Diabetes

DIABETES

 

            I have decided to write about the greatest health threat to Americans because I feel that understanding the disease may help people avoid and battle it.  Diabetes is characterized by elevated blood glucose, elevated blood pressure and an increased urine production. There is a cause and effect physiological response in which elevated blood glucose causes the body to retain more water.  The increased amount of water held by the body increases the blood volume…and the more blood in the space we call the circulatory system (arteries, veins and capillaries) increases the tendency for the kidneys to produce more urine in an attempt to reduce the body’s fluid holdings.  We all recognize the need to urinate after we ingest fluids.  Fluids which contain caffeine or alcohol increase the production of urine.

            Normally, physiological mechanisms adjust glucose levels at about 100 mg/100 ml (90-110 mg/ml).  These physiological mechanisms revolve largely around two hormones, insulin and glucagon.  Both of these hormones are secreted by the pancreas, an organ sandwiched between loops of the small intestine.  Insulin is released after a meal as glucose is absorbed into the bloodstream from the gut after digestion of food.  The more glucose presented to the pancreas, the more insulin is released.  The insulin in turn encourages cells to uptake glucose.  Without insulin, cells incur difficulty taking up glucose and blood glucose rises and that drink that you take is retained rather than eliminated as urine.  Glucagon on the other hand encourages the release of glucose from storage depots, mostly the liver and muscles in order to get the body through those periods between meals. Physical activity modifies the release of these hormones. 

            Diabetes mellitus is described as Type I and Type II.  Type I diabetes is characterized by a reduction of insulin secretion by the pancreas. It has been called juvenile diabetes because it often appears in childhood.  However, I know of individuals who did not develop Type I Diabetes until their thirties.  It is an inherited disease which predisposes individuals to destruction of the specific cells in the pancreas responsible for the secretion of insulin, upon infection with a still-unknown virus.  Therefore, it is classified as an autoimmune disease in which the body’s immune system mistakenly attacks its own tissues.  Though the specific attack mode is ill-understood, it is believed that the invader (virus) has features which resemble the pancreatic cells responsible for insulin production.  As the body mounts a defense against the invading virus, it inadvertently attacks the pancreatic cells mistaking them for viruses.  The pancreatic cells are destroyed in an attempt by the immune system to eradicate the virus, thus eliminating the source of insulin, causing blood glucose to rise and all the related effects. Again, to summarize…a person must inherit a defective gene from each parent and become exposed to a yet-unidentified virus resulting in destruction of specific cells in the pancreas. This is Type I diabetes mellitus and is often referred to as insulin-dependent diabetes. 

            The treatment for Type I diabetes is insulin injections.  The person must develop an ability to not only monitor his/her diet but also blood glucose (sugar).  Many can predict if their blood sugar is high or low by regulating the carbohydrates in their diet and the appropriate insulin injections.  Most rely on regular finger pricks to determine their exact blood glucose so that they may adjust their insulin injections.  Some people have implanted devices which monitor their blood glucose and provide appropriate amounts of insulin. 

            Type II diabetes mellitus is also an inherited trait with conditions.  Just as type I is inherited but requires an individual to become exposed to a virus, type II is inherited but is largely affected by body weight.  Type II was called senile diabetes in the mid-20^th century because it almost invariably affected older people.  It was deduced that older people gradually became obese as they became less active (still eating as if they were active twentysomethings)…but with a fraction of the activity of their youth.  As we age, there seems to be a natural inclination to gain weight (though I know of many exceptions) and it appears that in the obese individual, insulin does not have the same effect on blood glucose as it does in the non-obese. Consequently, Type II Diabetes is often referred to as insulin-independent diabetes.  The principle remedy for type II diabetes is simple…lose weight.

            Americans have become increasingly fat.  What was called senile diabetes because it was only seen in the aged has now become an increasingly common diagnosis in primary school children.

            John F. Kennedy experienced the Sputnik crisis…and responded in kind by directing a space program that landed a human on the moon in less than a decade.  He and his family also were very physically active (touch football, skiing, water sports,etc.) and instituted a program in public schools which mandated a required daily session of physical activity.  (I lived through that period and though I loved school, lived for that hour of dodge ball, basketball, soccer, etc.)                                         

            Cells require insulin to absorb glucose from the bloodstream with some notable exceptions…the brain…and muscles.  For type II diabetics, the best way to adjust blood glucose is to maintain an active exercise regimen.  During exercise, muscles suck up glucose without the need for insulin, thus lowering blood glucose levels, blood pressure and all the concomitant consequences such as blood vessel hardening, eye and kidney damage, infections as well as increased risks of heart attacks and strokes.  Obviously, the limitations presented by advanced diabetes type II often prevent individuals from exercise and they must rely upon diet.  Calories are calories, regardless of when they are eaten or what foods they are contained within.  The calories you take in are exactly the same as the calories you expend…if you’re weight remains the same.  If your weight increases, then you have consumed more calories than you have expended.  If your weight decreases, then you have consumed fewer calories than you have expended.  It is that simple.  It isn’t about whether the calories are carbohydrates, fats or proteins.  It is simply total calories.  If you intend to lose weight, you must count calories.  There are calorie counters which will tell you exactly how many calories are in the next forkful.   There are also calories counters which can detail how many calories are expended in particular activities…from sleep to strenuous exercise.  Keep a diary and find out where you can improve…by diminishing your caloric input…or increasing your caloric output.  If you are true to this method and adhere to the math, you’ll lose weight.

            There are so many children who are obese that health officials predict America will see a dramatic increase in the present epidemic of diabetes II-related illnesses within twenty years if not sooner.  America can not afford a generation lost to diabetes. Instituting a Kennedy-esque, compulsory physical fitness regime in American schools will have a telling effect on the future diabetes crisis.  In addition, physical activity increases brain activity and should have a positive effect on learning.  I think it is not coincidental that as compulsory physical activities have been replaced by computer laboratories, obesity has increased.  The neurological rush of scoring a basket or winning a race has been replaced by a video game.  That’s not right.