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Female hands testing blood sugar with a glucometer

What is Type 2 Diabetes and Why Is It Such a Big Deal?

Type 2 diabetes is the fastest growing disease in the world with nearly half a billion people affected. Globally 1 in 11 adults has diabetes, 95% of which is type 2 diabetes. What’s even more alarming is that type 2 diabetes, previously known as adult-onset diabetes, has increased at a rate of nearly 5%  each year in the US between 2002 and 2015 in people UNDER the age of 20. A British study showed that the lifespan of people with diabetes was shortened by an average of 8 years. 

With one in twenty Australian adults currently diagnosed with Type 2 diabetes and the same number estimated to remain undiagnosed, there’s never been a more crucial time to understand what exactly diabetes is and why it’s so dangerous. 

Pre-diabetes

Insulin resistance is the first stage of developing Type 2 diabetes. Insulin is a hormone produced by the pancreas to control the amount of sugar (glucose) in the blood. We get glucose from digested carbohydrates – foods such as grains, fruits, vegetables, dairy products, cakes, sweets and soft drinks. Whenever we consume these types of food and drink, as they are digested glucose is released into the bloodstream. The pancreas, which is an organ that sits behind the stomach, literally tastes the sweetness of the blood and starts releasing insulin whose role is to grab glucose out of the blood and move it into our cells to use as fuel. This way the blood sugar level should always remain nice and steady. Insulin resistance is when cells in your muscles, body fat and organs start ignoring the signal that insulin is trying to send out. 

When glucose isn’t shifted out of the blood effectively it keeps circulating around the body rather than being used for energy by the cells. This also means that your pancreas keeps tasting this sweet blood and responds by releasing even more insulin so that your blood levels of insulin also become too high. 

The most common reason for developing insulin resistance is being overweight or obese. When a person is overweight, even the fat cells around the muscles and organs grow, creating a padding around these tissues. The padding means the signal of insulin becomes harder for the organs to read. And thin people with a poor diet can have this problem too. Ever heard of the term TOFI ‘thin on the outside, fat on the inside’? Being overweight also causes fat cells to start building up inside some of your organs disrupting the way they work. This can happen in the liver and pancreas.

Type 2 Diabetes

When the fasting blood glucose level of a pre-diabetic crosses the threshold to 7mmol/L or more on two separate occasions, a diagnosis of diabetes is given. Once you are a diabetic the key focus of treatment is to get the blood sugar levels down into a healthy range. This can actually be achieved by diet alone. Lifestyle changes are the most powerful tool to reverse Type 2 diabetes. There are also a wide range of pharmaceutical options ranging from daily tablets, to weekly injections and finally insulin itself.

Pancreas illustration

The Pancreas

In type 2 diabetes the pancreas still works but it starts to wear itself out from all the over-production of insulin. Fat build up inside the pancreas from obesity creates inflammation and damage in the pancreas. The beta cells, which are the ones that make insulin, start to fall in numbers. When there has been too much destruction of the beta cells this is the stage at which a person will need to start insulin injections.

Simple tests to see if you have diabetes or pre-diabetes

The best way to find out if you have pre-diabetes or diabetes is to ask your doctor for these five blood tests.

  • Fasting Glucose Level
  • Fasting Insulin Level
  • Fasting C-Peptide
  • Fasting Glucose Tolerance Test
  • Glycated Haemoglobin 

The damage caused by high sugar levels

Homeostasis is the state of balance created within our bodies by our brain. We need this to survive. Examples of homeostasis are body temperature, rate of breathing and blood pressure control. Our body does this all by itself, without our conscious involvement, sending signals to the brain to do certain things to help maintain the balance such as creating thirst when we are dehydrated, or sweating when we are too hot. Regulating glucose levels is also an example of homeostasis. When the balance is broken in diabetes, survival is threatened.

Our blood reaches every nook and cranny in the body, bringing nutrients to help the cells function and removing toxins that damage the cells. In diabetes, excess glucose in the blood binds itself to proteins and fats creating unstable chemical compounds called AGEs (advanced glycated end-products). Normally the body can mop up AGEs. But in diabetes, the body can’t keep up with the amount of AGEs being made. As AGEs accumulate, they lead to inflammation and premature ageing everywhere in the body, from your skin, to your blood vessels, to your brain. 

Illustration of sugar in the blood

5 examples of how AGEs are dangerous in diabetes

Kidneys  – Diabetes is one of the leading causes of kidney disease with up to one third of people with diabetes developing some degree of kidney damage, nephropathy, as a result of AGEs. In its mildest forms this can be controlled with medications, at the most severe end of the spectrum people will need either dialysis or a kidney transplant to avoid the fatal build up of toxins in the bloodstream.

Heart – People with diabetes have a 2 to 4 times increased risk of heart disease. AGEs irritate the coronary arteries, the plumbing system to the heart, making it easier for cholesterol deposits to stick. Cholesterol build-up in the coronary vessels lead to higher blood pressure, angina and even heart attacks. 

Feet – AGEs damage the small blood vessels and the nerves in the feet – peripheral neuropathy. Neuropathy can be associated with increased pain, abnormal sensations like burning or tingling and even complete numbness. People with diabetes may not be able to tell if there is an injury or damage to their toes or feet. Because they also have poor blood supply to the feet, they are at increased risk of developing gangrene in the feet. It is estimate that around the world every 30 seconds a leg is amputated because of diabetes.

Brain – AGEs can cross the blood brain barrier. We’ve known for a long time that diabetes is linked with dementia, although exactly how is not yet fully understood. AGEs damage the small vessels in the brain, contributing to vascular dementia. They may also increase the build-up of protein clusters called beta amyloid, which are associated with Alzheimer’s Disease. 1 in 5 diabetics will get dementia. 

Eyes – AGEs cause damage to the blood vessels of the retina, retinopathy. In developed countries, diabetic retinopathy is the leading cause of blindness in people between the ages of 20 to 60.

The take home message

Diabetes is not just a disease of blood sugar, it is a disease that can affect every single cell in your body. It can reduce the quality of your life by causing chronic pain, reduced vision, lack of energy, loss of cognitive function and even death. But all of this can be avoided. By choosing to live better, smarter and more healthily, it’s possible to reduce the severity of type 2 diabetes and in some cases, to achieve the miraculous and even reverse it!

If you have anything you want to ask, or if there’s a topic you’d like me to write about just let me know. 

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