Diabetes –what it is

If you read this blog regularly you can expect to read about diabetes.  Please don’t skip these posts.  So many people are not aware of how devastating this disease can be or even really understand what it is and how one lives with it.  You may find you don’t know as much as you think you do.  I know I was certainly surprised by the big difference between what I thought diabetes was and what it actually is.

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The Today Show had a segment on diabetes this morning and I have to say I was very disappointed.  The focus was very much on type 2 diabetes and type 1 was barely mentioned and never clarified. They talked about the causes of T2 and how it’s almost always preventable but not once mentioned that type 1 is not preventable and is not caused by poor health habits.

Someone asked me about that when Maggie got sick.  She said “I thought only fat people got diabetes” I told her she was thinking about type 2 and while being overweight can certainly be a factor in type 2 it isn’t always.  I tried to explain that type 1 is not preventable (that we know of) and not curable (technically, though as always there are alternative medicine options that some people find success with), whereas type 2 can often be reversed.

I think there needs to be important clarifications made between the two types of diabetes because they are not at all the same disease. The clarification is important to me because while I can handle people thinking badly of me (like I fed my kids too much junk food and sugar which is funny because my sisters use to get on me about how I wouldn’t let my kids eat sugary cereal) I do not want my children to suffer under the notion that they did something to cause this disease when they in fact did not.  It’s hard enough to live with this disease as it is —they certainly don’t need to be made to feel they did something to contribute to it.

Please don’t misunderstand me.  I know that type 2 diabetes is a serious problem in this country and is nearly epidemic, and I am in no way wanting to point fingers of blame at type 2 diabetics.  I am a product of our culture as much as anyone.  I eat too many of the wrong foods and don’t exercise enough.  I am overweight and probably at pretty good risk for developing type 2 diabetes.  I am working to change all that but it’s easier said than done.

So what’s the difference?

Type 1 diabetes (which two of my children have) is an autoimmune disease.  Autoimmune means a self-allergy.  The body’s immune system attacks what it sees to be a threat.  In Type 1 diabetes the body mistakenly thinks it’s pancreas islet cells are invaders and it begins attacking them.  We don’t know exactly what causes this to happen but there seems to be a strong case for viral and environmental factors.

It isn’t contagious and it isn’t caused from eating too much sugar.  Let me say that again, type 1 diabetes is NOT caused by eating too much sugar.  BUT, eating too much sugar can cause insulin resistance which can lead to type 2 diabetes –but not type 1.  More on that in a minute.

There does seem to be an inherited factor in type 1 but not necessarily the way you might think.  It’s not uncommon for children who have type 1 to have no other close relative with it.  It may be that they got one HLA type from one parent and one from another and the mix is what causes a problem.  This mix wouldn’t be a cause of diabetes but it does put them at greater risk.   That being the case siblings then have a 1 in 20 (5%) chance of also developing type 1 diabetes.  But type 1 isn’t completely due to heredity.  We know this because when one identical twin gets type 1 only in half of the cases does the other twin also get it.

Environment also seems to be a factor and in fact may be what triggers the whole thing.

Basically it is believed that it breaks down this way:

• You inherit the tendency for the disease (which again doesn’t necessarily mean a relative has it but that the genetic markers are there, possibly from each parent)
• This tendency allows a virus or toxin to damage islet cells.  Part of the damaged cell is released into the blood and the body begins to make islet cell antibodies.
• The damage attracts white blood cells which produce chemicals that further injure other islet cells.
• Over time anything that activates white blood cells (viruses, toxins - in the environment and the foods we eat, stress) can result in further islet cells being destroyed until eventually so many cells are destroyed that the body cannot make enough insulin and type 1 diabetes develops.

For some children this process may have been happening since their birth.  It could have been years in the making.    Because newly diagnosed children with type 1 diabetes typically have not lost ALL islet cells yet and thus still have some pancreas function, there is hope that a cure can be found to stop this process further.

So what then is type 2 diabetes?

In type 2 diabetes the problem isn’t that there’s not enough insulin being produced or that islet cells have been destroyed (there are no islet antibodies present in type 2 diabetics) but that the insulin has become ineffective at controlling the body’s metabolism.  This is called insulin resistance and unfortunately it is most often related to being overweight and inactive.  Its rise in occurrence can be directly related to the way we live as a  culture.  We are too sedentary and we eat too much fat and sugar.

With insulin resistance the body makes more and more insulin to get the body to do what it needs to do until eventually the pancreas gives out.  At that point a type 2 diabetic would need to be on insulin.  But with serious lifestyle changes a lot of times type 2 diabetes can very often be reversed.  It isn’t easy and again I am not pointing fingers but I do think it’s important to make the clarification that type 1 and type 2 diabetes are very different diseases and one does not turn into the other.  Also note that not all type 2 diabetics are overweight and sedentary.  About 20% of type 2 diabetics have a genetic defect which causes insulin resistance –regardless of how well they eat and how active they are.

The risk factors for type 2 are:

Genetics for one.  They vary from family to family apparently but have nothing to with HLA type as in type 1 diabetes.  Also, children born after their mothers have been diagnosed with type 2 or if the mother had gestational diabetes are at greater risk of developing type 2.

Lifestyle is a factor (usually) but fortunately it is one that can be controlled.  Insulin resistance can be improved in most people with diet and exercise.

So that’s it in a  nutshell.  Now you know.

Questions?  Ask them in the com box or e-mail me.  I’m not an expert (though admittedly I feel like I am quickly becoming one) but I’ll do my best to answer them.

Thanks for reading!