Understanding Diabetes
By Phil Hardin, MD, FACP, FRCP(C)
A specialist in internal medicine and medical director of the West Edmonton Diabetes Centre in Edmonton, Alberta.

This information is provided by Family Health Magazine, a special publication of the Edmonton Journal.

Diabetes mellitus is probably as old as mankind. We certainly know that the ancient Egyptians gave an accurate description of the condition. The name came from the way the Greeks described diabetes 2,500 years ago. Diabetes means a siphon of "running through." Mellitus refers to the sweetness of honey. People with diabetes urinated more often than normal and their urine was found to be sweet. Hence, people with these symptoms were said to have diabetes mellitus.

Today we know more about the condition but the symptoms remain the same. Diabetes mellitus describes a group of disorders that have one feature in common. There is a greater than normal amount of sugar (glucose) in the blood. Six to eight per cent of the population has diabetes (although many do not know it) so there is probably over two million Canadians afflicted.

Reasons the blood sugar is high
Glucose (the main sugar in the blood) is necessary for all cells of the body to function properly. It is the main source of fuel for all cells and the only source of fuel for some. For instance, glucose is the only nutrient the brain can use as fuel. It is not surprising that the body maintains tight control of the glucose level.

Glucose is supplied to the blood stream by the food that we eat and by the liver, which serves as a "factory" to manufacture it. Once in the blood, it can be carried to the tissues to be used by al cells for energy.

Insulin is a hormone that is produced in the pancreas. It is needed for the glucose to enter, and be used by, certain cells of the body (especially muscle). Without the effect of insulin, glucose stays in the blood where it continues to accumulate. The level of glucose can be measured and when it gets too high, the diagnosis of diabetes is made.

The lack of insulin effect can be due to either the absolute lack of insulin in the blood or to a lack of insulin activity at the cell. Lack of insulin means that none is being produced by the body. Diminished, or lower insulin activity at the cell is referred to as "insulin resistance." In this situation the body resists the action of insulin and require greater amounts to do the same job.

Types of diabetes
There are two common types of diabetes mellitus, Type 1 and Type 2. Gestational diabetes, diabetes of pregnancy, is also common but is not being considered here.

Type 1 diabetes, formerly known as insulin-dependent diabetes, is associated with an absolute lack of insulin. Since insulin is essential for life, a person with Type 1 diabetes will not survive without its replacement.

People with Type 2 diabetes produce insulin but not enough to meet their needs. They almost certainly have insulin resistance and require even more insulin which their bodies are unable to produce.

Cause of diabetes

An individual does not become diabetic from eating too much sugar!

The tendency to have diabetes is inherited, meaning a person is born with the gene for the condition. We are not certain which specific factors cause Type 1 diabetes in someone carrying the gene. In certain circumstances, some viruses may be the cause.

In a person with Type 2 diabetes, it is often a high-fat diet or simply being overweight, added to the presence of the gene, that produces the condition.

Symptoms of diabetes
Classical symptoms that occur when the blood glucose is high include tiredness, thirst, increased urination during the day and having to get up at night to urinate with increased frequency. Other possible symptoms include vaginal yeast infections, muscle cramps, a "pins and needles" sensation of the feet, and more. It should be stressed that many people who have diabetes do not have any symptoms and the diagnosis is often made on a blood test during a routine physical exam. It is to these people that learning they have diabetes comes as the biggest surprise.

Treatment of diabetes
Diabetes is dangerous if left untreated. High blood sugars increase the risk of blindness, kidney disease (requiring dialysis or transplant), foot infections and amputations, and other disabilities. We also know diabetes is a major risk factor for heart attacks and strokes.

When diabetes is treated, these complications are much less likely and a person has a better chance at a long, healthy life. We now know that the closer to normal the glucose level is maintained, the less chance there will be of having problems.

The cornerstone of treating diabetes is a healthy diet. A low-fat diet with the proper number of calories is best. It is also much easier for the body to keep the blood glucose controlled if the calories are spread somewhat evenly through the day.

Exercise helps to lower blood sugar during and for several hours after exercise. A program of regular exercise is recommended for anyone with diabetes.

Pills are available to treat Type 2 diabetes when diet and exercise are not sufficient. There pills address the problems of Type 2 diabetes. The "sulfonylurea" drugs ask the body to produce more insulin, if it is capable. The second group, the "biguanides" improve the body's sensitivity to insulin and insulin has an easier time working. The "alpha-glucosidase inhibitors" produce lower blood sugars by controlling delivery of glucose to the blood after eating. Other classes of drugs used elsewhere are not presently available in Canada.

Insulin is required for a person with Type 2 diabetes who is not completely controlled on pills and for everyone with Type 1 diabetes. The only method of delivering insulin to the bloodstream at present is by injection because the stomach would digest the insulin molecule if it were swallowed.

Diabetes now and in the future
Because of research and better understanding we are entering a new era of treating diabetes. New pills are becoming available with novel mechanisms of action. New insulins are available and more will become so. With the new insulins, better delivery devices, and more accurate glucose monitors (blood glucose testing machines), it is easier to keep the blood sugars controlled.

Complications are being found and treated earlier. Drugs are becoming available to prevent complications or stop them from progressing.

Our understanding of both Type 1 and Type 2 diabetes is now to the point that several studies are underway to try to prevent these illnesses. A cure will be next.

This information is provided by Family Health Magazine, a special publication of the Edmonton Journal and distributed by your neighborhood Canadian Safeway Pharmacy.

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