Dr. Escabi: Diabetes 101

“But Doc, we just got through the holidays” is a statement that should be part of every medical school curriculum, especially the section on diabetes.

I’ve been wanting to write this column for several weeks, but my schedule wouldn’t allow it. Eventually, I had to write it or my chest would burst after hearing that so many patients threw caution to the wind during the holidays.

Types of Diabetes Mellitus include Type 1 or Juvenile Onset or Insulin Dependent, Type 2 or Adult Onset, Type 1.5 or Latent Autoimmune Diabetes in Adults, and Secondary Diabetes. Diabetes insipidus is a completely different condition that has nothing to do with sugars.

Type 1 diabetes occurs early in life and is usually the result of a malfunction of the body’s immune system, resulting in an attack on the cells of the pancreas that produce insulin. The only treatment for Type 1 is injectable insulin, although stem cell research is currently underway. Type 1.5 is similar to Type 1 but occurs later in life.

Secondary Diabetes Mellitus is triggered by another medical condition or medical treatment, such as long term use of a steroid such as prednisone or pancreatic tumors. While this type of diabetes can at times be treated by modifying lifestyle, it usually requires medical treatment. The degree of treatment depends on how much the body's ability to produce insulin has been compromised.

The most common, but, in some ways, hardest to treat, Type 2 or adult onset diabetes mellitus aka "We Just Got Through the Holidays Diabetes". It's written this way not to poke fun, but to illustrate how this form of the disease is more often than not the result of lifestyle choices.

Let me explain the mechanics of Type 2 diabetes. Glucose, a type of sugar which we generally get from food, is what our bodies use for fuel. When glucose is absorbed into the blood from our gut, or under our tongue, or in an intravenous infusion, insulin is responsible for routing it into the cells so it can be used for energy.

With Type 2 diabetes, our bodies lose the ability to use insulin effectively, so glucose just floats around in the bloodstream. In the vast majority of cases, our bodies become resistant to insulin because we are overweight. At first, our bodies will generate more insulin to compensate for that resistance, which is often when patients are told they are pre-diabetic, insulin resistant, glucose intolerant, or that their sugar levels are a little high.

Sugar floating around in the bloodstream doesn’t sound like a big problem, but sugar may end up damaging tissues and organs that should not be exposed to it for long periods of time. The eyes, heart, blood vessels, kidneys, stomach, and nerves of hands and feet are parts of the body that may be affected. The body's immune system and wound healing capacity may also be compromised.

While diabetes is a condition that, at first, is highly treatable with oral medications and injections that do not include insulin from outside the body, it can also, in the vast majority of cases, be controlled with weight loss, regular exercise, and portion control. Easy, right? Not really.

Unfortunately, most patients with Diabetes Mellitus 2 don’t put in the effort to change their lifestyle until the body no longer has the ability to produce enough insulin on its own, even at a healthy weight. Although I admit some patients have executed miraculous drops in their sugar levels through diet and exercise, the majority have either started too late or simply view medication as the means to control their diabetes without changing their ways.

Why do I write this? Not to give the impression that I have something against medicine, and certainly not to make anyone feel bad about their choices. I do it because even though I’m not against medication, I am against giving unnecessary medication.

Medication becomes unnecessary when there are alternative, safe ways to achieve comparable or superior results. There are no side effects to a properly balanced diet or a carefully planned exercise routine.

If you find yourself gaining a little too much weight with sudden changes in vision, increased thirst or hunger, and more frequent urination, please address these symptoms with your doctor. Even Chuck Norris said “Repeatedly eating too much sugar can lead to weight gain and obesity,” and who are we to argue with Chuck?