Diabetes type II in plain english

DiabetesThe human body in its structure and function is a marvel of engineering. It’s dexterity and adaptability are more or less unrivaled throughout the annals of time. In order for the human body to keep running smoothly, there are a number of vital signs that must be maintained and tightly regulated from moment to moment. A good example of one of these vital signs is your body temperature. Believe it or not, there are processes within your body that constantly work 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 a major theme of this article.

As mentioned in a previous article related to this topic, glucose (commonly known as sugar) is released into your bloodstream each time you eat. This is a good thing because glucose is a rich source of fuel for the cells that make up our bodies. That being said, glucose molecules have to find a way to get into the interior of our cells in order to actually serve as fuel. A hormone called insulin plays a critically important role in granting glucose molecules access to a cell’s interior. Having read that last sentence, you might be wondering if you have to take insulin after every meal. The answer to that question is a resounding yes and nature in her infinite wisdom, automated that process for a lot of us. So even though you don’t have to think about it, your body secretes insulin after each meal to help with the absorption of sugar/glucose provided your blood sugar system is in good shape. Thank goodness for mother nature because a lot of us would probably forget to take insulin after each meal and suffer the consequences (degenerating eyesight, kidney malfunction, etc). Speaking of which, how does the body automatically produce insulin when needed?


Enter the Pancreas

3d illustration with highlighted pancreas.
3d illustration with highlighted 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… even Steve Jobs didn’t know he had a pancreas until he contracted pancreatic cancer. 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.

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 each meal. Insulin acts as sort of a key that unlocks the walls of our cells, granting the glucose molecules from your food access so they can serve as fuel. As you can probably tell, this is an extremely important bodily function because I think we can agree that both of us would be pretty much useless 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 causes diabetes?

Notice that under normal conditions, roughly two major things are required for effective blood sugar regulation to take place. First, your pancreas has to actually produce insulin in response to an increase in blood sugar after you consume a meal. Second, your bodily cells have to actually respond to the insulin produced by opening up parts of their cell walls to let glucose in. In the form of diabetes known as “type I diabetes”, the problem arises because the beta cells in the pancreas are damaged which has the subsequent effect of hindering insulin secretion. In type II diabetes (which is the focal point of this article), the malady arises because the cells of the body have become resistant to insulin. So in most type II diabetes cases, the pancreas produces insulin no problem… it’s just that the cells of the body “ignore” insulin which has the net effect of keeping glucose molecules in the bloodstream. In response to this, the pancreas may try to produce even higher doses of insulin to overcome the insulin resistance and that might work for a while. Over time however, the pancreas usually can’t keep up with this increased demand for insulin and this leads to dangerously high levels of sugar in the blood.

Illustration depicting the difference between the types of diabetes. In type I, there is a lack of insulin. In type II, there is sufficient insulin, but the cells are resistant to it.
Illustration depicting the difference between the types of diabetes. In type I, there is a lack of insulin. In type II, there is sufficient insulin, but the cells are resistant to it.

No matter how you slice it though, diabetes (both type I and type II) results in the same outcome – hyperglycemia. In plain english, we can break down the word hyperglycemia 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).

Type II diabetes

OK so why on earth would our bodily cells ever get resistant to something as important as insulin as is the case in individuals with type II diabetes? Well the blunt truth as my fingers fly around the keyboard typing this (in 2016), is we still don’t exactly know why this is the case. Our current level of scientific understanding hasn’t yet found a figurative “smoking gun” that we can point to as the reason why the cells of the body develop insulin resistance in type II diabetes.

Although we don’t exactly know why folks with type II diabetes develop insulin resistance, we can make intelligent speculations as to why this would occur especially if we take the risk factors for type II diabetes into account. For those of us who don’t have a medical or science background, a “risk factor” is just the technical term for attributes or habits that put you at an elevated risk of contracting a disease. So an example of this would be that being a heavy smoker is a risk factor for lung cancer. On that note, let’s enumerate some of the risk factors for type II diabetes.

  • Excess Weight
  • Some factions of the scientific community believe obesity is a primary cause of insulin resistance. In the past, scientists used to think that the only function of fat tissue was to store energy. Over time however, studies have shown that belly fat produces hormones and other factors that can lead to serious health problems such as insulin resistance and high blood pressure.

    Further buttressing this argument is the fact that some scientific studies have shown that a concerted effort to lose weight can reduce insulin resistance and prevent or delay the onset type 2 diabetes.

  • Physical Inactivity
  • Many studies have pointed to a lack of physical activity as a serious risk factor for insulin resistance which is the root cause of type II diabetes. It just so happens that your muscle cells use more glucose on average than most other types of cells except perhaps your brain cells. Under normal conditions, muscles store up glucose and burn it off for energy during physical activity. These same muscle cells replenish their reserves with the glucose available in the blood stream. All this has the net effect of keeping blood glucose levels in balance.

    Interestingly, scientific studies have also shown that our muscles become more sensitive to insulin after exercise. This increased insulin sensitivity allows the muscles to take in more glucose which lowers the blood sugar level. Some scientific evidence also indicates that exercise may facilitate the absorption of glucose in the muscles without the need for insulin.


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 negative 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 II diabetes can actually be significantly mitigated and perhaps even reversed by the combination of electronic blood glucose monitoring, healthy lifestyle habits, and the administration of the right doses of synthetic insulin at the right times. In a weird way, those of us who are suffering from type II diabetes are actually really lucky because that variant of diabetes can often be reversed by adopting a much healthier lifestyle. For those of us who desire to live a healthier lifestyle but aren’t sure how to, the following articles might be good places to start.

  1. 10 strategies for maintaining your health
  2. How to lose weight effectively

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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