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Diabetes is a disease of glucose disposal from the blood stream to the organs and tissues in the body. Glucose comes primarily from the diet, but is also produced in the liver to augment dietary input. Once the glucose is in the blood stream, it must be able to exit the circulation to the tissues.

The vehicle for allowing glucose to move from the blood stream (intravascular area) to the tissues (extravascular area) is a chemical secreted by the pancreas. If an insufficient amount of insulin is secreted or inhibited from entering the blood stream once secreted, then an excess of glucose remains in the blood stream.

Depending on the amount of retained blood sugar it will cause mild symptoms of increased urination, fatigue, mild blurred eyesight and weight loss to passing out and falling or being confused and disoriented. Continued high concentrations of glucose will cause target organ damage (eyes, heart, brain, kidneys, etc) and lead to early heart disease, renal failure, and stroke and death.

There are several (3 main) types of diabetes. Insulin dependent (Type I) comes from the pancreas not making any insulin. This could be due to a virus or inherited issues. These patients require lifetime insulin injections. (Insulin is a protein so if taken by mouth the digestive system will degrade it and it will be ineffective.) It must be inhaled or injected to bypass the digestive system. A subtype of Type 1 is caused by a virus leaving the patient without the ability to produce insulin. Type II diabetes is slow deterioration of the pancreas to produce insulin, whereby needing treatment to stimulate the pancreas to make insulin or to cause insulin to be produced by another mechanism, and/or decreasing the liver’s input of glucose.

There is a hereditary component to diabetes and an acquired component. If a first line relative has early onset diabetes type II, or insulin dependent diabetes, then your risk of getting diabetes increases. If you are overweight, such that insulin is produced and inhibited from getting to the blood stream (to transport the glucose from the blood stream to the tissues) you will soon “burn out” the pancreas and insufficient insulin will be produced. Each leaves residual glucose in the blood stream.

Residual glucose in the blood stream is harmful to the vessels that carry blood and the target organs that receive the high glucose blood. (Eyes, kidneys, heart and brain, etc.)

Diabetes is similar to running salt water in a steel pipe and not expecting it to rust. Given sufficient salt water concentrations over time it is not will the pipe rust, but how early.

Treatment of diabetes is multifaceted. First, and continuously, is the dietary intake of carbohydrates that turn to sugar, balanced with fat, and protein to achieve a balanced and steady glucose input needed to run the body.

Most diabetics of any type will need to initially learn what foods are proteins, carbohydrates, and fats. With practice and coaching, this is a task that is easy to accomplish.

Augmenting diet in a Type II dietetic are various oral medications that can regulate the output of glucose from the liver and production of insulin. Eventually, most Type II diabetics will need insulin as the pancreas tends to continue its “burn out” state over time. This depends on the rate of “burn out” and the age you are when it starts (50 years old vs 80).

Diagnosis is reasonably straightforward. Your annual labs will have a fasting glucose level. If it is elevated then further testing can determine how long and how high (Hemoglobin A1C) the glucose has been over time. The normal fasting blood sugar should be under 90 and Hemoglobin A1C should be under 6 mg %.

Frequent testing, diet, and often medications can decrease the damage over time.

W. Lane Edwards, Jr., MSN, APRN, ANP. (retired)


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