What exactly is diabetes mellitus, also known as sugar diabetes or just diabetes? There are two types, aptly named Type I and Type II, but almost all diabetics are Type II. Mellitus means honey or sweet. Diabetes means "straight through." When our sugar levels are elevated, what we drink runs straight through us. Diabetics are often thirsty and have to empty their bladders frequently.
Most of us associate diabetes with an elevated sugar level. That is true, but it is important to understand that diabetes is much more than elevated sugar. It represents a constellation of problems including kidney failure, blindness, nerve pain (especially in the feet) and significantly elevated risk of infection, heart attack and stroke.
In fact, when we treat diabetes, we focus more on cholesterol, blood pressure and obesity than we do on lowering blood sugar. Elevated sugar affects the kidneys and nerves, but elevated cholesterol and high blood pressure can lead to strokes and heart attacks, which are more life-threatening.
Diabetes starts when our muscles and organs become unable to absorb sugar from the bloodstream. In diabetes, the insulin receptors on the organs become inoperable. Imagine a river barge being unable to unload its cargo onto the dock because the dock is falling apart. When that happens, our organs and muscles become starved of the glucose they need to function, and blood sugar levels rise above normal (79-99 milligrams per deciliter). We call this "impaired glucose intolerance." It is the physiological root of diabetes.
The combination of elevated sugar levels in the blood and low sugar levels in the organs slowly causes organ failure. The kidneys suffer and retinas breakdown. This is why diabetes is the No. 1 cause of renal failure and blindness.
The sugar imbalance also wreaks havoc on the nervous system causing problematic numbness and painful sensations in the feet and hands. Remember when you were a kid, and you would sit with your legs crossed underneath you? Soon, your feet would "fall asleep," and you would experience a pins-and-needles sensation for a few minutes. That kind of pain is what diabetics suffer.
Foot numbness combined with an impaired immune system and poor peripheral blood flow (both related to diabetes) explains why diabetes is the No. 1 cause of foot amputations. Dr. Paul Brand, a missionary physician who pioneered novel surgeries to treat leprosy patients, wrote a book called The Gift of Pain.
Brand's leper patients suffered from a loss of sensation and motor nerve function to their extremities. They would step on a hot coal without realizing it, not noticing the burn until days later after the wound had festered. In his book, Brand discusses how without painful stimuli, we are unable to avoid destructive activity (As we say at church, "That will preach."). Diabetics can get in the same sort of trouble when their foot sensation declines.
Attention to diet is the diabetic's first treatment concern. Diabetes levels in the population are lower in places where people walk more and drive less and where fattening food is less readily available. My patients frequently ask if they should eat more protein and fat and less sugar. While balancing the three caloric types is important, what is critical is limiting the caloric intake to a level that achieves and maintains a healthy weight.
The reason caloric restriction ranks first on a diabetic's health (to-do) list is that our bodies are so efficient at using energy. Particularly after age 30, if we eat just a little more than what we need to survive, we store it away in the form of fat. Getting rid of that extra energy takes a significant amount of work. The best illustration I've heard is that if you eat a Baby Ruth candy bar, you will have to expend the energy equivalent of climbing all the stairs of the Empire State Building to burn it off!
For my diabetic patients, I recommend eating a 2,000-2,200 calorie-per-day diet, preferably consisting of Mediterranean foods such as olive oil, fish, nuts, tomatoes, pesto and whole grain pasta. These foods have other benefits for cholesterol lowering and blood vessel health. If Mediterranean food isn't palatable, patients should still keep their calories under 2,200. Calorie counting apps, such as myfitnesspal.com, can be helpful in achieving and maintaining a low-calorie diet.
Exercise and fitness also play a significant role. Exercise is the only known way to lower glucose intolerance. A brisk one-hour walk burns about 100 calories per hour or approximately two Snack Wells cookies. "Cardio" exercises, such as running, cycling and swimming, are particularly helpful. These activities increase our heart rates to high levels, and it is this elevated heart rate, sustained for 20-30 minutes, that we think causes glucose intolerance to decline. A good exercise target is a heart rate of 200 minus your age for 30 minutes, three - four days a week.
Medications can be helpful, as well. The oldest are injectable insulin and pills that cause the pancreas to increase insulin release. (Insulin is a hormone produced in the pancreas that drives blood sugar into our organs and tissues.) Metformin is an older drug that induces weight loss and slows the production of sugar in the liver. I typically start all my patients on metformin when they present with a new diagnosis of diabetes. Some of the newer medications work by limiting sugar absorption from the GI tract, slowing the activity of glucagon (a hormone that increases blood sugar levels) and inducing our kidneys to release sugar into the bladder.
Elevated blood pressure and high cholesterol almost always exist in the presence of elevated sugar levels. For that reason, most diabetics should take blood pressure and cholesterol medications. Lastly, all diabetics should take a daily baby aspirin, unless they have an aspirin allergy or intolerance.
Diabetes can be fulfilling to treat because effective management can prevent a host of painful conditions.
