Diabetes (or Diabetes mellitus) is a complex group of diseases caused by a number of reasons. Individuals suffering from diabetes have hyperglycemia (high blood sugar) either because there is low production of insulin or body cells do not use the produced insulin. About 350 million people suffer from diabetes globally (Danaei et al., 2011). The World Health Organization (1999) has predicted that diabetes will rise to the top seventh cause of death worldwide by 2030. There are three common forms of diabetes: type 1 diabetes, type 2 diabetes and gestational diabetes. This paper mainly discusses these major forms of diabetes considering their causes and consequences.
Type 1 Diabetes
In type 1 diabetes mellitus, body cells fail to produce insulin due to a compromised immune system causing damage to the cells where production of insulin takes place. The cause and prevention of type 1 diabetes are not particularly known; however, it is suspected to be a consequence of certain genetic factors.
Type 2 Diabetes
In type 2 diabetes mellitus, there is low production of insulin by the body cells or the body does not effectively make use of the produced insulin. Type 2 diabetes is known to be the commonest type of diabetes; in fact, 90% of diabetes sufferers have type 2 diabetes (World Health Organization, 1999). The cause and cure of type 2 diabetes remains unknown; however, genetic factors and manner of living take part in its causes, and watching blood sugar level can control the disease.
Gestational diabetes happens when there is a development of high blood sugar level in pregnant women not previously diagnosed of diabetes. For mothers who had gestational diabetes during their first pregnancy, the probability that it will occur in subsequent pregnancies is approximately two-thirds. Furthermore, some patients may subsequently develop type 2 diabetes. After pregnancy, diabetes type 1 or 2 may occur and will require obligatory treatment.
Genetic Factors and Markers
The role of genetic factors as a cause of diabetes has been proven definitively. This is the main etiological factor for diabetes.
IDDM is considered to be a polygenic disease which is based on at least two of the mutant genes in diabetic chromosome 6. They are associated with the HLA system (D-locus), which determines the individual, genetically determined response of the body and B cells to various antigens.
The hypothesis of polygenic inheritance of IDDM suggests that diabetes is caused from two mutant genes (or two groups of genes) that have a recessive inherited predisposition to autoimmune lesions of the insular apparatus or increased sensitivity of B cells to viral antigens or attenuated antiviral immunity.
Genetic susceptibility is linked with particular genes of HLA systems, which are considered markers of such a predisposition.
Patients with a genetic predisposition to IDDM have an altered response to environmental factors. They have weakened antiviral immunity, and they are extremely susceptible to cytotoxic damage to the B cells by viruses and chemical agents.
Viral infection may be a factor that provokes the development of IDDM. The most common occurrence of IDDM clinically is preceded by the following viral infections: measles (rubella virus has a tropism to the islets of the pancreas, accumulates, and can be replicated in them), Coxsackievirus and hepatitis B virus (can be replicated in the insular apparatus), mumps (1-2 years after the epidemic of mumps, the incidence of IDDM in children dramatically increases), infectious mononucleosis, cytomegalovirus, influenza virus, etc. The role of viral infection is confirmed by seasonality in the incidence of IDDM development (often, the first diagnosed cases of IDDM among children occur in autumn and winter months, with a peak incidence in October and January), the detection of high titers of antibodies to the virus in the blood of patients with IDDM, and the detection by immunofluorescent methods for studying viral particles in the islets of Langerhans in people who have died of IDDM. The role of viral infections in the development of IDDM is confirmed in experimental studies. Viral infections among individuals with a genetic predisposition to IDDM are involved in the development of the disease as follows:
- the cause of acute injury to B cells (Coxsackievirus);
- leads to viral persistence (congenital cytomegalovirus infection, rubella) with the development of autoimmune reactions in the islet tissue.
In modern diabetology, the next staging of IDDM is expected.
First stage – a genetic predisposition, due to the presence of certain antigens in the HLA system, as well as genes of chromosomes 11 and 10.
Second stage – the initiation of the autoimmune process in islands of B cells influenced with viruses, cytotoxic agents and any other unknown factors. A crucial point in this step is the expression of B cells HLA-DR-antigen and glutamic acid, and therefore, they become autoantigens that cause the development of autoimmune response reactions.
Third stage – the stage of the active immunological process with formation of antibodies to B cells, insulin and autoimmune insulitis development.
Fourth stage – the progressive reduction of insulin secretion stimulated by glucose (1-phase secretion of insulin).
Fifth stage – clinical diabetes (the manifestation of diabetes). This step develops during the occurrence of the degradation and death of 85-90% of the B cells.
Many patients after the insulin treatment fall into remission of the disease (the “diabetic honeymoon”). Its length depends on the severity and degree of B cell damage, their ability to regenerate, and the level of residual insulin secretion, as well as the severity and frequency of related viral infections.
Sixth stage – the complete destruction of b-cells, and a complete lack of insulin secretion and C-peptide. Clinical signs of diabetes form and insulin treatment becomes necessary again.
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Just ask Jamie Oliver; here’s a guy raising his voice to our support, with a small detail forgotten – that there are two types of diabetes – and BAM! Blows up in his face, like an overly ripe foux da fa fa. Ouch.
So. let’s nail some basics here to keep it from happening to you.
The Most Common Pitfalls
When writing about diabetes and people with the disease, please mind the following:
- We do not suffer from; but live with diabetes.
- There are two main types. Do not mess’m up! We’ll have your head on a pole faster than you can scream “JAMIE ROCKS!” Srsly. This mistake is met with mobs equipped with torches and pitchforks, it gets very emotional – see below for a detailed description of the types.
- It is not a patient’s fault
–>In type 1, we have no clue why it happens.
–>In type 2, part of it can be lifestyle, but there is a massive random element to it and some genetics too!
- We do not measure our insulin, we measure our blood glucose.
- A hyper – high blood glucose – won’t kill you as fast as they do in the movies! They just wanted the script to be more exciting. Bastards…
- A hypo – low blood glucose – can land you in awkward situations, but we’re usually able to handle it. But, we may need help. Thanks.
- Speaking of insulin, it’s the LAST thing we need when “hypo.”
–>In fact a hypo calls for fast acting sugar. Surprised?
- There is no such thing as a special “diabetic diet.” We can eat the same things as everyone else, and would do well to follow a healthy, balanced diet. Just like you.
- We are not weak, we are awesome even if we have to invest ~2 hrs a day to manage this crap.
- Lacking fact checks and not caring about the quality of life for us with diabetes, just costs – ouch. Happened in NYT a while ago – was countered in an amazing and factual way by Kelly Close and diaTribe, and “one or two” other friends… big ouch.
Here are some facts, and a brief outline, to make life easier for you.
- Blood glucose rises due to things we eat; carbohydrates, protein and fat.
- Insulin lowers blood glucose.
- Diabetes means that the body in some way does not handle insulin like it should.
- Diabetes does not leave. It is chronic.
- Almost 400M people have diabetes, and there are two main types.
–>40M have type 1, where the body attacked itself – fancy name is autoimmune disease.
–>360M have type 2, where the body becomes resistant to insulin. Check out a video on this here!
So, we need to either lower resistance to insulin (type 2), or handle the blood glucose in some other way (type 1 and also later on type 2).
If things go really bad, it’s bye bye feet and such. The usual stuff you read about.
If all goes well, we’ll live longer than you guys – since we mind what we eat and stay active! HA!
One fact is certain: The therapy is annoying, whichever type you have.
Type 1 Therapy
Therapy is a major time drain, and very taxing in the long run.
We prick our fingers to find out what our blood glucose is. Based on that value we shoot insulin to lower our blood glucose or sometimes eat carbs to raise it.
For meals and snacks, we estimate the carbohydrates on the table and based on this estimation we calculate the proper dose of insulin to inject.
If we really want to be dramatic, we say we make life and death decisions 20 times a day – and it’s true. But seriously, it’s not that bad; if…
- we have decent control
- we have access to all the things we need
- we have the right basic education
- and the right mindset
We live – thanks to technology and science – the ultimate quantified lives. But in the mind, that’s where we make our decisions to USE that which we have, and that which we’ve learned.
Type 2 Therapy
Reducing insulin resistance is done using exercise, diet and meds if needed.
In early stages, it can be held off, and meds are not needed.
If the resistance does not drop due to lifestyle changes, meds are needed.
A few pills (and potentially shots) a week are enough as you start out.
At later stages, the body can no longer keep up with insulin production and simply stops. We become insulin dependant – same therapy as type 1, but add some meds.
When we speak about diabetes…
… doing it right is easy. Mind the pointers above, include us who live with diabetes, and ask before publishing. We enjoy being able to help, even if our names are not mentioned – you are most likely helping us!
Have an amazing day!