The Diabetes Continuum

diabetes continuum

 

 

 

 

 

 

We all pretty much know what diabetes is, essentially anyway, right?  It's high blood sugar over a certain set point of course.  Well that would be wrong in fact, as hyperglycemia, or high blood sugar, is just a symptom of diabetes, and the disease itself is the mechanisms behind the high blood sugar and whatever else diabetes may do to us, which isn't limited to just raising our blood sugar by the way.

The term diabetes may have come from the Greek word for "siphon," but that was because in the early days that's all they knew about diabetes, 2000 years ago when the term was coined, that you would urinate a lot more, so it's a disease of excessive urination then.

Well it's a lot more than this, the form of diabetes we have, and what is meant when we say diabetes, is diabetes mellitus, which was added in 1675  when it was discovered that people who urinate a lot, the diabetes part, sometimes had sweet urine, so mellitus actually means "honey sweet."

It took until 1776 though for them to figure out that this sweetness in the urine was actually due to too much sugar in the blood, but now we at least were on the right track.  In 1857, Claude Bernard discovered that this high blood sugar was caused by excessive glucose production in the liver, and now we were really getting somewhere finally.  In 1889 the role of the pancreas in diabetes was discovered, and in 1921 they started using insulin as a therapy.

We've learned quite a few things since then, and the more we learn, the more complicated this disease becomes.  We do know that diabetes is much more than high blood sugar though, or the pancreas not secreting enough insulin.  Of the two main blood sugar regulating hormones, it is glucagon and not insulin that is more central to type 2 diabetes, and excess glucagon even plays a major role in type 1 diabetes as well.

With type 1 diabetes though, removing the excess glucagon isn't going to solve their problem, as they still will produce some, and not have enough insulin to deal with it.  As far as blood sugar control goes, contrary to popular belief, it is insulin's effect on the liver and not the periphery that is fundamental, it's been shown that the rest of the body can do just fine maintaining good blood sugar even without insulin, provided that the liver is functioning normally.

We have been able to isolate the contribution of the liver to blood glucose and it has been determined that even people who normally have very high blood sugar can eat a normal diet and have normal blood sugar if not for all of this extra glucose secreted by the liver, which overwhelms one's glucose metabolism, and the more it secretes, the more overwhelmed it becomes.

Even more telling perhaps, they have removed the pancreas from diabetic rats and even with no insulin, blood sugar returns to normal, and that's because there's no glucagon being secreted either.

So Claude Bernard was certainly on the right track when he discovered the role of the liver in hyperglycemia, and we've got tons of information on this since, but we still don't focus on the liver very much when treating it.

In any case, we do know that type 2 diabetes is much more than high blood sugar, and also that it doesn't just strike us acutely, it takes years and even decades to develop.  So this is what I mean when I speak of the continuum of diabetes, and the big problem that we have when we define it as hyperglycemia over a certain range is that we don't really pay attention to it until you "get" it.

Since we don't really "get" the disease, we already have it and it just gets worse and worse over the years until it gets bad enough that you may qualify for meds, which gets the attention of doctors now, we might think about paying attention to the earlier stages as well.

Of course conventional medicine really isn't interested in preventing things, and in fact there's a lot less money to be made if you can pull this off, and this view of medicine is indeed only concerned with treating things, not preventing them.

That actually might be a good thing though, considering the quality of the little advice they do give to prevent disease, like eating a low fat high carb diet, which continues to be recommended in spite of all of the evidence we now have telling us this is a big mistake and causes disease instead of preventing it, including cardiovascular disease which is the goal of its so called prevention.

So if you are are reading this and you already have diabetes, as I do, then it's too late for sure to worry about the earlier stages of this disease, although more and more people are getting it these days, and there are countless people that already have at least the beginnings of glucose dysregulation syndrome, and the time to act is not after it is too late.

So the disease of diabetes is not a matter of your blood sugar being over a certain amount, it's actually a disease that makes it more and more difficult to manage blood sugar as it progresses, leading to a failure of blood sugar control.  So we should look at this disease as a continuum and not just look at when it results in full blown failure.

Next: How Conventional Medicine Views Diabetes

Previous: Does Insulin Really Cause Insulin Resistance?

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