14.8: Diabetes

Skills to Develop

• Summarize the long-term health implications and the dietary approaches to living with Type 1 and Type 2 diabetes.

Diabetes is one of the top three diseases in America. It affects millions of people and causes tens of thousands of deaths each year. Diabetes is a metabolic disease of insulin deficiency and glucose over-sufficiency. Like other diseases, genetics, nutrition, environment, and lifestyle are all involved in determining a person’s risk for developing diabetes. One sure way to decrease your chances of getting diabetes is to maintain an optimal body weight by adhering to a diet that is balanced in carbohydrate, fat, and protein intake. There are three different types of diabetes: Type 1 diabetes, Type 2 diabetes, and gestational diabetes.

Type 1 Diabetes

Type 1 diabetes is a metabolic disease in which insulin-secreting cells in the pancreas are killed by an abnormal response of the immune system, causing a lack of insulin in the body. Its onset typically occurs before the age of thirty. The only way to prevent the deadly symptoms of this disease is to inject insulin under the skin. Before this treatment was discovered, people with Type 1 diabetes died rapidly after disease onset. Death was the result of extremely high blood-glucose levels affecting brain function and leading to coma and death. Up until 1921, patients with Type 1 diabetes, the majority of them children, spent their last days in a ward where they lapsed into a coma awaiting death. One of the most inspiring acts in medical history is that of the scientists who discovered, isolated, and purified insulin and then went on to find out that it relieved the symptoms of Type 1 diabetes, first in dogs and then in humans. Frederick Banting, Charles Best, and James Collip went into a hospital ward in Toronto, Canada and injected comatose children with insulin. Before they completed their rounds children were already awakening to the cheers of their families.

A person with Type 1 diabetes usually has a rapid onset of symptoms that include hunger, excessive thirst and urination, and rapid weight loss. Because the main function of glucose is to provide energy for the body, when insulin is no longer present there is no message sent to cells to take up glucose from the blood. Instead, cells use fat and proteins to make energy, resulting in weight loss. If Type 1 diabetes goes untreated individuals with the disease will develop a life-threatening condition called ketoacidosis. This condition occurs when the body uses fats and not glucose to make energy, resulting in a build-up of ketone bodies in the blood. It is a severe form of ketosis with symptoms of vomiting, dehydration, rapid breathing, and confusion and eventually coma and death. Upon insulin injection these severe symptoms are treated and death is avoided. Unfortunately, while insulin injection prevents death, it is not considered a cure. People who have this disease must adhere to a strict diet to prevent the development of serious complications. Type 1 diabetics are advised to consume a diet low in the types of carbohydrates that rapidly spike glucose levels (high-GI foods), to count the carbohydrates they eat, to consume healthy-carbohydrate foods, and to eat small meals frequently. These guidelines are aimed at preventing large fluctuations in blood glucose. Frequent exercise also helps manage blood-glucose levels. Type 1 diabetes accounts for between 5 and 10 percent of diabetes cases.

Type 2 Diabetes

The other 90 to 95 percent of diabetes cases are Type 2 diabetes, which is defined as a metabolic disease of insulin insufficiency, but it is also caused by muscle, liver, and fat cells no longer responding to the insulin in the body (Figure \(\PageIndex{1}\)). In brief, cells in the body have become resistant to insulin and no longer receive the full physiological message of insulin to take up glucose from the blood. Thus, similar to patients with Type 1 diabetes, those with Type 2 diabetes also have high blood-glucose levels.

For Type 2 diabetics, the onset of symptoms is more gradual and less noticeable than for Type 1 diabetics. The symptoms are increased thirst and urination, unexplained weight loss, and hunger. The first stage of Type 2 diabetes is characterized by high glucose and insulin levels. This is because the insulin-secreting cells in the pancreas attempt to compensate for insulin resistance by making more insulin. In the second stage of Type 2 diabetes, the insulin-secreting cells in the pancreas become exhausted and die. At this point, Type 2 diabetics also have to be treated with insulin injections. Healthcare providers is to prevent the second stage from happening. As with Type 1 diabetes, chronically high-glucose levels cause big detriments to health over time, so another goal for patients with Type 2 diabetes is to properly manage their blood-glucose levels. The front-line approach for treating Type 2 diabetes includes eating a healthy diet and increasing physical activity.

Figure \(\PageIndex{1}\): Type 2 diabetes is a metabolic disease characterized by high blood-glucose levels. © Shutterstock

The Centers for Disease Control Prevention (CDC) estimates that as of 2010, 25.8 million Americans have diabetes, which is 8.3 percent of the population. In 2007 the cost of diabetes to the United States was estimated at $174 billion. The incidence of Type 2 diabetes has more than doubled in America in the past thirty years and the rise is partly attributed to the increase in obesity in this country. Genetics, environment, nutrition, and lifestyle all play a role in determining a person’s risk for Type 2 diabetes.

Video \(\PageIndex{1}\): Do You Have High Blood Sugar?

A more in-depth view of blood sugar and your health.(click to see video)

Summary

Diabetes is a disease of insulin deficiency and glucose oversufficiency. Like other diseases, genetics, nutrition, environment, and lifestyle are all involved in determining a person’s risk for developing diabetes. Type 1 diabetes was once a death sentence, but now can be treated with insulin injections. However, insulin injections do not cure the disease, and diabetics can suffer many disease complications. Diabetes complications can be relieved by strictly managing blood-glucose levels, adhering to a healthy diet, and increasing physical activity. The incidence of Type 2 diabetes has more than doubled in America in the past thirty years and the rise is partly attributed to the increase in obesity. The front-line approach for treating Type 2 diabetes includes eating a healthy diet and increasing physical activity.

Discussion Starters

1. If you owned a grocery store what are some practices you could introduce to combat the epidemic of Type 2 diabetes in this country?
2. What are some options for you to intervene in your lifestyle and decrease your risk for Type 2 diabetes?