Maybe diabetes is more complicated than it seems? (Part 1)
Diabetes is a common chronic disease in North America and is on the rise in not only the US and Canada, but worldwide. Statistics from the Canadian Diabetes Association estimates that 11 million Canadians have diabetes or have prediabetes. In a country whose population is only 35 million… that is a BIG percentage!
Diabetes essentially is an inability for our body to regulate blood sugar. When we eat, our body breaks down into the three macronutrients: carbohydrates (ie sugar), proteins
and fats. When there is sugar in our bloodstream because of the food that we ate, insulin gets secreted from our pancreas and signals the body to take up the sugar into the cells of our body. This sugar is called glucose. When a person is diagnosed with diabetes, it means that this process of taking up glucose by your body responding to insulin is impaired. Our body doesn’t respond to insulin as well anymore. This is called insulin resistance.
There are three classically considered types of diabetes and one newly coined term when we talk about diabetes. These are
1. Type I Diabetes Mellitus (T1DM).
In T1DM, this is when the body attacks and kills the cells in your pancreas that release insulin. For people with T1DM, their body doesn’t have any insulin to release when sugar goes into the blood stream. This type of diabetes is usually diagnosed when you are younger, though some adults develop it. Persons with Type 1 need to take insulin from the time they are diagnosed.
2. Type II Diabetes (T2DM)
T2DM is the most common type of diabetes making up about 95% of cases in the US. With T2DM, people develop insulin resistance (like we talked about above) and so their body stops responding to the insulin signal. What this does is creates longer periods of time with higher than normal levels of sugar in our blood. Over time, this high blood sugar can lead to complications and issues.
3. Gestational Diabetes (GD)
GD is when diabetes develops during pregnancy. It happens to between 3 to 20% of expecting moms. It is thought that this can happen because of the change in hormones and some of the hormones that the placenta develops during pregnancy. This can create a diabetic state in mom. This doesn’t mean that your baby will be born with diabetes but it is something that your healthcare team will need to monitor.
4. LADA (Latent Autoimmune Diabetes in Adults)
LADA is a hybrid form of diabetes, with aspects of type 1 and type 2. Persons in this category are few. It is when people are diagnosed with T2DM but show signs of autoimmune dysfunction like in T1DM. This creates a condition where your body is resistant to insulin but you also have less cells that create the hormone because your body has destroyed some. This diagnosis is relatively new and doctors are still trying to investigate risk factors and what causes LADA to occur.
How do you know if you have diabetes?
Diabetes is usually diagnosed by a blood test. There are a couple of ways that this is done … a fasting glucose test, an HbA1C test or a oral glucose tolerance test (OGTT). All give slightly different information relating to a diagnosis and all can be important.
Hemoglobin A1C (HbA1C)
This is a test of some of the markers on your blood cells. When you have higher levels of sugar in the blood, your blood cells adapt to it. They do this by binding sugar onto the outside of the cells. Our blood cells are alive for 3 months before they break down and new ones form. This blood test essentially shows you for how long over the last three months, your blood sugar has been higher than it should be.
Normal levels are under 6%.
Prediabetes is 6.0%-6.4%
Diabetes is over 6.5%
Fasting Glucose Test
This is a blood test that is done when you have been fasting for at least 8 hours. It’s usually the first test done if you doctor is worried about your blood sugar.
The glucose test can be measured in either mmol/L or mg/dl (I think this is a Canadian versus American standard but don’t quote me on that).
Normal values are under 6.8 mmol/L or 108 mg/dl.
Oral Glucose Tolerance Test (OGTT)
I don’t know whether I would like this test or hate it. An OGTT is when you are given a big dose of sugar and you see how your blood sugar responds to it two hours after. For people who don’t have a strong insulin response, the sugar stays in the blood for longer. Hence the diagnosis of T2DM or T1DM.
Normal values are less than 7.8 mmol/L or 140 mg/dl.
Why did I say that diabetes isn’t that simple?
Because of the growing concern of especially T2DM, a lot of research has been done on what causes it and what happens in the body for people who are diagnosed. Previously, people thought that it was just an issue with your pancreas and the hormone insulin. We are starting to realize with more research, that it is WAY more complicated than that.
Currently, there are eight different areas that appear to be involved in the development specifically of T2DM. These include the alpha and beta cells of the pancreas, the gut, the brain, the muscles, the liver, the GI tract and the kidneys. It is actually a hormone milieu that happens over time and leads to the issues we see with diabetes.
Because of this new information, doctors and researchers are learning about new targets for medications. They are also calling for individualized treatment plans for people depending on some of these markers. I think we are going to see a lot of shifts in the way we handle diabetes in the years to come.
Brunton S. Pathophysiology of Type 2 Diabetes: The Evolution of our Understand. J Fam Pract. 2016. 65 (4 Suppl).
Skylar JS, Bakris GL, Bonifacio E, et al. Differentiation of Diabetes by Pathophysiology, Natural History and Prognosis. Diabetes. 2017. 66(2): 241-55.