The New Glucose Revolution for Diabetes

In fact, the range of feelings many people experience when first diagnosed are not dissimilar to those of grieving. In a way, a diagnosis of diabetes represents the loss of your healthy whole self. Your initial reaction may be “not me” denial or “why me?” anger. You may even try bargaining, perhaps with the “Almighty.” You may experience a period of depression. Hopefully, finally will come acceptance that you have diabetes, that life will be different, but you can manage it successfully, and life will go on.

Whatever your reaction to the diagnosis, your feelings are perfectly natural. You are not alone. If it is any consolation, the pain you are feeling now may help you manage your health positively in the years to come. Having diabetes need not stop you from enjoying life to the full and achieving whatever you want from life.

According to research from the Diabetes Information Jigsaw, “depression greatly reduces the ability of people with diabetes to manage their condition, which can result in poorer management of blood glucose levels and difficulty in sticking to exercise, diet and treatment programs.” The most important thing you can do is take control of the things in your life you can change and get informed about your body and what is happening to it. Knowing what you need to do to manage diabetes will allow you to live well and lessen the impact of this disease.

To understand why diet and lifestyle are so important in managing diabetes successfully, it is useful to know about how your body normally handles the nutrients in the food you eat, and how (and why) disturbances to its metabolism can affect your overall health.

Your body needs protein to build and maintain tissues, good fats to function and thrive, and carbohydrates as an energy source. It is important to understand carbohydrate’s role. When you eat carbohydrate foods such as bread, cereals and fruit, your body converts them into a sugar called glucose. It is this glucose that is absorbed from your intestine and becomes the fuel that circulates in your bloodstream.

Glucose is a universal fuel for your body cells, the primary fuel source for the brain, red blood cells and a growing fetus, and the main source of energy during strenuous exercise.

In a healthy person, when glucose levels in the blood rise after a meal, the beta cells in the pancreas get the message to secrete a hormone called insulin. Insulin drives glucose out of the blood and into the cells. Once inside the cells, glucose is channeled into various pathways—to be used as an immediate source of energy, or converted to glycogen (a storage form of glucose) or to fat. Insulin has been likened to the key that opens the cell door to let the glucose inside.

Sometimes glucose builds up in the blood. There are two reasons for this. Either the pancreas can’t produce enough insulin on demand (some or all of the keys are missing) or the cells do not respond to the insulin in the blood the way they should (the locks are malfunctioning).

“Insulin deficiency” is when the pancreas does not produce enough insulin to reduce blood glucose levels; “insulin resistance” is when the insulin can’t do its job properly. Both these conditions lead to glucose accumulating in the bloodstream and to high blood glucose levels. Depending on how high the levels of glucose are, the condition is classified as:

How active you are and how much you weigh have a very important effect on your metabolism, especially on the way your body handles carbohydrates. Being overweight or obese is a very common cause of insulin resistance, and losing a little weight is a powerful way of reducing insulin resistance. Exercise and improving your physical strength are also good ways of reducing insulin resistance.

Type 1 diabetes is an autoimmune disease and is one of the most common childhood diseases. Rates are increasing throughout the world, and no one knows exactly why. Certain environmental triggers have been proposed as possible contributors.

About 10 percent of people with diabetes have type 1. In this type of diabetes, the pancreas does not produce any insulin, so you need insulin injections. Maintaining a balanced blood glucose level (BGL) requires regulating your food intake, your insulin dose and your exercise.

Formerly called juvenile diabetes or insulin-dependent diabetes, type 1 diabetes is usually first diagnosed in children, teenagers or young adults. At the moment, half of all people with type 1 diabetes are diagnosed before the age of 16. Within this group there are two peaks in the age of onset: the major peak at 10-12 years and a smaller one at 5-6 years. For some reason, type 1 diabetes is more commonly diagnosed in the winter months.

The risk of someone developing type 1 diabetes if no one in the family has it is around 1 in 200. If there is a family history, the chances of developing it are much higher: about 1 in 17 if you have a brother or sister under the age of 30 who has it, and about 1 in 3 if your identical twin has it. Children whose mothers have type 1 diabetes have about a 1 in 75 chance of developing the condition; children whose fathers have it have a much higher chance—1 in 16.

Where you live also seems to affect your chances of developing the disease. Children in Finland have the greatest risk (37 per 100,000), whereas children in Fiji have a very low chance (1 per 1 million). Overall, boys and girls have the same degree of risk.

In chapters 30-34 we look at managing type 1 diabetes.

Eighty-five to ninety percent of people with diabetes have type 2 diabetes. Usually, type 2 diabetes develops after the age of 40. With our society’s increasing trend to physical inactivity and obesity, however, this type of diabetes is being found in younger and younger people, and in some indigenous populations, even in children less than 10 years old. Overeating, being overweight and not exercising enough are important factors (what we call lifestyle factors) that can lead to this type of diabetes, especially in a family where someone already has diabetes.

People get type 2 diabetes because their insulin is not working properly (insulin resistance, when the locks are malfunctioning). For a long time the body will struggle to make extra insulin to overcome the problem, but eventually people with type 2 diabetes develop a shortage of insulin (the keys get lost). The aim of treatment is to help people with type 2 diabetes make the best use of the insulin they have and make it last as long as possible. Pills or insulin injections may be necessary.

Being diagnosed with type 2 diabetes can be a shock. However, if current estimates are anything to go by, you shouldn’t feel that you have been singled out. There are around 246 million people with diabetes worldwide; this number is expected to reach 380 million, or 7 percent of the adult population, by 2025. A recent Canadian study found that the rate of diabetes among people 20-50 years old has increased almost 100 percent in the last ten years—and it’s still on the rise.Right now in America there are nearly 21 million people with diabetes—almost 10 percent of the population. Makes it sound pretty common, doesn’t it?

In fact, scientists are predicting that 1 out of every 3 people born in the United States during the year 2000 will develop type 2 diabetes.

The cost of having type 2 diabetes to you as an individual and our community as a whole is enormous. The American Diabetes Association in 2002 found that total healthcare cost for people with type 2 diabetes who had no complications was over $13,000 for each person, each year. One out of every $10 spent on health care in the United States goes toward diabetes The total annual healthcare cost for diabetes and its complications is $92 billion—10% of the money spent on health care in the United States. The real challenge will be to fund and develop medical and public health programs that will help people manage their condition and prevent its complications.

The other scary thought is that for every person with diagnosed diabetes, there is someone else walking around with the conditiondoesn’t know it. In fact, many people have type 2 diabetes for several years before it is picked up—often during a routine medical exam, or after a major event like a heart attack or stroke. Regular health checks and screening by your doctor are a good idea after the age of 45, particularly if you have a close relative with the condition.

We know that the number of people with type 2 diabetes is increasing dramatically. Why? Mostly, it’s a combination of unlucky genetics, increasing rates of overweight and obesity, and other lifestyle factors, particularly decreasing levels of physical activity. People from certain ethnic backgrounds and age groups are at greatest risk. Also, many people who develop type 2 diabetes have had impaired glucose tolerance or impaired fasting glucose (both are early signs of imminent diabetes) for many years.

Insulin resistance, which occurs without your even knowing it, is thought to be an underlying cause of type 2 diabetes. With insulin resistance, your muscle and liver cells are not good at taking up glucose from the blood, unless there’s a truckload of insulin around. This makes the beta cells in your pancreas work overtime to produce extra insulin so that your muscle cells get enough glucose for making energy. Once your beta cells are unable to produce enough insulin to overcome the resistance, you get high blood glucose levels . . . and along with that, the diagnosis of diabetes.

Many factors are being identified as contributing to this failure of the beta cells, and it is believed to be at least partially genetically preprogrammed. This is why type 2 diabetes is more common among certain groups: African Americans, Hispanic Americans, Native Americans Aboriginal Australians or Torres Strait Islanders, Maoris, Pacific Islanders, Southeast Asians and Asian Indians. People from an Anglo-Celtic background, on the other hand, appear to be less susceptible.

However, genes alone do not account for the increasing diabetes rates. Environmental factors such as reduced activity and a high-calorie diet have led to increased rates of overweight and obesity. Not surprisingly, around 80 percent of all people with type 2 diabetes are either overweight or obese.