Diabetes Melitus

Diabetes Melitus

I promise to only get slightly technical in this piece… here we go! 

The Difference Between Type I and II Diabetes

Diabetes is classified as either type I or type II and is a disorder in which the body cannot metabolize glucose.  Type I, also known as insulin-dependant diabetes mellitus (IDDM), describes an inability to secrete insulin, due primarily to the failure of the b-cells in the pancreas.  We need exogenous insulin in order to avoid life-threatening situations, hence “insulin-dependant.”  Type II, non-insulin-dependant diabetes mellitus (NIDDM), is thought to be due to insulin resistance in peripheral tissue.  In other words, insulin is produced, but the target cells in the body fail to recognize its presence.

How Insulin Works in the Body

First, let’s take a closer look at insulin as a hormone.  Insulin is responsible for energy metabolism after we’ve eaten a meal.  It signals specific enzymes to increase glucose uptake in the muscles and liver and increases the production of glycogen and fatty acids.  It also influences production of stored fat (lipogenesis) by promoting the entry of glucose into adipose tissue (fat) and inhibits the use of stored triacylglycerols (fat).  A good analogy for insulin is to picture the hormone as a big bulldozer, which not only pushes substances into cells, but also blocks many substances from exiting the cell.

How Insulin Plays a Role in Diabetes

Now that we better understand the effects of this “bulldozing” hormone, we’ll apply it to diabetes.  Regardless of the type, the bulldozer (insulin) is powerless in pushing glucose into cells in a person with diabetes, which causes hyperglycemia.  Prolonged hyperglycemia begins a chain of events (osmotic diuresis, water and electrolyte loss, dehydration, hypotension, hemoconcentration and decreased renal and cerebral blood flow), which leads to a coma or death.  Individuals with type I diabetes must inject insulin daily to prevent hyperglycemia and be careful not to induce hypoglycemia (too much insulin and not enough glucose).  Type II (non-insulin-dependant) diabetes is typically caused by excessive food intake and a lack of exercise.  In time, receptor cells in peripheral tissues down regulate, becoming insensitive to excessively high levels of insulin.  There’s a picket line in front of the bulldozer!  Type II diabetes can be prevented by incorporating fitness and sensible dietary habits early in life.

What You Can Do to Lessen The Effects of Diabetes

Exercise is important for anyone with diabetes.  It helps patients control weight, improve insulin sensitivity and glucose tolerance, decrease blood pressure, bring about a healthier mental outlook and reduce cardiovascular risk factors.  Exercise also reduces the effects of those hormones that counter-regulate insulin by finding different bulldozers (hormones) to push glucose into the cells for utilization.  It is important to monitor both pre- and post- exercise blood glucose levels to be safe.  Also, packing a snack while exercising outside or away from home prepares patients for times when they feel poorly.  Those of you who have diabetes and are exercising… keep it up, your body will thank you!

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