Diabetes Basics
What is "diabetes"?
Diabetes is a disease that means the blood sugar levels in the blood are too high. And the reason that's important is because all of us need some blood sugar in our blood; that's how your brain gets fuel, gets energy. Sugar is necessary. It's energy. But in diabetes, what happens is the blood sugar levels go way too high. And that means two things for a person with diabetes: one is the body doesn't get enough energy, and second of all, it means that that high blood sugar level caused by diabetes starts causing damage, and over time it damages the eyes, the kidneys, the nerves, and can cause really serious complications. Treating diabetes means lowering the blood sugar levels and then keeping them normal forever.
What is the difference between "type 1" and "type 2" diabetes?
There are two kinds of diabetes and it's very important that people know what kind they have if they have diabetes, and even what kind of diabetes they are at risk of getting. Type 1 is the least common kind and we used to call type 1 diabetes 'juvenile onset diabetes' because we only thought kids got it. However, in my practice, I've seen people as old as 94 years get type 1 diabetes, because what type 1 diabetes means is that there is an abnormal response in the body. The body makes what we call antibodies (the infection-fighting cells), that destroy the Beta cells (the insulin-creating cells) in the pancreas so the body stops making insulin. When you have type 1 diabetes, you must take insulin injections for the rest of your life. That's what type 1 diabetes means; not making enough insulin, meaning the body can't use the sugar that's in your blood. Type 2 diabetes is by far the most common kind. It's a world-wide epidemic. It is really one of the most serious diseases of our time. In many cases type 2 diabetes occurs in people who have a family history of diabetes, and it also occurs because many people develop it as they gain weight and become sedentary. We used to call it 'adult onset diabetes' because we thought that older people got it, but the oldest case I know of adult onset diabetes is in a two-year-old. So, we know that age doesn't really matter. What matters, in many cases, is one's habits; one's health habits. That is, whether one keeps fit and active and takes care of themselves, or over time becomes heavier, less active, and then develops type 2 diabetes.
Can a person have both type 1 and type 2 diabetes?
It turns out that you can have both 1 and type 2 diabetes. In order to understand this, though, you actually have to understand a little bit more about type 2 diabetes, because type 2 diabetes is probably an adaptation for survival. It probably is a set of genes that helped our ancestors to survive famine, because back in the old days we didn't have food everywhere. We went through periods of eating and then fasting: literally not having food for weeks. Therefore we needed to store fat very efficiently. The place that our bodies store fat the best is right in the centre, and that's called central obesity. That storage form of fat is right there, right next to your liver, your pancreas and your stomach, and it's great. It immediately can put sugar back into your blood if you're starving. However, if you're living in a society, like our modern societies, where food isn't an issue for most people (not everybody, but for most) that central fat just grows and grows, and now instead of becoming a good thing it becomes a bad thing. All that fat by your liver causes it to make abnormal cholesterol particles and causes it to become inflamed; all these things start happening that cause diabetes but also the risk for heart attack and stroke. So people with type 2 diabetes and central obesity, and that's most people with type 2 diabetes, have a risk for heart attack and stroke. So, you can have type 1 diabetes, meaning your pancreas doesn't work anymore because it was attacked by antibodies, and you can come from a family where, say, your mother or father had type 2 diabetes; you can have central fat, high blood pressure, abnormal cholesterol levels and it means you have both type 1 and type 2 in a way. However, what's really important is not the names 'type 1' and 'type 2', but that if people have central fat, they need to be extra careful to avoid having heart attacks and strokes.
What causes type 1 diabetes?
Type 1 diabetes is probably caused by something genetic, meaning there's something in one's background that makes one at risk. We're looking for the kinds of genes that cause Type 1 diabetes. But then something has to happen that triggers the autoimmune response. So we think it's a chemical, we think it's in the environment, but we don't know what. But we know that, for instance, you can have an identical twin with the same genes you do and not everyone is going to get Type 1 diabetes. Less than half will end up getting Type 1, because it's some environmental trigger.
What causes type 2 diabetes?
Type 2 diabetes is a set of genes that are present in the wrong environment. So 50 years ago, we weren't having an epidemic of Type 2 diabetes and yet 50 years ago, we had the same genes. So what's happened in the past 50 years? Well, food is incredibly abundant. Not only food overall but refined food. So we have all this excess of things that have white flour and white sugar and everything else that gets absorbed in our bodies very quickly and our bodies don't know how to deal with. The second thing is we are not exercising. It is not just that we are not exercising in our leisure time. In fact, leisure time activity has not changed that much but what we are not doing is exercising at work. Most of us when we go to work just sit at a computer or sit at a desk. Compare that to the turn of the century 100 years ago when people were very active in their jobs. So, we decreased exercise and we've increased caloric intake, so people are becoming more resistent to insulin and that starts to lead to Type 2 diabetes in people who are at risk. Now, let me point out that not everyone is going to get Type 2 diabetes. You can get really fat and not get Type 2 diabetes unless you are genetically prone to get it.
Who is most likely to get type 2 diabetes?
People who are the most genetically prone to get type 2 diabetes are African Americans, Latinos, Asians, and Native Americans. There's a fairly large list, but the most important thing is to know your family history. I see lots of Eastern Europeans who have type 2 diabetes that runs in their family. So, if you have anybody in your family that has diabetes of any type, that means that you're at risk for getting it yourself. The other thing, though, that I think is incredibly important is that we can prevent type 2 diabetes if it's picked up early. So, anybody who has a child with a risk for type 2 diabetes, anyone with a history of type 2 diabetes in themselves, needs to look at their kids. What we're seeing now is that parents who have diabetes are passing it to their children, and their children are getting it at younger and younger ages. So, I look at this as a family disease, and everybody in the family needs to be involved in having a healthier lifestyle, eating better, and basically preventing type 2 diabetes from happening.
How is food used by the body and what is "glucose"?
When you look at food, there are three different types that we commonly consume. We consume carbohydrates, fat and protein. Carbohydrates become sugar in the body. Carbohydrates are starches. They're simple sugars. It's honey. It's an apple. It's a piece of bread. It's anything white, more or less, but it really is a lot of the different kinds of food that we eat. When you eat carbohydrate it goes into your bloodstream and it gives you energy. It gives you energy to run a race. It helps you learn, think and read or do mathematical equations. It's the body's fuel. Without glucose, without the ability to have glucose in your blood, you would die. It is vital to life. Fat on the other hand, is a stored form of fuel. In essence, both fat and protein can be broken down into sugar. So, sugar is what we all need to exist, to live our lives, and to have energy. Our bodies are very clever about sugar. For instance, say you decide, “I'm not going to eat any sugar.” If you don't have diabetes and you're normal, what would happen is your body would start making sugar. You can make sugar from your liver. You can bring up sugar from your muscles. You can break down stored glucose, for instance, glycogen that's in the muscles or in the liver. Your body has an incredible ability to maintain normal sugar levels so that we exist.
What happens to my body after prolonged exposure to a high blood sugar level?
High blood sugar levels are very, very toxic to the body, but before I use words like 'high,' I want to define 'high'. So a normal blood sugar, I say, is a hundred. It's an easy number to remember. There's a range around a hundred but most of us, most of the time, have blood sugar levels around a hundred, and that's what you expect. That's what you want. When you have diabetes, your blood sugar levels can be two hundred, three hundred, four hundred; very high. When your blood sugar levels get to be above three hundred you feel very thirsty, dehydrated, you start urinating a lot, your eyes may get blurry, and you don't feel right. High blood sugar levels, say they go up high to three or four hundred, will make you feel sick. The problem, though, is that most of the time people who are getting diabetes have blood sugar levels that are around two hundred and they don't feel sick. In fact, most people have diabetes for five to seven years before they're diagnosed. So, many people are wandering around who have diabetes and don't even know it because they have no symptoms. That blood sugar of two hundred, though, is causing damage. It's damaging the back of the eyes, the nerves, the kidneys, and the heart. All of that is susceptible to this damage from the sugar. We don't exactly know why and how sugar damages these vital organs but we know it does, and we know that lowering blood sugar levels to normal takes away the risk for those complications.
Does type 1 diabetes only occur in childhood?
Type 1 diabetes means that the body's immune system has attacked the insulin producing cells in the pancreas, called the beta cells, and basically rendered them killed; they're destroyed. We used to think that type 1 diabetes just happened in children, but we now know that it happens at any age. We've seen babies as young as just a couple weeks old getting type 1 diabetes, and my oldest patient with type 1 diabetes is 94 years old, so it really fits across the age spectrums. Type 1 diabetes is still probably more common in childhood, but certainly anyone, at any age, can develop type 1 diabetes.
Is one type of diabetes worse than the other?
Diabetes is a very serious disease, and contrary to what many, many people come to me saying, there is no such thing as a "little diabetes." Diabetes is diabetes is diabetes. It is deadly, and if you don't treat it, it is like cancer. Trust me, I have seen people die from it in their 20s and 30s. I've seen blindness, amputation. I have seen horrible things from diabetes; things that I don't even want to remember. So, untreated diabetes is very bad. I don't think that there is any bad or worse between type 1 and type 2, and I specifically think that if you treat diabetes, you can avoid most of the complications. Therefore, I look at it from a more positive perspective. This is a treatable disease. It isn't cancer. It is not invariably fatal, and both types are equally treatable. So I don't think one is worse than the other, but I think ignoring it is the worst thing of all.
