What is Diabetes?

Dear Dr. Deena,
What exactly is Diabetes? Can you please explain what happens in Diabetes in a simple way?
Thanks,

CW

Thanks for your question, CW. Diabetes happens to be one of my special interests, and I am very excited to teach you more about this disease.

The mechanisms by which people develop Diabetes is quite complicated, but I will try to explain it in a very basic way.

Most of us know at least one person who has Diabetes. According to the American Diabetes Association -- in 2012, 29.1 million Americans, or 9.3% of the population had Diabetes. This number is projected to increase every year, which is why it is so important to learn about this disease and what we can do to prevent it!

Diabetes is a medical condition that disrupts the way your body uses glucose. Glucose is often referred to as “sugar” and you may have many friends who refer to Diabetes as a “sugar problem”.  Sounds familiar right?

After you eat, your body breaks down the food you eat into glucose. Glucose is then absorbed into your bloodstream where it is taken up by cells. These cells use glucose as a form of energy to fuel most bodily functions. 

You may have heard of Insulin? Insulin is a hormone that is made by the pancreas.

The pancreas is located in your abdomen, and its main function is to produce insulin and other hormones which balance the levels of glucose in our bodies.

                                                                   
Insulin’s main role is to allow glucose (or sugar) to enter into cells. Without Insulin, glucose cannot enter into the cells.  This results in glucose building up in the blood which is exactly what happens in patients with Diabetes.

See the diagram below -- and picture a cell in your body with a door which leads into the cell. This door always stays locked and only the right key in this keyhole will unlock the door.

To let glucose into the cell, the door to the cell has to be unlocked.  Insulin is the special key that unlocks this door to the cell.

As long as the Insulin key works in the lock…. the door will open. When insulin unlocks the door to the cell, glucose can move from the blood into the cell to provide energy.

              

There are 2 types of Diabetes that exists -- Type 1  and Type 2. Its important to understand the difference, since both types require different medications.

Type 1 Diabetes occurs when the immune system attacks and destroys cells of the pancreas. Since the pancreas is destroyed it can no longer make Insulin.

Type 1 Diabetics cannot make Insulin, and are dependent on Insulin injections to survive. Type 1 Diabetes is most commonly seen in younger people, usually before age 40, but can occasionally be seen in adults. 

Let's go back to how Insulin is like a key which unlocks the door to cells to allow glucose to enter the cells. Since those with Type 1 Diabetes do not make insulin, there is no key to allow glucose to enter into the cells (the doors of the cell stay locked because there is no key).

As a result the level of glucose in the blood grows higher which leads to Diabetes.  Patients with Type 1 Diabetes have high levels of glucose and low levels of insulin.

Type 2 Diabetes is the most common type of Diabetes.

 In Type 2 Diabetes – patients are able to make insulin but the body does not respond to insulin in a normal way.

 In T2DM, cells that take up  glucose are “ resistant” to the effects of insulin, therefore glucose is less able to enter cells even when Insulin is present. When glucose cannot enter into cells – there is a rise in the glucose levels in the blood. This rise in glucose stimulates the pancreas to make even more Insulin.

To better visualize this- - lets once again envision Insulin as a key. Insulin is a key to the cell’s door which allows glucose to enter into cells. In Type 2 Diabetes the key to the door (Insulin) isn’t always working very well, and the door remains locked.

While the door remains locked…the glucose levels increase in the blood. The pancreas sees this, and makes even more keys (Insulin) with the hope that one of the keys will work to unlock the cell doors.

Eventually one of the keys is able to unlock the door and some glucose (but not all glucose) can enter into the cell. This why Type 2 Diabetics have high levels of glucose AND high levels of Insulin. 

Type 2 Diabetics can be trialed on oral medications to help treat their Diabetes since they make Insulin; however, majority of Type 2 Diabetics will require Insulin over time if their Diabetes is poorly controlled.

I hope that paints a clearer picture of what Diabetes is and the different types of Diabetes that exists!

Feel free to leave comments below, and please email me at DoctorDeenaMD@gmail.com with any further questions.