to a suitable range, with the goal being to prevent acute and chronic complications. <p> There are more diabetics in developed nations because most of the people in these nations eat food that is rich in carbohydrates, which includes glucose. Foods like these lead to insulin resistance and are a key factor leading to Type 2 diabetes. <p> <p> THE INNER WORKINGS OF DIABETES <p> Diabetes doesn't just suddenly appear out of the blue; nor does it make a person feel ill overnight. Prior to the disease taking shape, the body will have been exposed to various factors that encourage insulin intolerance. It is very important to learn about the pathophysiology and mechanism of diabetes. These are the processes that occur inside your organs and body systems once you are afflicted with the disease. <p> Let's begin with insulin. Since impaired insulin production is the main cause of diabetes, it is important to know its basic function. Insulin comes from beta cells, which in turn come from the islets of Langerhans located in the pancreas. As an anabolic substance, insulin builds molecules through the energy it receives from various sources. It also serves as a storage facility for glucose in the form of glucogen in the liver and muscles. When a person eats, insulin levels jump up, forcing glucose to move from the blood into the muscle, then to the liver, and in due course into fat cells. <p> Insulin serves the body by transporting and metabolizing glucose for energy, thus stimulating the storage of glucose. It signals the liver to halt the release of glucose, thus enhancing fat deposits in adipose tissue and accelerating the movement of amino acids from dietary protein to the inside of cells. <p> Insulin prevents stored glucose, protein, and fat from being degraded. Between meals and overnight, the pancreas releases very minute amounts of insulin, called the basal insulin rate. After blood glucose levels have been lowered, another hormone called glucagon is released from the pancreas by the alpha cells located in the islets of Langerhans. Glucagon causes the liver to secrete stored glucose and works with insulin to achieve typical sugar levels. <p> The liver manufactures glucose chiefly by breaking down glycogen through a process called glycogenesis. Once eight to twelve hours have passed without eating, the liver builds up glucose by breaking down amino acids and other noncarbohydrate substances via a process called gluconeogenesis. <p> Once insulin secretion is impaired in the pancreas, gastrointestinal (pertaining to stomach and intestines) absorption of glucose boosts basal hepatic glucose production in the liver and decreases insulin-stimulated glucose uptake in the muscles. Hyperglycemia then appears, indicating diabetes. <p> For Type 1 diabetes, the process is pretty much the same, but there is a genetic predisposition in Type 1 patients that causes beta cell destruction. This is explored further in upcoming chapters. For now we should focus on the basics. <p> <p> ANATOMY AND PHYSIOLOGY INVOLVED IN DIABETES <p> In order to understand the processes that take place when a person has diabetes, it is important to learn about the organs and systems affected. <p> Foremost is the pancreas, which is found in the upper abdomen. It performs both endocrine (secretion of somatostatin, glucagons, and insulin into the bloodstream) and exocrine (release of enzymes in the intestinal tract via the pancreatic duct) functions. <p> During the exocrine function, the pancreas secretes enzymes from the pancreatic duct, which then pass through the connecting bile duct and enter the small intestine through an entrance area called the ampulla of Vater. Near the ampulla is the sphincter of Oddi, which controls the rate at which secretions from the pancreas and gallbladder enter the small intestine through the duodenum. The duodenum is the initial part of the small intestine. <p> The enzymes secreted from the pancreas by the exocrine function are digestive enzymes, rich in protein and filled with electrolytes. They are considered alkaline because they have high contents of sodium bicarbonate. This makes them capable of neutralizing acidic gastric juice as it enters the duodenum. <p> There are several different kinds of exocrine pancreas secretions. One of these is amylase, which aids in the digestion of carbohydrates. Trypsin is responsible for protein digestion. Lipase helps to digest fats. Other enzymes that help break down different food types are also active at this time. <p> Hormones from the gastrointestinal tract influence the secretion of exocrine pancreatic juices. The hormone secretin plays a major role in increasing secretions of bicarbonate from the pancreas. When speaking of digestive enzymes, the CCK-PZ hormone is the working hand. <p> Insulin, glucagon, and somatostatin are hormones that are active in regulating the body's stored enzymes and other substances that control the body's natural functions. The islets of Langerhans, the part of the pancreas involved in endocrine functions, is equally important. The pancreatic cells consist of alpha cells that give off glucagon, beta cells that give off insulin, and delta cells that produce the hormone somatostatin. <p> <p> INSULIN VS. GLUCAGON <p> A primary role of insulin is to decrease blood glucose by allowing glucose to travel to the liver, muscle cells, and other tissues. The glucose is stored as glycogen and is otherwise used for energy. Insulin also allows for fat storage in adipose or fat tissue just as much as it synthesizes proteins in other body tissues. When insulin is low or absent, glucose is unable to move through the cells, and thus it exits the body in urine. Frequent urination is a symptom of diabetes mellitus. In the presence of diabetes, the body compromises and uses stored fats and proteins for energy purposes. This produces a loss of body mass. Glucose levels in the blood usually determine the rate at which insulin is secreted by the pancreas. <p> As opposed to insulin, glucagon's purpose is to reinforce total sugar levels by converting glycogen into glucose in the liver. The pancreas releases glucagon because there is a low blood glucose level. The somatostatin hormone produced by the cells in the pancreas interferes with the pituitary gland's secretion of growth hormone, which influences blood sugar. <p> <i>(Continues...)</i> <p> <p> <!-- copyright notice --> <br></pre> <blockquote><hr noshade size='1'><font size='-2'> Excerpted from <b>Diabetes and You</b> by <b>Naheed Ali</b> Copyright © 2011 by Rowman & Littlefield Publishers, Inc.. Excerpted by permission of ROWMAN & LITTLEFIELD PUBLISHERS, INC.. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.<br>Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.