Understanding Diabetes

Understanding Diabetes

by Dr. Michael B. Finkelstein, M.D., F.A.C.P., A.B.H.M.
posted on August 14th 2010

Diabetes is a chronic metabolic disorder characterized by elevated levels of blood sugar. 

There are several “forms” of diabetes and the nomenclature has been modified over the years, particularly recently now that a “new epidemic” of young people suffering from diabetes has evolved. 

Typically, Type 1 diabetes is an autoimmune disorder: A person’s immune system attacks the pancreas, destroying the cells that produce insulin, which is needed to metabolize blood sugar. Usually, the onset of this is in childhood, though younger adults are sometimes affected as well. Once a person’s pancreas is “destroyed” in this way, at the current time, other than the promise of pancreatic cell transplants (still somewhat experimental), the person usually requires supplemental insulin (in the form of injections) to control the impaired glucose metabolism (how we handle sugar and carbohydrate) that results. 

In type 2 diabetes, elevated blood sugar levels usually occur because a combination of poor diet, a sedentary lifestyle, and weight gain creates a condition known as insulin resistance: The pancreas produces insulin, but the body can’t respond to it efficiently. Often there is a strong genetic component operating in this form and is thus more likely to run in families. Up until the last decade, this form of diabetes was most common in older people who, as mentioned, aggravated whatever genetic tendency they had by poor diet and other “less than ideal” lifestyle choices. However, the growing incidence of this condition in children as young as 7 reveals that a lifetime of bad choices may not be necessary. Given the right conditions, e.g. poor nutrition in pregnant mothers, as well as devastatingly bad food choices for infants and children, coupled with stress and perhaps environmental toxins may be enough. Certainly, whatever the cause, the fact is the same, children are now getting what used to be called, “adult onset diabetes”. Indeed, while not the primary focus of this article, it is a cause for concern, if not alarm: what are we doing to make our children so sick? And, might this contribute to other conditions for adults and children we are not even aware of yet? 

All forms of diabetes increase the risk for heart disease, but people with type 2 diabetes — which is often accompanied by various cardiovascular risk factors such as high blood pressure, high cholesterol, elevated triglycerides, and obesity — are especially at risk. That is why an adult diagnosed with diabetes has the same high cardiac risk as someone who has already had a heart attack. But everyone with diabetes, regardless of type or when it was diagnosed, has reason for concern. Between 65% and 75% of people with diabetes can expect to die from some type of cardiovascular disease — a death rate that is two to four times that of people without diabetes. 

While experts don’t fully understand the causal relationship, it appears that the long−term elevated blood sugar and low−grade inflammation that results from other aspects of “impaired metabolism” that is seen in diabetes damage the coronary arteries, speeding the process of atherosclerosis. Heart attacks and other cardiovascular problems are not only more common in people with diabetes, but they occur earlier in life and are more likely to be fatal than in people without diabetes. 

So what do you do to protect yourself if you have diabetes? Like everyone at risk, it will be important for you to learn about and to practice a healthy lifestyle (see "Lifestyle changes to protect yourself"), control blood pressure, watch your weight, and keep cholesterol levels within normal limits (see sections that follow). Smoking is a double whammy. So if you do smoke, you know what you need to do. While none of this may be easy, there is no debating how important it is. 

Lifestyle changes to protect yourself:

Nothing will offer you a greater chance to be spared from the ravaging consequences of diabetes than how you take care of yourself. Here, there are three major components. And while each could be addressed separately, the fact is, the work you need to do for each is complementary to the others. For instance, a healthy diet is critical. And, it is easier to make the “tougher choices,” e.g. to control urges, when you remain active and stay positive. Thus, taken together, you should think about what you put into your body, how you use your body and what is going on with your mind. 

To begin, you need to eat smart. In this regard, it is time for you to really learn about nutrition, it couldn’t be more important. Suffice it to say that your diet needs to stay in control, otherwise, with your condition, how would you expect your metabolism to be in any better balance? A balanced diet, therefore, includes a diet that contains mostly whole foods and quantities that are just enough, not more. Sure, on occasion, Thanksgiving for example, it is appropriate to enjoy the bounty of what is available. But moderation will be necessary for you to make a difference. The fewer calories you consume from foods that are processed (in cans, boxes, packages, particularly food with a shelf life of more than 2 days), the better. This website is devoted to providing you information over time that will help you get there, but without the anxiety of having to do it all at once....we know that can be overwhelming. Thus, a good place to begin is with the recommendation above—whole foods and moderate quantities...just enough. 

Clearly, when you live a busy life, and are stressed to any degree, you will have to address this, or any substantial shift in your diet will feel too burdensome. Here I’d recommend at least a daily walk outside for 20 or 30 minutes. For some this might seem like too much. But I would urge you to try it for a month. I predict that it will empower you to accomplish the balance that you will need to lessen the impact diabetes has on your life. The importance and value in an improvement in mental attitude cannot be overestimated. Regular activity and stress management are thus the second and third component of the lifestyle changes that you must consider. As you can see these go hand in hand. 

Cholesterol (lipid profile) and Blood Pressure

Similarly, the need to address your cholesterol and blood pressure may initially seem like additional work. However, the good news is that the lifestyle improvements that were recommended in the preceding paragraphs are exactly what you need to handle the task of improving your lipid profile and blood pressure. This is the beauty of an integrated approach. Too often one set of recommendations seems to be at odds with another and people feel caught in between, often become immobilized. But, this is not the case here. Instead, if you work on what you put into your body, how you use your body and what is going on in your head, you will be far down the road to a better future. 

In short, diabetes often complicates the lives of those who have it. But, the degree of suffering will be dependent on what you do from this point on. The advice contained above is practical and for most, can be done in a stepwise fashion so that everything doesn’t have to change all at once.

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