Science by a Scientist: Diabetes

According to the Statistics Research Department, it is likely that almost 15% of Americans have diabetes—about 95% of these cases are Type 2. Of these, 90% are either overweight (27%), obese (47%), or extremely obese (16%). Clearly, Type 2 diabetes is associated with food intake. Two questions: what causes it, and how is it treated? And is there an alternative? I guess that’s three.

 Cell Biology

First, let’s look at what Type 2 diabetes is. To do this, we need to consider cell biology. Cells use glucose (blood sugar) as their energy source; it’s vital to them. But not all cells were created equal. That is, our nerve cells (including the brain) need it more. After all, without those, the rest of the body would perish. Therefore, they get first access—in fact, if there’s glucose in our blood, it can pass across a nerve’s outer surface into the cell unhindered. The glucose ‘doors’ are always propped open.

In the case of the other cells (skin, kidney, liver, muscle, etc.), glucose can only enter glucose ‘doors’ that have been opened after insulin rings the cellular ‘doorbell.’ If the doorbell isn’t rung, the doors don’t open. That is, if there isn’t any insulin, as happens in diabetes Type 1, the doors don’t open, and that’s a BIG problem requiring treatment with insulin injections. Back to Type 2.

Usually, the pancreas makes insulin in response to rising blood sugar levels. This allows body cells to take up glucose and prevents nerve damage from sugar overload. It’s a finely tuned system that keeps the amount of glucose in the blood steady, resulting in happy nerves and well-nourished body cells.

 Diabetes

However, in our culture, we tend to overindulge in processed foods, delightful treats that contain sugar. The sugar enters the bloodstream directly, causing a rapid increase in glucose levels. The pancreas releases insulin, as it should, but the process doesn’t stop there. Because their doorbells get rung too often, the body cells get fed up and turn the doorbells off. Then, no matter how much insulin the pancreas churns out, the body cells can’t take it up because their doors are never open. And the nerves get damaged by the over-the-top levels of glucose they receive. That’s Type 2 diabetes.

 Treatments

One way to treat Type 2 diabetes is obvious. Stop stressing out the pancreas and nerve cells by bathing them in glucose! The National Health Service in England found that remission of Type 2 diabetes can be achieved through a change in diet. Sometimes easier said than done.

The other treatment is a medication that reduces blood glucose levels: metformin. Although there is still debate about how it works, this drug appears to both prevent the liver from converting stored energy into glucose and force body cells, especially gut and muscle cells, to take up sugar. Thus, blood sugar levels decrease, and the nerves don’t continue to become increasingly damaged. Since neuropathy can lead to all kinds of hurt (blindness, pins and needles, ulcers, the need for amputation, kidney damage, heart problems, and more), that’s extremely important. Note: neuropathy cannot be reversed.

Problems

But, metformin-mediated control of blood sugar isn’t finely tuned. Therefore, when on metformin, if you don’t eat enough carbs, you could become hypoglycemic, lose consciousness, and even die. Ugh. This means that patients who take metformin must eat enough to keep their nerves bathed in adequate levels of glucose. And that causes the pancreas to produce more insulin. And that causes the body cells to turn off even more doorbells. That means the patient needs to take more metformin or upgrade to another medication. Eventually, the poor pancreas wears out and makes less insulin, so that the person has to inject insulin. And then the body cells… Yup. It’s a vicious cycle.

(Note also that metformin has all kinds of potential side effects–check them before you decide!)

 Knowledge is Power

Controlling or changing our food intake isn’t easy. There’s some evidence that health-related motivation helps. Perhaps small, cumulative changes, such as substituting fruit for sugary foods, avoiding processed foods, and limiting eating out, are more manageable. Beyond that, I don’t have the answers—but I do know the science. Now you do, too! And, often, knowledge is power.