Iwant to first say that this is another lengthy but good, simplified explanation of things. After reading this I think you will really get it. Enjoy.

Another very common health issue that plagues our country is diabetes mellitus. In my medical school days in Nashville, I was corrected by some patients that the proper term is “the sugar”. Diabetes comes from the Greek word “diabainein” meaning “to pass through” and mellitus from Latin meaning, “sweetened with honey” which refers to the sweetened urine from excess blood sugar in diabetics. Now I know you’re thinking how did they know the urine of a diabetic was sweet. Hmmmmm…

So let’s start at the beginning with some basic concepts about bodies so we can all be on the same page once again. First of all one of the key forms of energy the body uses is glucose, a simple form of sugar. Yes, sugar. Our bodies use sugar. We eat various forms of food and through long boring chemical processes, we ultimately use glucose or sugar to create energy. It is vital for our survival. This sugar or what I will try to call from now on by its proper medical term, glucose, is released into the blood as a fuel source. Now it doesn’t really help us when it’s in the blood. In fact, when the levels of glucose are too high it actually damages the blood vessels or the pipes. Remember the pipes or arteries are extremely important for our survival. Specifically, high glucose levels severely damage the very small blood vessels called capillaries which are the smallest blood vessels that bring blood to the body. Capillaries comes from the Latin word “capillus” which means hair. So yes these blood vessels are like small little hairs.

Now there are several theories as to exactly why this is the case. I kind of feel like all the theories make sense to some degree. Some believe that high levels of glucose cause inflammation in the body. Another theory which I feel makes more sense is that the red blood cell(which looks a little bit like a donut) typically can have some glucose that attaches to it. So when glucose attaches to a red blood cell it almost makes the red blood cell look like a donut with a few spikes on it. Now if the blood glucose levels are high then the red blood cells have a higher number of glucose on them so now you have more spikes on more red blood cells. So I just feel like having a lot of heavily spiked-out red blood cells traveling through tiny blood vessels probably is not healthy for a body. And it probably does some good damage to the insides of those small pipes or capillaries. So high levels of blood sugar or glucose, are bad. It literally damages the insides of the pipes.

So how do we get the glucose or sugar out of the blood vessels and into the cells of the body? Insulin. Insulin is the hormone made by the pancreas, a specialized structure in the body that sits underneath the stomach and is about six inches long in an adult. Pretty simple. One of the major functions of the pancreas is to make insulin to get glucose into the cells of the body.

So when the pancreas is not functioning properly by either not making enough insulin or not making any insulin at all we get a build-up of sugar or glucose in the blood.

When the pancreas is just flat out not making insulin we call that type 1 diabetes. This typically happens in kids. In the medical world, we really don’t know why this happens. When the pancreas just isn’t quite making enough insulin we call that type 2 diabetes. Your type 1 diabetics need insulin shots to survive. With your type 2 diabetics, insulin usually is not required and we can handle it by using oral medications as well as really handling the cause of the problem.

So what really causes type 2 diabetes? Again a lot of theories out there. Here is what is real for me. Type 2 diabetes tends to occur later in life. Usually as the person ages and typically gets fatter. Why is that important? Simple. As bodies age things wear out. For instance your heart at age 25 is probably stronger than your heart at age 75. The same is true for all your body parts. Aging does that. But you can do things to preserve and optimize the function of all the structures of a body.

So with regards to the pancreas I like to consider it as a factory. It’s job is to produce insulin. Let’s just use an arbitrary or made up number here for simplicity sake and say the pancreas needs to make about 10 units of insulin a day for the average sized 175 pound adult. What do you think happens when that average size body goes up in size to say 200 or 250 pounds. How much insulin does the pancreas have to produce now to meet the demands of this larger body? Exactly! The pancreas now has to work harder. (In fact everything in the body has to work a little harder when it’s bigger.) What essentially is happening in your type 2 diabetic is the pancreas can’t meet the demands of this now larger body. So what happens is the blood glucose levels begin to rise. And we know that high glucose levels damage the pipes.

So how do we handle this problem with type 2 diabetes? There are several oral medications which basically function to either reduce the amount of sugar in the blood or make the pancreas squeeze out more insulin or increase the body’s sensitivity to the insulin it has. Sometimes we just give more insulin in the form of injections. What I have seen work very well with patients is to simply get the body size back down to normal so the pancreas doesn’t have to work so hard. In fact when this happens there typically is no need to even be on diabetic medications.

Managing or taking control over your diabetes is not difficult but does take work. If you are having trouble getting a handle on this issue please stop by the clinic so we can help you figure this out.

Richard Wallace MD

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