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Sunday, March 9, 2014
Quality Health Care and You - Diabetes
Types of Diabetes
What are the different types of diabetes?
First, let's address what diabetes is. Diabetes is a medical syndrome or group of findings which include abnormalities in how the body utilizes or stores the common sugar, glucose, as well as in how it utilizes the building blocks of protein and fat.
Diabetes can go on for many years and these abnormalities can result in damage to a number of body organs or systems. This damage is referred to as diabetic complications and they particularly affect large and small blood vessels and nerves. As a consequence of this damage, the complications of greatest concern include damage to:
- eyes leading to blindness
- kidneys leading to kidney failure
- large blood vessels leading to heart attacks and strokes
- nerves and blood vessels, sometimes leading to amputation of feet or legs
These are the worst things that can happen but for the most part, they can be prevented or delayed by overcoming the problems with metabolism of sugar, fat and protein.
Key to this prevention is careful attention to what the person eats and their physical activity. Other preventive steps depend on whether the person has type 1 or type 2 diabetes and what stage it has reached.
Type 1 Diabetes
Type 1 diabetes is a condition in which the body has completely lost the ability to produce insulin, a hormone which regulates how those fuels are distributed to tissues. In type 1 diabetes, generally the insulin is lost because the cells in the pancreas which produce the insulin have been destroyed.
Type 2 Diabetes
In contrast, type 2 diabetes is a condition in which there is a combination of two problems: first, the tissues which ordinarily respond to the insulin do not respond as well, so-called 'insulin resistance'; second, the insulin producing cells may still be able to produce some insulin but do not produce enough to overcome the insulin resistance. Over the course of time, people with type 2 diabetes who are initially able to make some insulin progress to the point where their pancreases may no longer produce insulin.
For the treatment of diabetes, we therefore have available some drugs (approved by the federal government Food and Drug Administration) which replace the insulin that is not made, some which stimulate the pancreas beta cells to produce more insulin, some which improve the target tissues ability to respond to insulin, one which reduces the production of sugar by the liver and one which reduces how rapidly foods like starches are broken down in the intestine to small sugar molecules that can cross into the blood stream.
Type 2 diabetes is in the news now because many people are developing it that didn`t use to. This is thought to be because increased body weight and an inactive life style are common and increase the risk of this disease. So there are efforts being devoted to recognizing this risk and preventing the type 2 diabetes in the first place.
The important messages are that it may be possible to prevent or delay the development of type 2 diabetes and that is worthwhile because of the long-term damage the disease causes. Even when people do develop type 2 diabetes, the major emphasis should be on controlling the disease in order to prevent the major long-term consequences and to minimize the effect the disease has on people`s lives on a day-to-day basis. Additional information is available at the web site for the American Diabetes Association.
Robert M Cohen, MD
Professor of Clinical Medicine
College of Medicine
University of Cincinnati