Diabetes Basics: Understanding the disease

The diabetic condition is one in which the body doesn’t produce or properly use insulin and therefore cannot let glucose (converted from carbohydrates) into the cells for energy.

Carbohydrates are the body's primary source of energy. Although the body can use protein, fats and carbohydrates for energy, it is the carbohydrates that trigger a more dramatic insulin release and response. Here's what happens to carbohydrates in your body if you don't have diabetes:

• When you eat a food containing carbohydrates, the carbohydrates are converted to glucose and released into the bloodstream.
• The glucose then wants to get into the body’s cells to give them energy. However, the glucose cannot just enter the cells – it needs a "key" to unlock the cell "door", and insulin carries that key.
• Therefore, when glucose levels in the bloodstream get high enough, the pancreas releases some insulin to go and unlock the cells so that the glucose can get in and give energy to the cells. 

If you do have diabetes, the process fails at one of two points.

• In Type 1 diabetes, the pancreas does not produce enough insulin.
• In Type 2 diabetes, the cell’s keyholes are not the right shape for the insulin keys.

Either way, glucose cannot enter the cells and so remains in the blood stream.

When glucose remains in the blood stream, glucose levels get too high; this is called hyperglycemia - also known as high blood-glucose (sugar).

The body tries to combat hyperglycemia by pulling water out of the body’s cells and sending it into the bloodstream. In the bloodstream, the water dilutes the high glucose and then excretes it in the urine. This produces symptoms of frequent urination, continual thirst, and tiredness. At the same time, the cells remain starving for glucose and send signals to the body to eat more food. People with diabetes are thus often very hungry.

Checking your blood sugar count regularly and then treating high blood-glucose early can help you detect and avoid hyperglycemia.

If you don't treat hyperglycemia quickly, a serious condition called ketoacidosis can occur. This occurs when your body does not have enough insulin. To make more, your body tries to break down fats into glucose. However, this produces waste products called ketones. Your body cannot tolerate large amounts of ketones and tries to remove them through the urine. Unfortunately your body cannot remove all of the ketones this way and they can build up in your blood. This excess of ketones in your blood can lead to ketoacidosis. This is a life-threatening condition that needs to be treated immediately.

Many health problems can occur as a result of diabetes.

In the short term, there is ketone damage, extreme thirst, exhaustion, nausea, and slow healing of wounds.

If diabetes remains untreated and the blood-glucose level stays high for many years, damage to nerves and blood vessels can occur. This in turn leads to the more serious complications associated with diabetes such as:

• High blood pressure
• High cholesterol
• Blood-clotting
• Heart failure
• Eye diseases including diabetic retinopathy, glaucoma, cataracts
• Strokes
• Impotence
• Foot ulcers leading to amputations
• Renal disease

The most important difference between Type 1 and Type 2 diabetes is that Type 2 diabetes is preventable. Although it has a genetic basis, Type 2 diabetes is very dependent on environmental factors. The misshapen "key holes" in Type 2 diabetes which stop insulin from entering the cells are almost always caused by excess fat or inactivity; in fact 90 percent of people with Type 2 diabetes are overweight or obese. Losing weight and increasing physical activity can help treat or prevent Type 2 diabetes in most cases.

Type 1 diabetes, on the other hand, is a hereditary condition where the problem is lack of insulin.  Type 1 diabetes must be managed through insulin injections as well as carefully-monitored eating and regular exercise. Although the causes of Type 1 and 2 diabetes are different, both forms of the disease are equally serious and have equally serious consequences if left untreated.

There is also a third type of diabetes called gestational diabetes. Gestational diabetes occurs during pregnancy, but with proper management the condition usually resolves itself after the baby is born. Gestational diabetes occurs in about eight percent of pregnancies. 

Type 1 diabetes is mostly genetic and usually occurs in children or young adults. Researchers believe that in Type 1 diabetes the body’s immune system is somehow environmentally triggered to destroy the cells in the pancreas that produce insulin. But why this happens is not understood.

Overweight and inactive adults are the people most likely to develop Type 2 diabetes. Obesity, a family history of diabetes, high blood pressure, a previous diagnosis of gestational diabetes, delivery of a baby over 9 lbs, and pre-diabetes (see the section 'What is pre-diabetes?' below) are also common factors in people predisposed to the disease. In the United States people of African-American, Native American, Hispanic, Native Hawaiian and Chinese descent are at a higher risk of Type 2 diabetes than those of European descent.

Diabetes is first diagnosed by symptoms. Urine tests and blood tests are then used to confirm a diagnosis. Symptoms can develop suddenly in healthy children or adults, and gradually over several years in overweight adults. If you have any of the following symptoms you should see your doctor for testing:

• Increased thirst
• Unusually frequent hunger
• Frequent urination
• Unusual fatigue
• Infections
• Blurred vision
• Cramps or burning sensation in your feet and/or legs
• Unexplained weight loss
• Nausea or vomiting
• Sores that do not heal

A fasting plasma glucose test (FPGT) is the preferred glucose test for diagnosing diabetes. You should see your doctor for a blood-glucose test at least once every three years.

Pre-diabetes, also called glucose intolerance, is a condition in which a person's blood glucose levels are higher than normal but not high enough for diagnosis of Type 2 diabetes. It is estimated that at least 20.1 million Americans have pre-diabetes. Left unmanaged, pre-diabetes can develop into Type 2 diabetes in 5-10 years. Lifestyle improvement, including better diet and more exercise, can prevent pre-diabetes from turning into this more serious condition.

For every person who has been diagnosed with diabetes, there is also someone who has it but remains undiagnosed - that's at least 18 million undiagnosed cases.

This is because many of the symptoms can initially be very mild or ignored. It is also possible to have very high blood-glucose levels, with damage to the body occurring, yet not feel unwell. This is called silent diabetes. It is still important to treat these cases, though, because research has shown that good control of blood glucose levels prevents or lessens the likelihood of the complications of diabetes. Therefore, you should have your blood-glucose level checked by your doctor every three years.

Prevention is the best cure for Type 2 diabetes; this fact can't be emphasized enough. The recently-completed Diabetes Prevention Program study has conclusively shown that a well-balanced diet and regular exercise will greatly reduce the risk of pre-diabetes and Type 2 diabetes. Remember – this one is up to you. Don’t just sit around waiting for diabetes to happen, take action before it does.

Of course, for many people, making the change to eating more healthily and exercising more often can be a very difficult one. If you know that you need to make changes to your current lifestyle but are struggling for motivation and support, talk to a health professional: it is a lot easier with support and guidance. A dietitian, doctor or diabetes educator will help you to get on track with healthy living in order to prevent Type 2 diabetes.

If you haven’t done so already, take a good look around CalorieKing.com for lots of information, ideas, support and tools for effective weight control. Also talk to existing members in our community Forums to find out how CK has helped them make important lifestyle changes. 

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Please note: This article is for informational purposes only and is not intended to replace professional medical advice. Please see your doctor immediately if any of the following occurs:

• Your blood glucose level is consistently high or low even though you are taking your insulin/medications correctly.
• Your symptoms worsen
• You get chest pain, vision problems, sweatiness or numbness