Diabetes Type 2 – “Too Sweet for Words” but Don’t Fool with It by James D. Okun, MD

 

 

James D. Okun, MD is a Phi Beta Kappa graduate of Duke University and of the Albert Einstein College of Medicine in New York. He is the co-author of The History of New Innovations in Modern Medicine and of Erasing Scars: Herpes and Healing.


“Health is not just order; it is the oneness of order and freedom, or order and new possibility” (Eli Siegel in TRO 149 Feb 4, 1976)

Diabetes Mellitus type 2 is a disease in which there is a discord between the amount of sugar released into the bloodstream by the liver after digestion (excess glucose stored as glycogen in the liver is released back into the bloodstream between meals when sugar levels are low) and the pancreas’ failure to produce enough of the hormone insulin to keep blood sugar levels in a normal range.

It is thought that “insulin resistance” causes diabetes to develop when insulin receptors on fat, muscle and liver cells become resistant to the effect of insulin leading to elevated blood sugar levels (hyperglycemia). Conditions such as a “fatty liver” are thought to predispose to insulin resistance. According to MedicineNet.com “ With insulin resistance, the pancreas produces more and more insulin until the pancreas can no longer produce sufficient insulin for the body’s demands, and blood sugar rises.” Basically, the pancreas “burns out.”

Chronic stress can also lead to elevated blood sugar levels due to the effects of the “fight or flight response” which leads to the release of the stress hormones epinephrine and cortisol which then stimulate the release of more sugar into the bloodstream to deal with the “emergency.”

In addition, according to the psychosomatic approach as discussed in “Psychosomatics” (Howard R and Martha E, Lewis Pinnacle Books 1972 pp. 77-78) “Dr. Dunbar found the typical diabetic to be indecisive, frequently letting others make decisions and then bearing his lot with much grumbling, rarely doing anything to relieve his seeming hard luck. In early childhood, most diabetics were torn between resenting their parents and docilely submitting to them. Many were spoiled children. Diabetic men especially were dominated by their mothers and dependent on them.”

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Copyright 2004 Medical Illustrations by Lik Kwong Kluwer/Lippincott Williams and Wilkins

 

The name diabetes is derived from the Greek term “diabainein” which means “a siphon” referring to the fact that patients with diabetes usually have a significantly increased amount of urination. The term Mellitus which in Greek means “like honey” was added later and describes the often sweet odor of urine which is due to elevated levels of sugar. Other symptoms of diabetes include increased thirst, fatigue, frequent infections, slow healing, visual changes and increased hunger (polyphagia). Patients often experience hunger despite eating a full meal because sugar from the blood stream is not entering into cells and so the body’s cells are “starving” for nutrition.

The pancreas is an organ in the posterior abdomen lying horizontally behind the stomach and in front of the spine. It has a head, a body, and a tail. There are two main types of cells in the Pancreas that make up what are called “the islets of Langerhans.” These are the cells scattered throughout the pancreas known as endocrine cells that secrete hormones directly into the bloodstream. The beta cells of the islets of Langerhans produce the hormone insulin and the alpha cells produce the hormone glucagon.

 

If the blood sugar is too high (normal blood sugar levels 70-99) then the beta cells of the islets of Langerhans produce more insulin to move more sugar out of the bloodstream and into the celIs. If blood sugar is too low (hypoglycemia) then the alpha cells of the islets of Langerhans produce more glucagon to raise the blood sugar.

It is when the balance in the regulation of sugar is disrupted, and levels of blood sugar remain elevated that diabetes develops.

Risk factors for diabetes include obesity, lack of exercise, genetics and what is known as the metabolic syndrome. In this syndrome there is an increased risk of diabetes if “a man’s waist size is greater than forty inches, his HDL (or good cholesterol) is less than forty mg/dl and his blood pressure is 135/85 mm Hg … and his fasting blood sugar is greater than 110.” (The History of New Innovations in Modern Medicine Chapter 6 https://goo.gl/yYdgLJ).

Damage from diabetes includes damage to blood vessels that supply crucial “end organs” such as the kidneys, the heart, the eyes and the brain. Another crucial complication from diabetes includes the development of impotence ten to fifteen years earlier than men without diabetes (The History of New Innovations in Modern Medicine Chapter 6). Diabetics can develop kidney failure, cardiovascular disease, strokes, peripheral vascular and nervous system disease and may require amputations of digits or limbs.

Treatment of diabetes first begins with an attempt to lose weight through exercise and diet. If this fails to lower blood sugar and the HgbA1C ( the average amount of sugar on red blood cells over a three month period) stays elevated, then medication may be indicated. Normal HgbA1C level is less than 5.7%. Pre-diabetic levels are between 5.7% and 6.4%. HgbA1C levels greater than or equal to 6.5% indicate diabetes (labtestsonline.org).

 

Medication to treat Diabetes include: sulfonureas which stimulate the pancreas’ beta cells to release more insulin, alpha-glucosidase inhibitors which block the breakdown of starches in the intestines, metformin which decreases blood sugar by making muscle cells more sensitive to insulin, meglitinides which stimulate increased insulin production, thiazolidinediones which decrease sugar production in the liver, DPPH inhibitors that interfere with the breakdown of GLP-1 thus reducing blood sugar levels, SGLTZ inhibitors that block glucose reabsorption in the kidney and exogenous insulin given by injection, via an insulin pump or by inhalation.

Potential side effects of some of the medications mentioned above include increased the risk of heart failure, liver problems, increased urinary tract infections and even kidney failure.

To sum up, the causes of diabetes are multifarious involving external factors such as diet and exercise and internal factors such as stress and attitude. The hope is that the condition can be prevented or caught early enough to treat effectively to avoid what can be devastating consequences.


James D. Okun, MD is a Phi Beta Kappa graduate of Duke University and of the Albert Einstein College of Medicine in New York. He is the co-author of The History of New Innovations in Modern Medicine and of Erasing Scars: Herpes and Healing.

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