An Unsugar-coated Look at Diabetes

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Most people have some familiarity with diabetes. A family member, perhaps, takes medication to control it, or maybe a friend is avoiding dessert to keep their sugar levels in check. In the US, 10% of the population has diabetes. Diabetes numbers are ballooning all over the world. It is projected that there will be over 365 million cases of diabetes world-wide by 2030 – a couple million more than the population of the United States today.

Diabetes is a metabolic disease which causes high blood sugar. Typically, when we eat, our blood sugar levels increase due to the digestion of carbohydrates in our food. Insulin, a hormone secreted by the pancreas, binds to receptors on the surface of muscle and fat cells, setting off a series of reactions that ultimately help the cells absorb glucose from the blood. Diabetes can occur when the cells in the pancreas that secrete insulin (called beta-cells) are destroyed by the immune system and can no longer produce insulin. This condition is called Type 1 diabetes, and most frequently appears between the ages 4-7 and between 10-14. Type 1 diabetes is relatively rare – only about 5% of those diagnosed with diabetes have Type 1 diabetes.

The more common type of diabetes is called Type 2 diabetes. This is when the body is either unable to produce sufficient insulin because of damage to beta-cells, or because the cells of the body no longer respond to insulin and no longer absorb glucose from blood, a phenomenon that is called insulin resistance. While there are several factors, both genetic and environmental, that can lead to insulin resistance, obesity is said to account for up to 85% of the risk. This is because fat cells produce a chemical called tumor necrosis factor-alpha (TNF-α) which prevents the chemical reaction from proceeding when insulin binds to receptors on fat or muscle cells. As a result, the body has to secrete large amounts of insulin to ensure that excess blood sugar is absorbed. However, the increased insulin secretion also leads to the production of fat cells, which in turn increase insulin resistance – setting off a vicious cycle. Eventually, as insulin resistance increases, the body is not able to secrete the amount of insulin required for cells to absorb all the glucose in the blood, leading to high blood sugar levels. Additionally, these higher-than-normal blood sugar levels caused by insulin resistance can damage beta-cells, hampering their ability to produce insulin, and further pushing the body along the path of diabetes.

If diabetes is not controlled, it can lead to severe complications. Because of the interconnectedness between obesity and diabetes, diabetics are prone to developing heart disease. High blood sugar can also tax kidneys and the liver. Patients with severe diabetes can also have foot problems because arteries become narrow due to fat deposits and can no longer supply sufficient blood to legs. However, diabetes can be controlled! If controlled – by maintaining a healthy weight, by eating healthy food, and by exercising regularly – people with diabetes can live normal lives.

More on the molecular mechanisms of insulin resistance:
Genetic factors that contributing to development of diabetes: