Like Maria von Trapp sang in the movie: “Let’s start at the very beginning/ it’s a very good place to start.” She wasn’t talking about diabetes, but work with me on this. Before we discuss what diabetes is, we need to learn some basic anatomy.
Our bodies are amazing, intricate machines. Our hearts pump blood throughout miles of tiny vessels, lungs fill and empty without us even thinking, a bite of food starts a series of events that boggle the mind. Hey! Let’s follow that bite of food and see where it goes, shall we? (We won’t follow it all of the way. Promise.)
It’s Party Time
Before food even hits your tongue, the brain is working to prepare your digestive system. It’s the equivalent of an announcer booming: “Start your engines!” The autonomic nervous systems revs up and gets ready for that, what one can only hope will be, delicious morsel to be ingested. (And your pancreas is already putting on its dancing shoes, releasing insulin if you don’t have diabetes. It likes to party.)
The salivary glands are the early partygoers of your digestive system, hitting the floor for the first wave of breaking down food into smaller and smaller bits. Amylase, an enzyme, begins to rip apart starches into simpler forms. (Polysaccharides down to disaccharides, if you want to go all technical on me.)
That bite of food, which doesn’t resemble what you put in your mouth, goes down through your esophagus to your stomach, where it hits an acidic pool party in full swing. Chemical reactions break down that food even further as the stomach churns and spits out chemicals and enzymes and acids. (If you’ve washed down that bite with a beer, the alcohol makes an early exit right there, absorbed through the stomach membrane and into your bloodstream.)
That food is now called chyme and is a slurry of nutrients and small molecules when it enters the small intestines, going from a pool party to a mosh pit, mixing with additional liquids: bile, intestinal juice, and pancreatic juice. Some of the food is absorbed and shipped off to the liver through the blood and the rest party on in the large intestine.
If there’s sugar to be had, the small intestine screams: “Winner, winner, chicken dinner!” (Although chicken is a protein, not a carb.) Think of sugar as a beautiful woman. She never leaves a party alone. Insulin is the hot guy who offers her a ride home. Home in this case is the cells throughout the body, where the sugar is either immediately used as energy or stored as fat. (Not all sugar stays pretty. Some stick around and start a cat collection.)
Wait. What About Diabetes?
It’s all about the hot guy, insulin. Insulin is a hormone that is supposed to be produced by the pancreas. I say “supposed”, because sometimes the beta cells that produce insulin decide to take a permanent vacation. (I’m hoping it’s somewhere warm and tropical and that they brought sunscreen.) In Type 1 diabetes, it’s a mass exodus, leaving all those beautiful sugar cells to dance around slowly in the blood, looking for partners. In Type 2 diabetes, there may be some insulin hanging around, but it’s not enough to clear the room. (Or the insulin is an awkward shy guy who needs help holding hands with sugar.)
In Type 1 diabetes, without insulin bringing the sugar home, they just hang out in the blood vessels. No insulin means no way for the body to get energy, so it uses the fat stores (Siyonara, cats!) to eek out energy. When the body uses those fat stores, it “burns” or coverts the fat into usable energy, leaving toxic waste behind in the form of ketonic acid. Too much ketonic acid and diabetic ketoacidosis can occur… and that can be deadly. (That’s a story for another day.)
In Type 2 diabetes, insulin may still be made, but not enough to keep blood sugars in the proper range.
Type 1 diabetics must take insulin from an external source (subcutaneously), which may involve injections or infusions using an insulin pump. No insulin = party is permanently shut down. Type 2 diabetics may use insulin or oral medications to help sensitize the body to use the insulin it produces.
So, Insulin Is The Cure, Right?
Au contraire, mon frère. (Which is French for… nice guess, thanks for playing, but no.)
Insulin is not a cure. The pancreas is broken and no amount of duct tape will fix it. Insulin is an essential hormone for the body, so when it’s not made by the pancreas, it’s got to come from somewhere. A cure for diabetes doesn’t exist. Treatment does. Careful dosing of insulin and other diabetes medications, monitoring of blood glucose levels, careful food intake, exercise and much more goes into the balancing act that 26 million Americans face.
And that concludes today’s post.
Party on, Garth.