Diabetes – What is it and how does it work?

In a nutshell, Diabetes is a basically under-performance of parts of the pancreas. The pancreas is a gland that sits behind the stomach and it does many things, including making a protein called insulin.

Insulin’s job is to take the sugar that the bloodstream has absorbed from the intestines, and make sure this sugar is carried to all the cells of the body.

Think of all the cells that make up your body as little tiny “engines”.

Like your car engine, the cells need fuel.

That fuel is sugar, more accurately referred to as glucose. In foods, sugar may be called sucrose or fructose, but these sugars are all ultimately converted to glucose. Hence, insulin’s role is to “pump the fuel/glucose into the body’s cellular engines”.

The pancreatic cells that produce insulin are like little islands within the pancreas. In fact, they are called the islets of Langerhans, named after – you guessed it, Dr. Langerhans!

So to recap, the islets of Langerhans in the pancreas normally make insulin, which pumps the glucose that is floating in the bloodstream, into the cells of the body where it provides energy to the cells and is “burned”, much like a car burns fuel to go, go, go!

Diabetics have high blood sugars

So after this brief course in the pancreas, its islets of Langerhans, insulin, and glucose – how does this all relate to diabetes?

Well, like I said earlier, diabetes means that the pancreas, specifically the cells that are supposed to make insulin, are under-performers. That is, the islets of Langerhans are not able to produce enough insulin to pump blood sugar into the cells. Hence, the blood sugar builds up in the bloodstream, and the cells are not getting enough glucose pumped into them, which makes them unhappy.

This is why diabetics have high blood sugars. They just don’t make enough insulin to pump the glucose into the cells, and so when we measure the amount of glucose floating around aimlessly in the bloodstream, it is elevated, and can actually harm many of the vital organs of the body, such as the kidneys, eyes, some nerves, and heart.

The food you eat will affect your blood sugars

When this situation gets more severe, insulin may need to be administered to make up for their natural lack of insulin. But there are many types of other medicines to treat diabetes and they basically all try to “kick start” the islets of Langerhans in the pancreas to crank out insulin.

These medicines are generally taken by mouth, although some of the newer medicines are injected under the skin, either daily or weekly. The degree of success of these medicines varies tremendously with the type of diabetes and the extent of their under-performing pancreases.

Type 1 Diabetes

For instance, Type 1 diabetics, also commonly referred to as “juvenile-onset diabetics” usually starts in childhood. In type 1 diabetes, the islets of Langerhans are almost inactive, and hence produce virtually no insulin, and don’t react to being “jump started”.

Therefore, type 1 diabetics usually require insulin injections or an insulin pump to get enough insulin to grab the blood sugar from the bloodstream and place it inside the cells.

Type 2 Diabetes

In type 2 diabetics, commonly referred to as “adult-onset” diabetics because this type of diabetes usually starts in adulthood, the pancreas usually doesn’t underperform as much as in type 1 diabetes. Hence type 1 diabetes generally tends to be more challenging to treat than type 2 diabetics, who may not need insulin until later in life if ever.

Sometimes in type 2 diabetics, the pancreatic islets of Langerhans have been “jump started” so many times, that they essentially “burn out” and stop producing insulin. At this point, a type 2 diabetic may need insulin, although a cross over period may occur when both oral medications and insulin are necessary.

In all diabetics, it important to avoid eating sugar of any kind (sucrose, fructose) and to also minimize eating “alcohol sugars” such as Xylitol, which if consumed in large quantities can act as a laxative and cause diarrhea. Sugar substitutes such as Splenda, Equal, Truvia and Nutrasweet may used in place of sugar as well, and although generally felt to be safe, should be used in moderation.

For more information and treatment advice on how to manage your diabetes, see your physician or schedule a confidential video-consultation on www.guhamd.com to speak with a highly trained US physician.

Dr. Guha
Medical Director

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