Distinguishing between controlled and uncontrolled glucose

The Big Diabetes Lie

Diabetes Causes and Treatments

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The definition of type 1 diabetes is simple: It's the lack of control of glucose in the body due to a lack of insulin. In the following sections, I explain the differences between normally controlled glucose and out-of-control glucose.

Controlling glucose normally

Glucose from the blood gets into most cells (other than those previously listed) when insulin is available to let it in. In the cell, glucose is converted into energy. If there's more than enough glucose to meet the energy needs of the individual, the excess glucose is stored in the liver and in muscle. When the liver and muscle are filled, additional glucose is converted to fat. Your body has an enormous ability to store fat, whether it comes from glucose or from the food you eat.

In a healthy person who diets, the release of insulin declines because glucose is what stimulates insulin to be released. The body then turns to the liver, where glucose is stored as glycogen. The A cells of the pancreas (refer to Figure 2-1) release glucagon, which breaks down the glycogen back into glucose to continue to provide energy.

When the glycogen is used up, the body turns to the other form of stored energy, fat. Fat is converted into compounds called glycerol and fatty acids.

1 Glycerol is changed into glucose to provide energy and is used up.

1 Fatty acids are converted into other compounds called ketones in the liver. Except for the brain, the entire body can use fatty acids for energy.

Over time, as the diet continues, the body begins to break down muscle to convert it into glucose.

Losing control of glucose

When the body experiences a complete lack of insulin, as in people with T1DM (see the next section to find out how a lack of insulin is triggered), glucose can't enter cells from the blood with the exception of those it enters passively (as I note earlier in this chapter). These cells continue to take up glucose as long as the glucose inside them is less than the glucose in the bloodstream. When blood glucose is high as a result of inadequate insulin, the cells and organs that can take up glucose continue doing so even though other cells and organs that depend on insulin can't do so. The latter cells and organs suffer the complications of type 1 diabetes that I explain in Chapters 4 and 5.

Sharing some patient stories

For some time, Vincent's parents had noticed that their 8-year-old son didn't have his usual energy. He was drinking more soda than usual and seemed to have an increased appetite. But despite eating more food, he was losing weight. Vincent looked tired, which his parents thought was because he woke up a few times each night to go to the bathroom. He even wet his bed for the first time in years. His concerned parents took him to his pediatrician, who measured Vincent's blood glucose, did a few other tests, and informed Vincent's parents that their son had type 1 diabetes. Vincent's parents were quite upset by the diagnosis, but they began giving him insulin shots and carefully monitoring his food intake. In just a few days, Vincent put on weight, stopped urinating so frequently, and was able to sleep through the night.

Lynn was a 12-year-old girl who loved to play sports. In fact, she was the best soccer player on her team. Because she was so active, she drank a lot of sports drinks and water. One day, she complained to her mother that she was very tired after a particularly strenuous soccer game on a very hot day. Her mother felt this was normal, considering the circumstances. She noticed, however, that her daughter was looking a little thinner. Between soccer games the following week, Lynn was very thirsty and going to the bathroom frequently, but her parents thought it was normal for an active young girl. However, at her next soccer game, Lynn was too tired to play for very long, and afterward, she went right home and got in bed. Lynn's mother couldn't wake her for dinner, so she called an ambulance and took her daughter to an emergency room. The doctor did an immediate blood glucose test, found it to be 618 mg/dl, and had Lynn admitted to the intensive care unit with a diagnosis of diabetic ketoacidosis caused by type 1 diabetes. Lynn received intravenous insulin and fluids and was awake and alert within 48 hours. She was converted to subcutaneous insulin injections. Lynn and her parents followed up by participating in a diabetes education program, which taught them the skills Lynn would need for the rest of her life.

These two cases are typical of the way type 1 diabetes begins, and the apparent suddenness of the disease in both children obscures the fact that it was probably developing over several months. At one time, Lynn's story was more common in that the condition was unexpected and the child ended up in the intensive care unit. Now, as a result of more awareness of diabetes in the general population, Vincent's story is the more typical one.

Despite there being plenty of glucose in the blood, insulin-requiring cells behave as though there's no glucose. The body therefore begins breaking down fat and turning muscle into glucose for those cells, leading to a large amount of glucose in the body. If this process isn't reversed by giving insulin, the person becomes very sick with diabetic ketoacidosis (see Chapter 4).

Other hormones besides insulin play an important role as control of glucose is lost. Each tries to raise the blood glucose to satisfy the needs of the tissues. I mention one such hormone, glucagon, from the A cells in the pancreas's islets of Langerhans, in the previous section. In addition, the adrenal glands located above the kidneys begin to secrete two important hormones, adrenaline and cortisol. After a while, the pituitary gland in the brain secretes growth hormone. Following is more information on these hormones:

^ Adrenaline works with glucagon on the glycogen in the liver to break it down to produce more glucose. Adrenaline stimulates production of glucose from protein. It also decreases the glucose taken up by muscle and liver cells, thus making it more available to the brain. Adrenaline turns fat into fatty acids as well. Other effects of adrenaline are shakiness, sweating, rapid heartbeat, and hunger.

^ Cortisol increases the production of glucose by stimulating the breakdown of both proteins and fats while decreasing the uptake of glucose by tissues that require insulin, like muscles and the liver, to make it available for the brain.

^ Growth hormone breaks down body fat and decreases the uptake of glucose by blocking the action of insulin where it's necessary to open the cells to glucose, such as in the liver and muscles.

Interestingly, these same hormones play important roles in raising blood glucose when it's too low for any reason (not just a lack of insulin); such a condition is called hypoglycemia, and I discuss it in Chapter 4.

Figure 2-2 shows the origins of the different hormones that affect blood glucose.

Figure 2-2:

The origins of hormones that affect glucose.

blood

Figure 2-2 shows the origins of the different hormones that affect blood glucose.

glucose.

blood

Glucagon and insulin from the pancreas

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