Type I Diabetes in plain english

My first memory of diabetes was at about the age of ten while attending a wedding with my family in my native Nigeria. The grown ups at the time were busy enjoying the wedding festivities while me and my cousins spent the entire day running all over the place engaged in a bunch of games, the names of which I can no longer remember. Our intense play sessions got broken up by the adults a bunch of times that day but the play interruption that I can still clearly remember was when we stopped to eat lunch. Like the rest of the children, I got ushered to one of the many tables in the “crockpot” restaurant at the Sheraton in Lagos and started work on the plate of Jollof rice, chicken, and fried plantains placed in front of me by one of the servers. As I attacked my rice dish, I noticed out of the corner of my eye as my aunt Stella pulled out a syringe from her purse. I was puzzled as to why she had a syringe in her purse in the first place… even doubly confusing was why she would need to bring it to a wedding. I sat there completely bemused as she nonchalantly injected herself, completely emptying the contents of the syringe into her bloodstream before she began her meal. In my youthful innocence, I blurted out “Why did you bring that to a wedding Aunt Stella”. She looked over in my direction and said in her usual elegant voice “Agwu agwu (one of my nicknames)… it‘s because I need it for my diabetes”. My super short 10 year old attention span at the time got the better of me before I could follow up with clarifying questions. I wouldn’t really understand what Aunt Stella was doing and why she was doing it until almost two decades later when I developed an interest in the biochemistry of the human body.

The human body in its structure and function is truly a marvel of engineering. Think about it for a second, which other gismo do you know of that is capable of doing so many things so well? To keep this ridiculously complex physical instrument (the human body) running smoothly, there are a number of vital signs that must be maintained and tightly regulated from moment to moment. Your body temperature is a good example of something that must be tightly regulated for you to survive. Your body constantly works to ensure that its temperature remains between 97.8oF (36.5oC) and 99oF (37.2oC) regardless of how high or low the ambient temperature around you is. Among the other vital signs that must be tightly regulated to ensure that you and I keep functioning properly is the amount of sugar we each have in our bloodstream and that my friends is the focal point of this article.

Each time you eat a substantial meal, glucose (commonly known as sugar) is released into the bloodstream. Glucose can serve as a rich source of fuel for the cells of the body provided the glucose molecules can actually gain access to the interior of the cells. The glucose molecules that enter each of our bloodstreams after a meal cannot get inside our bodily cells to fuel them without some help from a hormone called insulin. Having read that last sentence, the following question might currently be bouncing around in your head: “Does that mean I have to take insulin every time I eat?”. The answer to that question is yes, but luckily for most of us, nature has already automated that part of our nutrition. I don’t know about you, but I’d probably be in the group of people that frequently forget to take an insulin shot after each meal if my body didn’t just automatically take care of it. Speaking of which, what is the mechanism through which the body automatically produces insulin when needed?

Enter the Pancreas

Located deep inside each of our abdomens, sandwiched between the stomach and the spine, lies an organ about six inches in length known as the pancreas. Don’t feel bad if you don’t know what a pancreas is… most people don’t know they have a pancreas until it breaks (i.e. malfunctions). Anyway, the pancreas is a strange bodily organ because it has both endocrine and exocrine functions. Endocrine is just a fancy word for “this thing makes and secretes hormones”, while exocrine is just a fancy word for “this thing makes and secretes enzymes”. Most organs only do one of the above, but the pancreas is a weird outlier because it does both.

3d illustration with highlighted pancreas.
3d illustration with highlighted pancreas.

Under normal conditions, your blood sugar system prompts the “beta cells” of the pancreas to secrete insulin in response to a rise in your blood sugar levels after a meal. The insulin secreted by the pancreas acts as sort of a key that unlocks the walls of our cells, granting the glucose molecules from your food access to the interior of your bodily cells where they can serve as fuel. As you can probably tell, this is an extremely important bodily function because I think we can both agree that neither of us can do much of anything without a good source of energy. Thus, making sure our cells can actually absorb and utilize one of the major sources of energy at their disposal is of the utmost importance.
How does insulin work? Insulin regulates the metabolism and is the key that unlocks the cell's glucose channel to let the glucose molecules into a cell
How does insulin work? Insulin regulates the metabolism and is the key that unlocks the cell’s glucose channel to let the glucose molecules into a cell


What happens when the pancreas breaks?

In some individuals, the vital function of controlling blood sugar levels is impaired due to some damage to the pancreas. Although the underlying root cause is still not fully unederstood, current scientific evidence attributes the damage to the beta cells of the pancreas to an autoimmune condition. In plain english, “autoimmune condition” simply means that a person’s immune system is “confused” and mistakenly identifying normal parts of the body as foreign invaders that it needs to destroy. The unfortunate turn of events that ensues when the pancreas sustains an autoimmune attack is as follows: Insulin secreting beta cells get destroyed… no beta cells, no insulin. No insulin = high blood sugar = lots of problems.

Notice that the Beta cells are destroyed in the case of Type I diabetes relative to the normal case.
Notice that the Beta cells are destroyed in the case of Type I diabetes relative to the normal case.

The condition described above in which the beta cells in an individual’s pancreas are decimated by their own immune system is commonly referred to as Type I Diabetes (aka Juvenile Diabetes). According to wikipedia, an estimated 415 million people worldwide had some form of diabetes as of 2015. This represents 8.3% of the adult population, with equal rates in both women and men… surprisingly high in my opinion! Technically speaking, diabetes is a disease in which there is hyperglycemia in a person’s bloodstream for a prolonged period of time. Let’s break the word “hyperglycemia” down into plain english. The word hyperglycemia can be broken down into three parts. “Hyper” which means a lot or too much, “glyco” which means of or pertaining to sugar, and “emia” which denotes that a substance is present in the blood. So Hyperglycemia literally means there is too much (hyper) sugar (glyco) in the blood (emia).

People with type I diabetes must inject insulin several times each day, or have an insulin pump implanted in order to keep their blood sugar levels under control and cope with the mundane demands of everyday life. It turns out that this was exactly what my Aunt Stella was doing with the syringe she pulled out of her purse before her meal at that wedding we both attended almost a lifetime ago. By the way, insulin pumps are actually a pretty cool piece of medical technology… they automatically infuse insulin into the bloodstream at regular intervals based on the needs of the body. It should also be mentioned that diabetics (just like the rest of us) do much better when they closely manage their diet and exercise habits.


Health complications for diabetics

If this is the first time you’ve actually peered beneath the surface of the diabetic condition to really understand it, you might be wondering why having too much sugar in your blood stream is such a big bad deal. Well… let’s talk about it for a minute to explain why.

Diabetes can destroy the kidneys

For those of us that might not know, the kidneys are the bodily organs (yep… we all have two of them) in charge of processing and filtering your urine before it is sent to your bladder for excretion.

As we’ve just learned, diabetes can cause your blood glucose levels to rise and this can have an adverse effect on the kidneys if left untreated. It turns out that high blood glucose levels cause your body to pull fluid from your cells into the bloodstream in an attempt to lower the blood sugar level by diluting the blood. It’s like when you are trying to make a Ribena or Kool-aid drink from the bottle of concentrate… you can’t drink it straight from the bottle because it has too much sugar in it. To compensate for that fact, you simply dilute with water. In a weird analogous way, the body tries to do the same thing when there is too much sugar in your blood.

Although the mechanism of diluting sugar laden blood with fluid from the cells is pretty slick in my opinion, it has its side effects. Let’s break it down. Let’s assume that in response to high blood sugar levels, your body pulls a bunch of fluid from your cells. Your body will interpret the excess fluid in your bloodstream as a sign that you need to urinate so you get the urge and eventually obey it as we all do. Since the fundamental problem (high blood sugar) still exists, your cells will continually be depleted of fluid because the body will keep pulling water from them to compensate for the high blood sugar level. Since your cells are lacking sufficient fluid, your body will make you feel thirsty so that you can drink and replenish the fluids you lost. You will eventually oblige that frequent urge to quench your thirst by drinking a lot of water. When you drink to quench your thirst, your body will pull much of that water into the blood to try to bring down your blood sugar levels still leaving your cells parched. As a result, your “still-thirsty” cells will force you to drink more water, which will make you want to urinate more often… and on, and on. If left unchecked, this vicious cycle can overwork and eventually destroy the kidneys.

Diabetes can destroy the cardiovascular system

Before we dive headfirst into any of this, let’s briefly define what the cardiovascular system is. The “cardio” in cardiovascular is derived from the greek word Kardia which means pertaining to the heart. While the “vascular” in cardiovascular means vessel. So the cardiovascular system in plain english is the system in the body that pertains to the workings of the heart and the blood vessels to which the heart is connected. There are a lot of important systems in the body such as the digestive system and the skeletal system, but the cardiovascular system is of especially critical importance. To put it in the proper context, if a person’s heart stops working for longer than 5 minutes, the various organs within the body will start to shut down as they’ll be starved of the nutrients and raw materials that they need to survive, killing the affected person shortly thereafter.

According to current scientific opinion as I type this, high blood sugar can lead to a list of serious maladies related to the cardiovascular system. Some examples of these would be high blood pressure, heart attack, tissue necrosis, blindness and so on. At the root of all these problems is the damage that high blood sugar levels have on the blood vessels in the human body. Let’s take high blood pressure as an example that we can discuss. You see, your cardiovascular system depends on a very important vasodilator called Nitric oxide (chemical formula: NO). In plain english, the word vasodilator literally means “widener of vessel” so nitric oxide works to widen your blood vessels when needed which is crucial for maintaining normal blood pressure. As it turns out, high blood sugar suppresses nitric oxide in the body which has the net effect of making the vessels much more stiff and narrow. A good analogy to help you understand why this is bad is to think about a garden water hose that we all played around with as children. When you first turn on the water faucet that the garden hose is connected to, the water flows out at a nice and steady pace. If you block part of the orifice at the open end of the hose however, the water squirts out with much more pressure. In an analogous way, that’s what happens when high blood glucose levels make your blood vessels much more narrow and stiff. The heart now has to work super hard to force blood through those same vessels to the rest of your body, which leads to high blood pressure. Also, if the heart has to work that super hard for an extended period of time, it will also probably fail much faster than it otherwise should. This is why diabetic people have an elevated risk of heart attacks and other heart related ailments.

Some of you might have heard of diabetic people who have lost their eyesight, or others who have had to get a toe amputated, this is also as a result of damage to the blood vessels that are responsible for carrying nutrients to the tissues of the eye and toe respectively. If high blood sugar levels eventually lead to damage of those vessels over time, it means those tissues will be deprived of the nutrients that they need to survive. If that carries on for too long, those tissues will die and in the case of a dead toe, it has to get amputated so that the rest of the body doesn’t rot away with it because of some sort of infection.

To conclude, diabetes is a serious condition that can significantly alter the quality of a human being’s life if left untreated. We should all count ourselves truly lucky to live in a time when the effects of type I diabetes can actually be significantly mitigated/controlled by the combination of electronic blood glucose monitoring and the administration of the right doses of synthetic insulin at the right times. It is pretty amazing that we are able to isolate this important hormone and mass produce it so that it is readily available to all. Although there is currently no permanent cure for diabetes, those in the field of stem cell engineering continue to devote a monumental amount of time and resources towards discovering a way to provide a sustainable source of replacement cells for each individual with type I diabetes. This is a lot more difficult than it sounds because remember that the body will reject cells from another human being unless they are somehow genetically matched to the recipient, or the immune system of the recipient is somehow suppressed. Let’s hope we figure that one out relatively soon so that we can abate more suffering from this rather serious condition. From all of us here at chubaoyolu.org, take care of yourselves and each other.

Without Wax
Oyolu B.C. Ph.D.
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