Tuesday, December 11, 2007

Diabetes: Old Disease, New Remedies

Join the Team!

When you have diabetes, you become a member of a very important team. Teams need players and coaches, and, in many ways, having diabetes is similar. It's hard to manage diabetes alone. You need a coach or coaches to help you learn the skills necessary to do the very best you can and to help guide your skill development. Others, such as family members, significant others, and friends, cheer your successes and provide support when things are not going well. But coaches and others can't do it for you. You have to learn about diabetes and be the one who controls your health and your diabetes care.

The first step in joining the team is to acquire the skills you need. Any time you want to learn about a medical problem or condition, it helps to approach it in two steps. First, learn how the body functions normally. Then learn what happens when something goes wrong. This is the best way to learn about diabetes too. The Joslin Guide to Diabetes will help you learn how your body works -- what happens to it when you have diabetes -- and how to keep your body working as normally as possible.

If you have been diagnosed with diabetes, you may wonder: "Why do I need to know about diabetes? After all, isn't my doctor the one responsible for my treatment?" The answer to this isn't as simple as it seems. The care provided by your doctor and your healthcare team is a very important part of managing diabetes. But to properly control your diabetes, you are the one who must be primarily responsible.

You will also need to know your treatment goals and how to achieve them.For many individuals this may mean acquiring some new skills so you can put into action the information you have learned. This action plan is called your diabetes treatment program. However, you also need coaches. That's where your healthcare team becomes important. It can help you take the information, goals, and skills you gain from reading and practicing and put them into an individual "game plan."

And once you understand the importance of a treatment program and your role in carrying it out, you're on the way to being a successful team player. The other players are only there to assist you to do the best you can. They are important because they have a lot to share with you.

Diabetes -- an Old Disease,

but Many New Remedies

Medical descriptions of diabetes date back to at least 1500 B.C., more than 3,500 years ago. Writings from ancient cultures in China and the Middle East describe the classic signs of diabetes, such as passing large quantities of urine through the body. The ancient Greeks gave us the name diabetes, which means "to flow through." Later the Latin word mellitus (meaning "sweet urine") was added to form the present medical name diabetes mellitus. Physicians actually diagnosed diabetes in ancient times by tasting the urine, but modern physicians have developed newer methods to accomplish this!

Until recent times, people with diabetes could use only diet, exercise, or weight control for treatment. But in 1921, a major breakthrough occurred that changed the outlook and saved the lives of millions of individuals with diabetes -- insulin was discovered. Later in this book you will learn a lot about how insulin is used today. Research in diabetes has continued to make major strides. In the late 1970s it became possible for someone to check his or her blood glucose without the help of a doctor or nurse -- one of the most important advances in the care of diabetes since the discovery of insulin. Once self-monitoring of blood glucose became available, research studies of people with type 1 and type 2 diabetes were undertaken, and these studies proved that controlling one's blood glucose makes a difference. By maintaining near-normal blood glucose levels, you can prevent or slow the progression of the long-term complications of diabetes. These include problems with the eyes, nerves, kidneys, feet, skin, heart, and blood vessels. The list of advances in diabetes management goes on and on, and all of them help you to gain increased control of your diabetes and thus reduce the risk of developing complications.

Discovering Your Diabetes

If you think back to the time just before you learned you had diabetes, you may have noticed some physical symptoms and some changes in your health. For example, you may have felt very tired and sluggish because your body was unable to properly use food for energy. For some of you, the symptoms were severe enough to cause you to see your doctor to find out what the cause was. For others of you, the symptoms were mild and you had little reason to suspect anything was wrong. But what is important is that at some point you discovered you have diabetes and now you want to learn more about it.

No doubt, you felt some type of stress even before the diagnosis of diabetes. And once you realized that you had diabetes, the stresses associated with its symptoms probably didn't go away. Questions occurred to you, such as How did this happen? What causes diabetes? Can it be cured? How will it affect my daily life? Can I keep my job? What will it cost? What lies ahead? Will I still be healthy enough to do the things in life that I enjoy? Such questions are steps in the right direction. They mean you are concerned about your health. To help you with your feelings about diabetes, it's often a good idea to find someone in whom you can confide -- perhaps your physician, a healthcare professional, a family member, or a good friend.

It is extremely important that you gain a complete understanding of diabetes and methods of treatment. Diabetes is a uniquely personal condition. At first you may ask yourself, "Can I really handle this?" But your skills and confidence will grow as the weeks pass and as you learn about and have more experiences living with diabetes. Understanding diabetes will happen over time -- you don't have to learn it all at once. However, by becoming more actively involved in your diabetes management, you will feel more confident about your own ability to solve problems, less angry and fearful about diabetes, and more motivated to keep up the effort. The Joslin Guide to Diabetes will help you develop that confidence.

This book is designed to be used as a reference tool for people with diabetes who are under the care of a physician and other healthcare professionals. It was written and reviewed by a team of experts in the field of diabetes care and education here at Joslin Diabetes Center in Boston, Massachusetts. Founded in 1898 by Elliott P. Joslin, M.D., a pioneer in diabetes research and care, Joslin Diabetes Center is affiliated with Harvard Medical School and has treated over a quarter of a million people with diabetes. Healthcare providers and educators at Joslin are dedicated to making sure that people with diabetes have the very latest information and know how to use this information to improve their diabetes care. We want you to live healthfully and well with diabetes, and we think this book will help.

Copyright © 1995, 2005 by Joslin Diabetes Center
Read a Sample Chapter

Chapter 1

What Is Diabetes?

Anytime you want to learn about a medical problem, it's best to approach it in two steps. First, learn how the body functions normally. Then focus on what happens when something goes wrong. This is the best way to learn about diabetes, too. First, you need to understand how the body normally produces energy. You should then focus on how a breakdown in this process leads to the two major types of diabetes -- either your body can't make any or enough insulin, or it can't properly use the insulin it produces.

How the Body Normally Produces Energy

Quite simply, you can't live without food. The body needs food to nourish itself and sustain life. Food is both "fuel" and "building material." It produces energy, builds and repairs body tissue, and regulates body functions. But before food is used by the cells, it's put through some biological paces. First, your body must break down the food you eat into its basic ingredients, or nutrients: These nutrients fall into three major categories -- carbohydrates, proteins, and fats.

Carbohydrates are found in most foods. Often called "starches" and "sugars," they are found in bread, pasta, fruits, and vegetables. Proteins are found in meats, milk, and fish. Fats are found in such foods as vegetable oils, meat, cheese, and other dairy products. All these nutrients are digested, or broken down, in the stomach and intestines. Carbohydrates are broken down into a simple sugar called glucose, which passes through the wall of the intestines into your bloodstream. This is the form of sugar that is often called "blood glucose" or, more simply,just "blood sugar." Diabetes is a disorder in the way the body uses blood sugar, or glucose.

The Role of Insulin

Once glucose gets into your bloodstream, it circulates to the body's cells to provide them energy. But glucose can't simply flow into the cells. All cells are enclosed by a thin wall called a membrane, and something has to tell your cells that glucose is waiting outside. That something is insulin. It attaches on the outside of the cells to special sites called insulin receptors -- much like a key that fits into a lock. Insulin is the "key" that unlocks the cells, allowing glucose to enter. Once inside, the glucose is metabolized, or "burned," by the cells for energy.

Exactly what kind of substance is insulin? It is a hormone -- a chemical messenger made in one part of the body to transmit "information" through your bloodstream to cells in another part of the body. Your body produces many types of hormones. Insulin is a specific kind of hormone made in the organ called the pancreas.

The Pancreas

The pancreas is a small gland situated below and behind the stomach. In an adult, it weighs less than half a pound. The pancreas is shaped like a long cone lying on its side, with the end tapering off into a "tail." Within this tail are tiny bits of tissue called islets of Langerhans.

A normal pancreas has about 100,000 islets of Langerhans. But these islets are actually clusters of various types of cells. The most important are the beta cells -- the tiny "factories" that make insulin. The beta cells also serve as "warehouses," storing insulin until it's needed by the body.

In addition to producing insulin, the pancreas has other important duties. Some cells produce hormones that are quite different from insulin, such as glucagon. This hormone actually raises the blood sugar -- just the opposite function of insulin. The balancing act between insulin and glucagon helps keep blood sugar in the normal range, approximately 60-140 milligrams (mg) of sugar per deciliter (dl) of blood. Other cells in the pancreas produce substances called enzymes, which help in digestion by splitting foodstuffs into simpler substances, which can then be absorbed through the intestine into the bloodstream.

How Insulin Works

During normal digestion, enzymes in the stomach and intestines act upon the nutrients (carbohydrates, proteins, and fats), splitting them into simple substances, which enter the bloodstream in the following forms:

* Carbohydrates are converted into glucose, which is metabolized, or "burned," for energy.
* Proteins are converted into amino acids, which provide the basic building blocks for bone, muscle, and other tissues. Proteins also can be burned for energy.
* Fats become fatty acids, which are burned for energy or stored as body fat for later use. However, fat is burned differently from glucose, producing substances called ketones.

Insulin plays a role in the burning and storage of all these nutrients. In diabetes, however, its main role relates to the action of glucose, the simplified form of carbohydrates. The whole process works like a dietary drama. The key actors are the beta cells, which make and store insulin. When they sense the level of glucose rising in the blood, they respond by releasing just the right amount of insulin into the bloodstream.

At first, the beta cells release the insulin held in storage. But what if the body needs even more? This often happens right after a meal, and as the blood glucose levels increase, a second stage begins. The "control centers" of the beta cells trigger them to make more insulin. When functioning normally, the beta cells release just enough insulin to maintain the level of glucose in the blood within the normal range of 60-140 mg/dl, and once in the bloodstream, the insulin enables the glucose to enter your body's cells for energy.

Another process also occurs. Generally when you eat, you don't need to use all the glucose from your food immediately. The body takes some of the glucose and stores it for future needs. With insulin's help, the extra glucose is taken up by the liver cells and changed to a storage form called glycogen. Glycogen comes in handy when your body needs extra energy in a hurry, for instance, during exercise. At those times, your body rises to the occasion by quickly changing the stored glycogen back into glucose. In addition, this stored glucose takes care of your energy needs overnight, a time when you normally aren't eating. Insulin also helps convert some of the extra glucose into fat, which is stored in the body's fat cells.

What Goes Wrong in Diabetes?

Diabetes is caused by a breakdown in the normal processes described above. A breakdown can occur in one of two ways: (1) the body produces little or no insulin; or (2) the insulin that the body produces can't link up with the body's cells. Type I diabetes is the result of the first defect; Type II is the result of the second. It is important to note, however, that there are many similarities between Type I and Type II diabetes, and that some people display characteristics of both types.

Type I: Insulin-Dependent Diabetes

Of all people with diabetes, about 5-10 percent have Type I, which develops most often in children and young adults. That's why it was once called "juvenile-onset" diabetes. However, this type of diabetes can occur in people of any age.

The Problem. Type I diabetes occurs when the pancreas produces very little, if any, insulin. In short, the beta cells do not function. People with this type of diabetes are insulin-dependent. They must have daily doses of insulin from an outside source to function and survive. Insulin must be provided by injection with a syringe ("a shot"). It cannot be taken by mouth because the stomach acids make insulin ineffective.

The Symptoms. By understanding what happens when the body lacks insulin, you can understand the various symptoms of diabetes -- the outward signs that something is wrong.

Excerpted from

Joslin Guide to Diabetes: A Program for Managing Your Treatment
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