What are Type 1 & Type 2? Part 3

The high BGLs caused by both types can wreak havoc with your body over the long term. But the good news is that with modern equipment and therapies, diabetics have the tools to effectively control their BGLs and prevent or forestall complications. And even if complications occur, modern treatments can prevent blindness, amputation and other extreme consequences if caught early on.

A number of potential complications are caused by chronically high blood sugar. The feet are one example. Since they’re the furthest parts of the body from the heart, if circulation problems develop they’re likely to show up there first. The feet can get nerve damage, called neuropathy, that can cause pain, tingling or numbness that impairs the ability to feel heat, cold, and pain. This increases the possibility of having an injury that could go unnoticed. At the same time, the healing process may be weakened and that increases the chance of infection. An infection is bad enough for non-diabetics; in diabetics it’s a major league threat that can lead to amputation if it gets out of hand.

Because of this, foot problems must be addressed quickly. If you ask a podiatrist for a diabetic horror story, they’ll usually tell you about the person who came in with a gangrenous foot that required amputation. The furrow their brows, get really serious and quietly say, “Why didn’t they see me earlier?” Since foot problems like infections can be immediately threatening, podiatrists will see you on the day you call if they know you’re diabetic.

In the old days, blindness was a frequent untreatable complication of diabetes. The most common eye disease among diabetics is called diabetic retinopathy. A number of bad things happen as a result of the condition. One is the leakage of blood from weak blood vessels that can cloud the center of the eye and block vision.

Eye problems are sneaky because there aren’t obvious symptoms before the trouble starts. That’s why it’s important to have a comprehensive dilated eye exam at least annually. It can identify potential problems early so they can be addressed before vision is impaired.

What are Type 1 & Type 2? Part 2

In both types of diabetes this process is short-circuited and glucose is left circulating in the bloodstream, causing a high BGL. The body reacts by generating thirst, driving you to drink fluids that will be expelled and carry excess sugar from the bloodstream with it. That’s why the term diabetes mellitus (honeysweet urination) mentioned in Chapter 1 applies to both types. They both result in high BGLs and the resultant expelling of sugar in the urine. But this is where the similarity between Type 1 and Type 2 ends.

Type 1 diabetes is an autoimmune disease in which the body’s own defenses turn against the insulin-producing cells in the pancreas. The cells are killed, wrecking the pancreas’s ability to produce insulin. When a Type 1 eats, glucose enters the bloodstream but the insulin doesn’t get produced to enable the body to use it. The unused glucose stays in the blood.

In Type 2, the pancreas initially works fine. It senses the rising BGLs and produces insulin just like a non-diabetic person. The problem here is called “insulin resistance” because many of the body’s cells don’t allow insulin to unlock them. When a Type 2 eats, the glucose enters the bloodstream and the pancreas produces insulin. But the insulin resistant cells have barred the doors and the sugar stays in the bloodstream.

Insulin resistance doesn’t trigger the Type 2 diagnosis all by itself. Because the body’s cells get increasingly more insulin resistant, the pancreas works ever harder to produce enough insulin to overcome it. Eventually many of the overworked insulin producing cells die, the ability of the pancreas to produce insulin is compromised and high BGLs result. So the immediate cause of a diabetes diagnosis is insufficient insulin production but the underlying cause is insulin resistance that may have been present for years.

What are Type 1 & Type 2? Part 1

The word “diabetes” means high blood sugar. Type 1 and Type 2 both cause this but they do it in different ways. In fact, they are different diseases. Let me explain it by first going back to basics.

Glucose (sugar) is a product of digestion, which breaks food down into sugar that is put into the bloodstream for distribution throughout the body where it’s needed for nourishment. Despite an overabundance of sugar in the blood, the body’s cells are unable to use it. This inability causes two things to happen:
1. The body’s cells can’t use the glucose so they starve.
2. Excessive sugar in the blood causes damage to the body.

The potential complications are the same in both types. Sustained high blood glucose levels (BGLs) can weaken and clog blood vessels while also damaging the kidneys, eyes, feet, heart, nerves and skin. It may also increase the chances of Alzheimer’s disease, stroke and hearing impairment.

Let’s look a what happens. When a normal person eats, the food is digested into glucose and the bloodstream carries it to the body’s cells. When it gets there a hormone called insulin “unlocks” the cells and and allows the glucose to enter so the cells can absorb it for nourishment. The pancreas produces the right amount of insulin for the glucose in the blood in a finely tuned dance. By doing this the body automatically keeps the glucose in a narrow healthy range.

It’s an amazing system. Candy and junk food obviously contain lots of sugar. But healthy foods raise the BGL too – potato does it big time, even before you load on the fixin’s. Carbohydrates, which the body converts into glucose, are all over the place – bread, beans, fruit, pasta, corn, salad dressings and tons of other places you may not think of.

Whatever a non-diabetic person eats, their body automatically produces the right amount of insulin for it, their cells allow the insulin to work so they absorb the glucose from the blood, and the BGL is kept in balance.

A Brief History, Part 3

Charles Best and Dr. Frederick Banting

With research continuing, the name “insulin” was suggested for the curative pancreatic substance. Insulin means “island” and refers to the “Islets of Langerhans” which had been discovered by Paul Langerhans 40 years earlier. They were enclosed in a fibrous capsule that separated them from the rest of the pancreatic tissue. , so they really are islands within the organ. The islets turned out to be home to the beta cells that produced the magic hormone.

Frederick Banting, a Canadian medical doctor, suspected that earlier insulin extracts were compromised by enzymes during removal. In 1921, he and assistant Charles Best began working to find out. Within a year, Banting’s purer insulin was injected into a 14 year-old boy. The test was successful and within the year the University of Toronto contracted with Eli Lilly & Co. to mass produce insulin. An effective treatment was finally available. Banting, Best and Minkowski all won Nobel Prizes for helping solve a medical mystery that had devastated mankind for thousands of years.

Since then therapies, equipment, monitoring devices and management have improved in hundreds of ways, Real-time home blood glucose monitoring is routine, human insulin has been synthesized and pump technology perfected. The “artificial pancreas” that has been dreamed of for decades is now a reality. The work continues to offer diabetics ever-improving lifestyles and life expectancies that were impossible as recently as the 1920s.

Even with great care, diabetes is no walk in the park. But thanks to researchers over the centuries, we now truly have a fighting chance to live and live well.

A Brief History, Part 2

Over the years therapies included a high fat and protein diet (which was on the right track,because it reduced the number of sugar-producing starches), eating excessive amounts of sugar (wrong track), an “oat cure” where the patient would eat 8 ounces of butter mixed with 8 ounces of oatmeal, opium or a whiskey/black coffee cocktail every two hours. Some were moderately successful in helping temper the symptoms by restricting food consumption and reducing the amount of sugar in the bloodstream, but undereating could cause death by starvation.

Nothing worked. sometimes the symptoms got temporarily better and other times they got devastatingly worse, but it remained a mysterious fatal disease no matter what was tried.

An opportunity to explain the disease was missed in 1709, when Swiss doctor and researcher Johann Brunner experimented with removing the pancreases from dogs. They became extremely thirsty and urinated excessively, which were known to be the classic symptoms of diabetes, but Brunner didn’t see the link.

Finally, in 1889, scientists researching digestion removed the pancreas from a dog. The animal became diabetic and a huge clue was discovered – partly by accident. The dog’s excessive urination was noticed when a lazy janitor didn’t clean up the mess. Scientist Oskar Minkowski checked the urine for sugar – and found it. This proved that the pancreas – and not the kidneys as some had suspected – was the source of whatever controlled blood sugar.

Dr. Georg Zuelzer extracted the substance from animal pancreases, called it “Acomatrol” and injected it into a comatose diabetic patient. The patient rallied but died when the small supply of what would later be called insulin ran out. This showed that insulin did, in fact, lower blood sugar. But problems cropped up in later experiments, like painful abscesses, fevers and the mysterious, scary symptoms of insulin reactions.

A Brief History, Part 1

Diabetes has been diagnosed for thousands of years but effective treatment wasn’t available until the early 20th century. To help explain what earlier physicians saw and thought, it’s helpful to know how the disease operates.

Diabetes disables the body’s ability to metabolize sugar. Excess sugar builds up in the bloodstream, causing the body to try to eliminate it through excessive urination. The medical term is diabetes mellitus, diabetes meaning “excessive urination” and mellitus meaning “honeysweet.” It refers to the sweetness of urine containing excessive amounts of sugar expelled by the body.

The ancients recognized there were two types. The first affected younger people who died from it quickly. This would eventually be called “Juvenile Diabetes” but it’s also been found to strike adults and is now typically referred to as “Type 1.” The second was associated with older people who could live for years while enduring debilitating complications. It came to be called “Adult Onset Diabetes” but it now affects young people as well. The disease is now referred to as “Type 2.” Both types were always fatal.

The ancient Egyptians noted the frequent urination problem, while their Hindu contemporaries wrote of ants being attracted to the urine of people suffering emaciation. The Greeks thought the disease melted flesh and expelled it. In what has to be one of the worst medical jobs ever, diabetes was diagnosed by “water tasters” who sampled the urine of those suspected of having the disease to detect sweetness.

My Story

When you’re diagnosed with diabetes you instantly become a tightrope walker, even if you’ve got bad balance and a fear of heights. Your constant lifelong task becomes maintaining a blood sugar level as close to normal as possible without going too high or too low. Like every other tightrope walker, you need to pay attention and make continual adjustments to stay in balance.

I was diagnosed in 1981 and have taken insulin ever since. I’m not a medical professional; I’m just a guy who’s had diabetes for a long time and can write plainly about dealing with it day-to-day.

On one hand, diabetes is much harder to control than most non-diabetics imagine. On the other hand, it is manageable and if it’s done well diabetics can lead close to normal lives. Both Type 1 and Type 2 diabetes are complex diseases with issues and therapies that vary from person to person. It’s been said that because of the complexity of diabetes it’s possible no two cases may be exactly alike.

Let me tell you my story. I almost never became ill (in fact, I still rarely do) but in the Spring of 1981 I got sicker that I can ever remember. I was weak with no appetite and spent a couple of days lying on the sofa reading The Island by Peter Benchley. I felt better afterward but over time found I had a lack of energy and developed a constant thirst.

Some time later I was on a business trip and got really thirsty so I drank orange juice to quench it. The high sugar content blasted my blood glucose level through the roof. I became so parched and groggy it was difficult to speak, which made for a difficult sales call. I didn’t know what was happening but it was obvious something was wrong. A few weeks later I went to the Blue Cross/Blue Shield office on business and spotted some pamphlets in the waiting room that described various common medical conditions. I randomly picked one up to kill time and discovered I had all the symptoms it described except for the ones that applied to women. It seemed pretty clear I had diabetes. I made an appointment with an internist. Our conversation went like this:
“What brings you here?”
“I think I’ve got diabetes.”
He gave me the look he probably gives every hypochondriac who comes in with their own diagnosis and then he took a blood sample. He returned and said
“You’ve got diabetes.”
“Can it be treated with pills?”
“No, you’ll need injections.”

Even though I wasn’t surprised, the official diagnosis still hit me between the eyes. One of my brothers had diabetes and I was aware of some of the difficulties in managing it. I knew my life had changed – but I also knew it wasn’t over.

Type 1 and Type 2 diabetes – which are very different – will both be discussed in this book. Some elements of control apply to both types but others are relevant to just one or the other. Regardless of which type you have it’ll be helpful to read about both. At the very least, you’ll learn what the differences are and be better able to explain your condition to others.

With either type, living with diabetes truly is a question of balance. It requires thinking about what you’re doing throughout the day and how it will affect your blood glucose level (BGL). And you need to know how to make adjustments to keep your BGL as close to the normal range as possible.

We diabetics have been shanghaied into an adventure we didn’t sign up for. But since we’re in it we’ve got to make the most of it. And you know what? You can still have a great life! But you’ve got to take this seriously and pay attention. It’s important – losing your BGL balance can be as serious as a tightrope walker falling off the wire.

An Important Note, Part 2

Diabetes is a serious, life-threatening disease that’s reached epidemic proportions and the chances are everyone either has it or knows someone who does. Given its prevalence everyone should have a basic knowledge of it.

The Diabetes Book offers this. The information presented is accurate, but please understand it’s a general overview and shouldn’t be used for medical advice. It simply aims to convey how the two major types of diabetes work, drive home the importance of the patient’s active participation in his/her own care and offer some practical advice for living with it. Readers must remember that diabetes affects individuals differently and professionals are needed to develop personal treatment strategies. If the book raises questions – and I hope it does – you should see your medical professional for answers. Believe me, it’s a complicated disease and you won’t figure it out on your own.

This book isn’t comprehensive and I readily acknowledge that many things have been simplified or omitted. For example, the chapter on “Incorrect Common “Knowledge” note that diabetics don’t need special foods aside from the normal, healthy diets that a good for everyone. That’s true for the vast majority of us but there are exceptions. If you have diabetic kidney disease, you’ll need a low-protein diet. Or you may have a gluten intolerance possibly caused by the autoimmune system in Type 1s.

My purpose is to help people easily learn about diabetes. If I tried to explain all the “ifs,” “ands,” “whys” and “buts” it would have become too long, boring and time consuming for most people to read. That would have defeated its purpose, which is to inform as many people as possible.

If you’re diabetic you’ll need to refine, modify and add to this information as you learn what works in your individual case. If you’re not, you’ll better understand how it works and have a real idea of what your diabetic friends and relatives are dealing with. I sincerely hope The Diabetes Book makes everyone more knowledgeable, curious and committed to good health.

An Important Note, Part 1

The Diabetes Book is for everyone – diabetic or not – who wants a basic understanding of diabetes and some insights into the day to day issues involved in it. People with diabetes and those close to them will probably learn some new things. I know I did in doing the research.

Everyone else can benefit too. The book is written like its directed toward diabetics but it can help others by throwing light on a threat that’s often feared as a dark, mysterious monster lurking around the corner. Once non-diabetics learn of the strides made in treatment and understand diabetes can be treated, they’ll discover that the horror shows they imagine do not need to happen. And once they know the symptoms they may more readily seek treatment for themselves or suggest it for others. If people with symptoms get medical help sooner rather than later they’ll take a huge step toward staying healthy.

I was in Chicago the week Ron Santo was inducted into the Baseball Hall of Fame. Previously unknown to me, Santo had Type 1 diabetes in the 1960s and kept it to himself for fear of losing is job. The Chicago Tribune ran stories about his battle that I, as a person with diabetes, could relate to. But I realized most people couldn’t understand them because they don’t know enough about diabetes to appreciate Santo’s position. That’s where the idea for this book came from.

Over the next few months I spoke to people about Santo’s story and found there’s a much greater lack of knowledge about diabetes than I ever dreamed. And it’s almost as prevalent among diabetics as it is in the general public. To make matters worse, misinformation, old wives’ tales and often-repeated falsehoods cause confusion for people who accept them at face value. Good, caring people often “know” things that simply aren’t true and harbor misconceptions that can be counterproductive.

Excerpted from The Diabetes Book: What Everyone Should Know

What Does a Diabetic Look Like?

Photo by Pixabay on Pexels.com

I didn’t tell people about my diabetes for 30 years to avoid negative perceptions of who I am and what I can do. During that time I co-founded a company that melted stainless steel and poured it to make castings for corrosive applications. I was as likely to find myself on one end of a ladle holding 3,000 pounds of 3,000 degree metal as to be sitting across from a banker negotiating a loan. The last thing I needed was anyone questioning my abilities.

When I opened up about the disease most people reacted with surprise. A business associate I had known for 20 years said “So you’ve got diabetes. You don’t look like a diabetic.” I wondered what he thought a diabetic should look like.

But you know what? Depending on his personal experiences my friend may not have been off base. Here are some quotes taken from Dr. Bernstein’s Diabetes Solution:

“I met a wealthy car dealer at the golf club, with his legs cut off as high as legs go, who explained he hadn’t paid much attention to his diabetes at the time and his doctor couldn’t help him.”

“I developed severe retinopathy, glaucoma, high blood pressure, neuropathy that required me to wear a leg brace. Both of my kidneys ceased functioning … and I was placed on kidney dialysis for many months until I received a kidney transplant.”

“Years of widely fluctuating blood sugars affected my mental and physical ability, with great injury to my family life. The resultant disability also forced me to give up my surgical practice and suffer an almost total loss of income.”

“During a subway ride which generally took about 25 minutes, the train was delayed for close to 2 hours and – to my utter dismay – I had forgotten my bag of goodies. As I felt myself “going bananas” (from low blood glucose), sweating and perhaps acting a little strange, a man sitting across from me screamed “She has diabetes!” Food, juice, candy bars and fruit came from all directions. I was so grateful and embarrassed that I stopped riding the subway.

Perhaps my friend witnessed things like this. If he did, it’s understandable that they would have a jaded view of diabetics in general. After all, for every negative episode the public sees there are probably 20 diabetics like me who outwardly live normal lives. We commonly don’t tip our hands to avoid being lumped in with the bad stereotypes.

Unfortunately, our silence helps perpetuate a stigma that diabetics are less able or reliable than those who don’t have the disease.