Understanding diabetes, its causes, the various types and its place in history: Part 1

Author’s note: This is the first of a three-part series about diabetes. Part 1 offers a basic overview of the disease and its different types. Part 2 discusses ways to control it with pills, diet and exercise. Part 3 considers the new treatment possibilities, including medicines, as well as the Spanish names. 

 By Garnett Stewart

In the United States deep south, relatives would frequently remark, “He’s got the sugar,” after a patient was diagnosed with diabetes. We would find pastries and candy bars in the back packs and garments of the comatose patients as they were wheeled into the emergency room. Of course, there was also a bottle of cheap wine or alcohol, a pack of Camel cigarettes, and fattening snacks like cheeseburgers.

These patients were unconscious due to the toxic level of ketone bodies from not getting energy from glucose. The body literally was eating its muscles to survive. Muscles break down to make glucose and amino acids but this creates waste ketones. This ketone acid builds up and wreaks havoc. The body lives in a narrow balance of acid and alkaline. Out of balance pH is a killer. The family and patient are referred to diabetic support groups including endocrinologists, dieticians, and nutritional consults. The first time new diagnosed diabetic is given a huge immersion in medicine and often the overwhelming result is a terribly confused patient and support persons.

Due to the severe nature of diabetes, early medical biochemists dedicated their resources — limited in terms technology — to studying it. Our focus was on normalizing blood sugar levels and trying to reverse this poisonous and fatal situation, with limited laboratory testing. Intravenous hydration and intravenous insulin were a common protocol. The patients were almost dead, had lost consciousness, and had an alcoholic (moonshine-like) stench. The highest blood sugar I ever saw was 1906 mg/dl. The authorities were unable to establish that the husband had attempted to murder his wife. From her coma, she never came out. He succeeded.

The conversion of refined sugar to glucose was the main topic of discussion in the diabetic literature after WWII. Diabetics used to follow a diet plan, a food pyramid, and a urine test to measure their ketones and glucose levels to monitor their health. They only sought care in the hospital when they were very unwell. People did not thrive. Death was common and early in their illness.

Outside of the hospital, there was no real-time information. The best we could do is evaluate their urine. Urine glucose levels ranged from 1+ to 4+, while ketones were found to be low, moderate, and high. The toilet bowl was our only tool outside the hospital. Based on urine results, the patient was given insulin in varying doses.

It is challenging to understand this metabolism system in a straightforward manner. The body needs to get rid of the toxins that are created by its continuous work. To complete this work, we will use multiple organs and thirteen body systems. Every system has an on/off switch. There is a deceleration process for each acceleration. The issue of basic survival is to keep the body breathing and the heart pumping blood at a functional pressure. The brain needs blood, oxygen, and glucose to work.

Many people have performed CPR or learned it. It was not until the most recent century that we have the technology to “see” the cells at action. We profit from the latest developments in industrial medicine. Physicians are trained to examine organs. Now that we have cellular survival under control, we can focus on cellular operations and function.

The true means of survival for a human cell is its metabolism. Glucose is the energy required.  Think about the automobile’s gasoline needs. No fuel. No nothing! Cells require glucose to produce energy to continue living.

Are you aware of how diabetes was identified in the past?

• Egyptian scientists acknowledged diabetes as early as 1500 BC. They noted the typical signs and symptoms. intense thirst, intense appetite, and quick weight loss. Once these patients began to exhibit signs of diabetes, their lives did not last long. The patient often passed away in a coma.
• In 600 BC, scientists saw ants being attracted to a person’s delicious urine. With no indoor plumbing, both sexes utilized urinals and chamber pots.
• During the Middle Ages, physicians in Egypt, China, and India drank urine to test its sweetness.
• Urine test strips were invented at the close of World War II. This was groundbreaking for the diabetes community. The Jamaican Hospital Newsletter is cited for our history.

It is obvious that the individual with diabetes around 1000 BC was consuming food to try to sate their intense hunger. Their ravenous cells pleaded for more fuel. They were consuming large quantities of liquids, including alcohol. Nobody really wanted to be a part of their lives because most of them displayed extremely rude actions. Physicians could not provide much help. The religious and ecclesiastical communities assisted the priests and clergy who worked as nurses till their deaths. Injuries would smell and fester. They were repulsive, demanding, and difficult. Although it’s less common now, this still happens occasionally.

There are four types of diabetes:

• Gestational A pregnant person with gestational diabetes is unable to regulate her blood sugar levels. The infant absorbs excess weight and a host of medical issues just like a sponge. The baby gains over 10 pounds during the pregnancy, and many times the mother and child do not make it through labor and delivery. If the infant lived, its high-sugar world would abruptly come to an end. After delivery, those babies who made it often passed away soon after. Now every newborn has a blood glucose test as part of their routine delivery.
• The disorder known as diabetes insipidus exhibits an improper balance of salt and water. These individuals urinate copiously and are quite thirsty. Bedwetting can begin in adulthood. Dehydration is the result and it can be fatal. With a diet low in sodium, there is a good chance of control. Hormones that can cause self-harm are secreted by the adrenal glands. In a single day, I witnessed a patient lose three and a half gallons of urine
• Diabetes Mellitus Type 1 Initially known as juvenile diabetes because the pancreas cannot produce insulin in young individuals. 14 is the average age of onset. The medication is insulin. There’s no remedy or cure only control. Life expectancy is shortened. .
• Diabetes Mellitus Type 2 typically begins in adulthood at age 50 or older. Regretfully, teens are increasingly at risk for diabetes as a result of poor eating habits, obesity, and inactivity. The pancreas produces insulin, which needs to be adequate and efficient. Those with type 2 diabetes experience low production and insufficient amounts of insulin. Most react to oral medication, but many also require subcutaneous insulin.

Four abdominal organs are neighbors:

• Gall bladder – bile digests fat to give us cholesterol
• Liver – very complex organ with multiple productions of hormones and enzymes
• Pancreas — Insulin is made here along with enzymes
• Stomach and small intestines – Beginning of digestion and the breakdown of and absorption of nutrients

Except for the gall bladder, which is a balloon of bile that emulsifies fat, all of these organs generate multiple hormones and enzymes for digestion.

Once food reaches the stomach, it is churned until it becomes liquid. Enzymes are deposited here for digestion when this liquid form reaches the small intestine. Hormones control acceleration or deceleration of digestion. The pancreas, liver, and gall bladder all feed into a single, larger tube, which can get clogged by gall bladder stones. Gall stones can obstruct flow and cause pancreatitis and hepatitis.

Reducing fat to fatty acids and glucose, proteins to amino acids and glucose, and carbohydrates to glucose is the objective. Toxins and waste products are produced during the breakdown process. Urine and stool eliminate waste pollutants. We also exhale acids. But note that all food components become glucose. Not just carbohydrates as originally thought. It is not about “the sugar”!

The 37 feet of intestinal lining is where absorption begins. The liquid runs like a garden hose as soon as it enters the big intestine. It is dehydrated. Nutrients are recycled and absorbed. The act of eliminating waste from the feces is known as stooling. We recycle 85–90% of the total amount of water required, and we only consume a small bit of fresh water per day. As food components are broken down within, vital water is also created. This system is quite amazing.

Insulin fails to fit the door lock necessary to exit the bloodstream and enter the cell in both Types 1 and Type 2 diabetes. Cell fuel is vital. Insulin functions as a doorman. Insulin opens the channel for blood glucose to enter the cell’s core. We are thirsty, hungry, and urinate a lot if the glucose does not enter the cell. We perish if we run out of energy. We can even digest ourselves to glean the glucose for energy.

It’s challenging to talk about this incredibly complicated metabolism process in a simple fashion. A basic understanding is needed and many people inadequately understand these principles.

Why are amino acids and cholesterol necessary? Since amino acids are a component of DNA, the DNA strands need to be supplied with amino acids in order for the cell to divide. No amino acids; our cells perish. Cholesterol is fat. Fat is an insulator. You may not know this but cholesterol is one component of every cell wall in your body. Three layers make up the cell wall: the outer layer is protein; the middle layer is cholesterol and the inner layer is protein. Because waste must exit the cell or it will die, and because glucose must enter the cell to provide fuel, the cell wall is not constantly closed.  I envision a rotating door that keeps turning in my three-dimensional mental image of the cell wall. Glucose in and trash out. Water out and cofactors of cellular life in.

The human body is equipped with numerous safeguards. Excess glucose is converted by the liver into a molecule that may be stored, and this fat can eventually form “gut” adipose tissue. This fat serves as a reserve in case the fuel supply runs low. In a sense, it’s a reserve tank. Therefore, even after a binge of food or drink, our blood sugar should be stable. Too much leads to storage and we frequently store too much.

In my 3D fantasy, I see a doorman inside the rotating door who only wants the greatest glucose to be inside. He is snobby. Insulin of high grade will transport his chosen glucose inside. Type 2 diabetes is a result of both inadequate and insufficient insulin. The pancreas has just been overworked and extremely exhausted — it hasn’t failed as it does in Type 1. Insulin is, obviously, the treatment. However, because the pancreas may still produce some insulin on its own, oral medications can boost the amount of good insulin produced and change the composition of bad insulin. Insulin is called resistant because it is of lower quality and it cannot accomplish as much as it should.

I tried to make this informative but not too dry. Next parts, we will go through the popular drugs used in Ecuador and other therapies. Diet changes and more will be discussed. Thanks for finishing the article.
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Garnett Stewart is a permanent resident of Ecuador. She is a retired Adult Medicine Nurse Practitioner with a specialty in Cardiology and Cardiovascular Surgery and is the author of several published articles. She holds Bachelors and Masters degrees in nursing. Her undergraduate university studies focused on biochemistry and biophysics. She can be contacted at Ecuador.advice@gmail.com