Let’s discus diabetes. More than 30 million Americans have diabetes, and yet most people don’t understand just how serious of a disease it is, or how it exactly works.
Before we begin, let’s clarify that there are many different types if diabetes, from Type 1, Type 2, Gestational Diabetes, prediabetes, and much more. I’ll talk about them later.
Let’s take a look at a few key players; The pancreas, the liver, the kidneys, your blood cells, and well, the rest of your cells lol. Insulin, glucose, ADH hormone. The stomach (breaks down and absorbs food), your muscles (stores and uses glucose)
Okay so all foods, once they are broken down, are only one of three things, a carbohydrate molecule, a fat molecule, or a protein molecule. Glucose is a type of carb, a very simple one, and it’s what your body turns all carbs into.
Even though I said glucose is a simple carb (one of the smallest), its still really big, in fact its too large to be absorbed into most cells, like your skeletal muscles (aka most all of the muscles you think of), your fat cells, and your cardiac muscles (your heart). Glucose can however be absorbed by your brain, pancreas, and liver.
So after you eat some carbs, its broken down into glucose. This glucose is now chilling in your blood stream until its taken up into your liver and pancreas. The pancreas realizes that theres a good amount of sugar in the bloodstream and it releases insulin, which allows your muscles and fat cells to use that glucose. Now here’s the part that I personally hate because no one ever explains how insulin lets your body use glucose other than “it works like a key”, but to be fair it doesn’t actually help you to know how, so skip this part if you don’t care to know.
[Ight nerds, so remember how I said earlier that glucose is literally too big to just squeeze into the cells? Well then you must be wondering how does it? Good question. So inside your cells you have these things called hexose transporters, which are some cool yet boring membrane proteins. For the most part they kind of just chill in cytoplasmic vesicles, doing nothing and floating within a cell, but when insulin comes and binds to receptors on the outside of the cell, it basically summons all of the hexose transporters, to which they then join together like a fucking mech from power rangers and attach to the surface of the cell, creating enough space to allow them to be channeled through via facilitated diffusion, which is like passive diffusion (high to low), but through a channel/passageway. When the insulin goes away, voltron disassembles and glucose can no longer just float into the cell. Dope shit.]
Let’s first discuss type 2 diabetes, since it is the most common type. 90-95% of people with diabetes have this type. At the end of the day, the cause of type two diabetes is Ineffective Insulin use.
Now, what does that mean? Well, it might mean that the body isn’t producing enough insulin, or that the body’s cells aren’t responding to insulin. I’ll give a few examples to help explain.
Let’s say that you wake up and eat a large breakfast of sugary ass cereal and drink a lot of juice. On the way to school or work you have a bar of what is basically sugar, and a cup of coffee. Which is in reality (if you are like me at least), is just liquid sugar and caffeine. For lunch you go and decide to eat a sandwich, which, while it might not be bad, still does have carbs which turn into sugar. You then proceed to have another cup of coffee or soda or something high in sugar. You later have a candy bar as a way of congratulating yourself for getting through the work/school day (honestly, fucking mood, same. lmao) and then for dinner you eat some pasta (again, not innately bad, but because you already had so many carbs it’ll just fuck you up). You also drink some high sugar liquids because you like the taste of it. Then you have another snack before bed. Probably high in sugar.
Well you remember how I previously said that insulin is released by your pancreas when blood sugar levels are high? Yeah well that shit is going to always be fucking high with a diet like that. Eventually the insulin receptors that are just chilling on your cells become fatigued and no longer respond to insulin because they’re just so done with it. Well the pancreas freaks out and decides to release even more insulin to try to compensate, but it will never be able to keep up, but it keeps trying and trying.
That’s basically how type 2 diabetes goes for the majority of people. Now for type 1.
So type 1 diabetes is a lot more rare. Less than 10% of people with diabetes have it. Type 1 diabetes is when your body’s immune system (the thing responsible for fighting infections) decides to attack the cells of the pancreas instead. It’s funny how the things meant to keep us safe can often times hurt us the worst. Ouch. Anyways, the scientific and medical community still aren’t sure what causes the immune system to do so. Some believe it’s due to genes, others believe its caused by viruses, or other environmental factors. More research is coming out every day. Really dope stuff. I guarantee you that the first person to discover the cause will not only quickly become incredibly rich (fuck the bourgeoise though) but will also win the Nobel Peace Prize that year.
Well since the pancreas is no longer functioning, your body is unable to actually use any of the carbs you eat, and since your body kind of needs glucose to live and do anything, you quickly waste away. Before the invention of insulin in 1921, the average life expectancy for someone with type 1 diabetes was only 3 years. Imagine being a parent and bearing a child that quickly just died at 3 years old for reasons you didn’t understand. Terrifying and tragic.
Most people with type 1 diabetes get diagnosed at the age of 14. There are some very telltale signs. So because the cells are unable to actually use the glucose, it kind of just sits in the bloodstream. This puts you at an incredibly high risk for infections, since bacteria will gladly use that sugar and grow rapidly in the bloodstream. Well because of concentration gradients (dude nature really loves conserving energy, I’ll write about it later), the water from within cells decide to leave the cell and enter the bloodstream, to balance out the concentration gradient of the high amount of molecules in the blood. Well on top of that the body really wants to get rid of the high sugar in the blood so it decides to urinate a lot to get rid of it, causing polyuria (poly meaning a lot, and uria meaning piss. So you piss a lot.)
So in your body your kidneys are whats responsible for creating urine, and then it sends it off to the bladder to be stored till you piss it out. Well it works by filtering your blood and then getting rid of stuff it doesn’t need, like sugar, urea (which is the main part of urine, so your body uses proteins a lot, and when proteins are broken down you are left with nitrogen. Well this nitrogen when combined with carbon, hydrogen, and oxygen, create urea. Which isn’t healthy for you. That’s why you piss it out ), and toxins like ammonia. Among other stuff.
Normally your kidneys reabsorb the sugars and put it back into your bloodstream, but because you have so much sugar in your blood it’s unable to and instead the glucose goes to your urine. This is why they test your urine for sugar, and why diabetic patients can have urine that smells sweet. In fact old timey ass doctors would even taste your piss because if it was sweet you probably had diabetes. Well due to concentration gradients and your body naturally wanted to go to equilibrium, more water from your cells and body goes to join that urine. Because you are urinating so much, aka polyuria, you become really thirsty since you have no more liquid in your body. Like incredibly thirsty. We call this polydipsia. It’s almost an insatiable thirst.
Well remember how I said your cells are unable to absorb sugar? Well your cells don’t like this and so it tells your brain to become hungry, to make you eat more, so that it can get sugar. But because you are unable to use the sugar no matter what, you stay hungry and continue to starve. This intense hunger is called polyphagia. (poly means a lot, phagia means eating.)
These three form the trinity of signs of diabetes. Polydipsia, Polyuria, and Polyphagua.
There is a fourth sign however. Diabetic Ketoacidosis.
So a question you might have is how do people manage to live for so long if they aren’t able to process sugar? Good question.
They process fats instead.
Okay so this isn’t innately bad. Yay, your body is burning fat, not too bad right? Well. Because someone with DM1 (diabetes mellitus type 1) can only process fats and no carbs, they quickly build up the amount of ketones (whats left when your body processes fats for energy) in the blood, and since ketones are a bit acidic, when they are present en masse they are able to change the pH of your blood.
Other bad things that can happen due to DM1 and Ketoacidosis include having your electrolytes thrown out of wack due to them being urinated out, and with enough potassium gone you can have irregular heart rhythms which is never good. Lets see, due to severe dehydration your kidneys can decide to give up causing kidney failure. Because your body no longer gets rid of waste you can get really sick, and I don’t want to go into depth on that, but just think of all the troubles that can occur in your own house if you never threw out the trash. Tough shit. This is why so many patients with diabetes end up having to go to dialysis. Since they can’t filter their blood, a machine will have to. On top of this, because your fluid levels get thrown out of wack, fluids can actually build up in your lungs which makes it really difficult to breathe, as you can imagine. Basically it all just sucks.
So treatment for type 1 diabetes is pretty straight forward, everytime you eat, wake up, go to bed, or feel terrible, you pretty much have to prick your finger, check your blood sugar levels, then give yourself a shot of insulin to compensate and everything works out. It’s very annoying, but something you ultimately have to just live with. And if you live in America then it is incredibly expensive and good luck fam.
For type two diabetics treatments a bit different. For a good amount of people, most people actually, if they were to just have a proper diet, eat less sugars and carbs, and just exercise daily, they would be fine and would be able to go about their days without worrying about diabetes. But this is the modern age we’re talking about and people are lazy sacks of shits and are unwilling to do the bare fucking minimum to ensure they have a good life and so instead we’ve developed a lot of drugs to compensate.
Different drugs do different things. Heres what the main ones do:
Biguanides like metformin or glucophage combat insulin resistance and they decrease hepatic glucose production.
Sulfonylureas work by increasing insulin production from the pancreas.
Meglitinides increase insulin production from the pancreas as well, but these are absorbed much quicker than sulfonylureas which means that they are a lot less likely to cause hypoglycemia.
alpha glucpsidase inhibitors work by decreasing the absorption of carbs in the small intestine.
Theres more drugs but honestly I’ve spent more than 2 hours writing this already and I have to be at the hospital at 6 in the morning and I just want to shower and sleep. I’ll just say this is part 1 and I’ll continue writing about diabetes later on. Like gestational diabetes.
