ASK AN EXPERT

Q.

I’m feeling so frustrated—my blood sugar levels are higher in the morning than they are at bedtime. How do I figure this out?

A.

Estelle, there are many reasons why your blood sugar may increase overnight. To understand them, you need to consider the body’s normal processes. First, insulin is required 24 hours a day—daytime and nighttime, waking and sleeping. And... READ MORE

Both type 1 and type 2 diabetes can cause serious complications over time if not well controlled.

Material for the “Living with Diabetes” part of this website was reviewed by Carolyn Robertson, a certified diabetes educator (CDE), board certified in Advanced Diabetes Management, who has more than 30 years of experience in patient education in intensive/flexible diabetes management. One of her patients in New York wrote of her, “She is absolutely, positively the world’s most brilliant, dedicated, empowering diabetes educator on the planet.”

Diabetes Basics

Diabetes is a family of diseases defined by the body’s inability to regulate blood sugar— because it cannot produce enough of the hormone insulin or cannot effectively use the insulin that is there. Like a plant that gets too much water or not enough, either condition compromises health and vitality.

To understand diabetes, we need to understand normal metabolism—the process in which food is broken down and used by the body for energy. When food is digested:

  • A nutrient called glucose enters the bloodstream. Glucose, which is converted from more complex foods such as carbohydrates, is a source of fuel for the body.
  • An organ called the pancreas makes insulin. (Specifically, it is produced by cells called beta cells in the islets of Langerhans.) The main job of insulin is to move glucose from the bloodstream into muscle, fat, and liver cells, where it can be used as fuel.

People with diabetes have high blood sugar. This is because their pancreas does not make enough insulin, or their muscle, fat, and liver cells do not respond to insulin normally. Or both. This elevated blood sugar has given rise to several informal names for diabetes, such as “sweet urine disease.” It is still known as diabetes mellitus (mellitus = “honey sweet”).

Insulin also regulates the breakdown of fats and protein. So diabetes is a disorder of the metabolism of glucose, fats, and proteins, and people with diabetes often have high cholesterol and triglycerides as well as high blood sugar.

Types of Diabetes

The two main forms of diabetes are type 1 and type 2. Type 1 formerly was known as juvenile diabetes because it is most often diagnosed in younger people. It is also called insulin-dependent diabetes mellitus (IDDM), because those who have it need insulin injections to survive and must closely monitor their blood glucose.

Type 1 is considered an “autoimmune” disease—that is, the body’s own immune defenses attack and eventually destroy the insulin-producing beta cells, for reasons unknown. Although less than 10 percent of all diabetes (about 5 percent in adults) is type 1, it is a very serious and potentially fatal condition if left untreated.

Type 2 diabetes is also known as non-insulin-dependent diabetes mellitus (NIDDM). With type 2, insulin production is changed—first rising, eventually falling below normal—and your body cannot properly use the insulin it produces. We don’t know the exact cause of type 2, though it has been linked to “insulin resistance”—a declining sensitivity to insulin—coupled with a drop in insulin production. We do know that the disease runs in families. But it usually takes another factor such as obesity to bring it on. Other factors include low activity and stress. In contrast to type 1, which typically is diagnosed in people under 30, type 2 occurs most in older adults. People with NIDDM are treated with exercise and diet. Many also take oral medication; some use daily insulin injections, and some measure their blood glucose.

In the United States approximately 12 percent of the population will develop type 2 diabetes, and millions more go undiagnosed. The rate of type 2 has risen alarmingly in recent decades—especially in younger people and children—and this has become a major public health issue.

Complications and Consequences

High blood sugar levels from diabetes in all its forms are associated with retinal, renal, neurological, and cardiovascular complications. This causes 24,000 new cases of blindness annually. Diabetes is the leading cause of end-stage kidney disease and increases the risk for cardiovascular disease fourfold.

Many of the complications of diabetes result from breakdown of the microvasculature—the network of small blood vessels that carry vital oxygen and nutrients to the organs. These vascular-related complications are preventable through careful management of diabetes.

Focus on Type 1

Since the mission of Hanuman Medical Foundation centers on type 1 diabetes research, the site will not go into further detail about type 2. A multitude of excellent information sources are available online.

Takeaways

  • Diabetes is a metabolic disease in which the body cannot regulate blood sugar because it doesn’t produce enough insulin, or can’t use this hormone properly.
  • The two main forms are type 1 and type 2 diabetes. Type 1 affects fewer people but is more dangerous in the short term. Type 2 is more strongly linked to heredity and lifestyle, and is rapidly increasing worldwide.
  • Both types can lead to serious complications over time. The focus here will be on type 1.