Diabetes, Not So Sweet.Nov 19, 2019
Welcome back, fellow geeks. Today’s Health Bar is going to take a deep dive into the world of Diabetes. We will look at what it is, the history, the treatments, the science and pseudoscience surrounding this fascinating metabolic disorder. (with some additional comments from me, Robin, who has type 1 diabetes)
Diabetes – What’s in a name?
Let’s start with the word Diabetes Insipidus/Mellitus. It comes from the ancient Greek diabainein which means ‘to go through’. Insipidus comes from the Latin Insipidus for tasteless. Mellitus comes from the Latin mel ‘Which means sweet/honey/etc and ītus which refers to an inflammation. Interestingly, English Doctor Thomas Willis was the first to put the two terms together in 1675 when he noted the sweetness of the urine of Diabetic patients. From what I, understand he reached this conclusion via reading previous works, as sweet urine had been noted by the Greeks, Chinese, Romans and a few others beforehand. I can not comment on if he tested it himself, for science, obviously.
Diabetes – What is it?
Diabetes is a condition, or rather a number of conditions, where a person loses the ability to manage their own blood glucose levels. It affects over 425 million people worldwide and there are 2 main forms, type 1 and type 2, (but there are several other forms).
Let’s start with type 1.
Type 1 is when the body doesn’t produce enough insulin. This can be because of an immune disorder where the body attacks its own cells in the pancreas leading to the deficiency. Genetics can be a right bitch. If it doesn’t appear to be any of the known genetic abnormalities it is described as ‘idiopathic’. This just means we don’t know, and it’s sporadic and “Just one of those things”. Type 1 is a lifelong condition that makes up roughly 10% of all people with diabetes globally. There is no cure, (Robin – apart from a pancreas transplant which is highly dangerous and only done if other organs are being transplanted at the same time) though there is plenty of research going on; we will get to that later. This tends to be diagnosed at a younger age and is usually determined via blood and urine tests. Our own Coaching for Geeks Overlord, Robin, has had Type 1 diabetes for 30 years.
Now for Type 2
Type 2 diabetes is when the body builds a resistance to insulin or doesn’t produce enough. This tends to form when the body has an excess of glucose in the body often, so more insulin is produced and a vicious cycle begins. The body then becomes increasingly resistant to insulin as it is at such high levels. From this, the pancreas can start to actually slow down the production of insulin. Type 2 is far more common in the UK and other developed nations and accounts for roughly 90% of all people with diabetes globally. It is not usually diagnosed until after 40 though this number is sadly falling and poor health is more and more common in the younger generations. Type 2 is strongly linked with obesity and lack of exercise, and thankfully, it can be reversible with a healthy diet and exercise. It should be noted that it is possible to relapse into type 2 again as you age and it will still be important to have regular checks.
Gestational diabetes is a form of diabetes that affects some pregnant women. It tends to be picked up in the 2nd half of pregnancy and commonly dissipates after the child is born. As we all know pregnancy places a hell of a toll on a woman’s body and this can have a negative effect on the body’s ability to produce insulin. There are a few risk factors as well, things like being overweight, having a family history of diabetes, having had a large baby or having had gestational diabetes previously. Pregnancy is really tough on the body, and I don’t even need to go through it. Women are amazing.
Some other, lesser-known forms include:
‘Maturity onset diabetes of the young’ (MODY) which is a hereditary condition where a gene is affected causing a form of diabetes different to that of type 1 and type 2.
Transient (non-permanent) and permanent neonatal diabetes which, as the name suggests appears in really small/young babies and it the result of a faulty gene.
Some disorders also have a very strong correlation with diabetes, like Wolfram Syndrome or DIDMOAD syndrome which is a rare condition in which diabetes features heavily, with diabetes mellitus being very prominent and diabetes insipidus (need to drink and pass urine loads) appearing roughly half the time, or Alström Syndrome in which people with the condition are very prone to type 2 due to the presentation of Alström Syndrome.
Latent Autoimmune Diabetes in Adults (LADA) sits somewhere between type 1 and type 2 given that it takes some of the issues from one and some from the other. LADA isn’t truly considered its own thing as of yet, but there is plenty of research going into it.
Diabetes – History
We have known about diabetes for as long (probably longer) as we have been jotting down medical thoughts. The famous Egyptian Elbers papyrus talks of the “great emptying of urine” in the earliest description of type 1 diabetes. Since then the Indians identified diabetes along with several of the other advanced cultures. It was Indians though that first described 2 types of diabetes, roughly between 500 and 400 CE. The two Indian physicians Sushruta and Charaka noted that there was a difference and diabetes either seemed to affect the young or the overweight. We have said about Thomas Willis and him putting a name to the separation of the two and the less said about that the better. Let’s jump forward to the early 1920’s when Canadian medical scientists Frederick Banting and Charles Herbert Best discovered, isolated and refined insulin. It was roughly 20 years later we had neutral protamine hagedorn (NPH) insulin being mass-produced and since has even been added to the WHO’s list of essential medicines and saved countless lives.
Diabetes – Complications
Diabetes comes with a considerable amount of potential complications if not managed correctly. Do you know how blood vessels are kind of everywhere in your body? Well, blood vessels can be damaged from the production of oxygen-derived free radicals which you get when the sugar levels are high over a prolonged period of time (Free radicals are single atoms with an unpaired electron that damage the body in hunt for another electron). This damage can lead to eye issues, kidney damage, stroke, nerve damage/neuropathy, etc. Ultimately it can lead to death. Diabetes is not something to be taken lightly and really does require a certain lifestyle to reduce the effects. (I’ve got some retinal damage, had two frozen shoulders, and get neuropathic pain in my right foot – Robin)
Diabetes – Diagnosis
There are a few signs to look out for, such as –
More frequent urinating
Thirsty more often
If you have any of these and speak to your doctor, they may want to do a fasting blood sugar as well as some blood tests to check glucose in your plasma, and how much is attached to haemoglobin in your blood cells (a HBa1c blood test). Once a diagnosis is made you will have access to a diabetes nurse and doctors (UK for sure, less sure in other areas) and they will look at what treatments are best suited for you, depending on your type, and will work with you to help you make lifestyle choices. (I see a diabetes specialist nurse, a diabetes consultant, and if needed, a dietician. I also have access to local support groups to talk about the real world of living with diabetes as opposed to the more medical/hypothetical side – Robin)
Treatments for Diabetes
For type 1 Diabetes, the gold standard is insulin injections and has been for nearly a century now. Delivery methods are starting to improve and move away from the traditional needle 2-5 times a day. We are pushing implantable devices and needle-free devices that measure and control blood glucose, freeing people from the pain and bruising of the injections, usually through a cannula via a pump device. Most people in the UK currently use disposable insulin pens with changeable needles (I started off having to draw insulin up into a syringe – things have come so far – Robin)
There is something to be said for the management of needles at home though. They should be stored away safely, they need to be disposed of properly in designated sharps containers as soon after injection as possible and never just thrown in the trash. (Your local health trust should have a way for you to get rid of your sharps bin – Robin) It is important each needle is single-use too as they really degrade in quality if you attempt an injection more than once. Needles are best injected subcutaneously (the fatty bits) for regular usage. They can go in intramuscularly for more rapid absorption, but this really isn’t recommended for regular use. There is also incredible research looking at turning the gene that causes diabetes off and we could be nearing the end of diabetes being a lifetime of management. I for one, am very hopeful of this. (Since I was a kid there have been regular ‘diabetes being nearly cured’. I’ll believe it when I see it – Robin)
For type 2 it’s a lot of lifestyle choices like diet, exercise and general wellbeing but there are tablets that can be taken to help the body respond normally to insulin in the body, such as metformin.
It’s also a common myth that people with diabetes can’t eat sugar. They can, but it really has to be a part of a healthy balanced diet.
What about if you find someone who is diabetic and they are having trouble? Inject them right? Wrong. This is a big no-no. An injection must only be done by the person themselves or a trained professional. If you need to do first aid for a diabetic having a hypoglycemic episode then all you are going to do is give them some sugary drinks and call for help. That’s it. Never the needle.
Robin: a person who’s going into hypoglycaemia may exhibit a variety of behaviours; sweating/clamminess, getting confused, slowing down, slurring, stumbling, it can appear a lot like they’re drunk or on drugs. As the brain becomes more starved of glucose it cannot process data, and they’ll get more difficult, exhibit more bizarre behaviour, before collapsing. You need to get sugar into them as quickly as possible – a full-fat coke, some sweets/candy, orange juice, an apple. Starchy food like potatoes, bread, and pasta will eventually help, but it takes the body a lot longer to convert the food into glucose. Anyone with diabetes should be carrying some sort of glucose on them, Lucozade Energy Tablets are a common one.
It can be scary for the person treating it, and it’s scary for the person having the hypo – for me it’s best if you adopt a stern teacher-like approach and guide me through exactly what you need me to do. Remember you do not need to check their blood glucose or inject them – give them some sugar, make sure they eat/drink it, and if they don’t improve in 15 minutes give them some more and phone for medical help. You just might save their life.
Living with diabetes
Us folk who are living with diabetes have a constant tightrope to balance. Counting carbohydrates and injecting the right amount of a potentially lethal drug, multiple times a day. Everything affects it, from stress to hormones, to the weather. We have to make sure we’ve got our kit with us at all times and there is no break from it, ever. It’s amazing the strides that have been made, but we have to deal with a lot of pricks, every day. If you ever feel like asking a diabetic “should you be having that” when they let themselves have a piece of cake after dinner, stop. We’ve got this. We’ve probably had an extra jab just for the cake.
It is a very manageable condition and while it sucks in a lot of ways, and throws curveballs from time to time when nothing seems to work despite doing everything right, it becomes part of the daily routine.
Yes, injections still hurt sometimes. Yes, I can have dessert. Yes, I can play sports.
From Nick Jonas and Halle Berry (type 1) to Tom Hanks and Sir Steve Redgrave (type 2) you can still become a celeb with diabetes. You just can’t be a pilot or join the army, sorry. Robin out.
There are three very interesting lines of research I wanted to bring up.
Firstly there is ongoing work into a Diabetes vaccine that has shown good promise from teams in Sweden and Canada, ranging from working in mice, and drug trials showing a delay in onset. These are still early days but I am hopeful. On a side note to this, a diabetes vaccine, like all other vaccines DO NOT CAUSE AUTISM, so that’s good.
The other is a cure for people with diabetes and the area been researched involves replacing the Islet Cells in the Pancreas that are not working properly. Again its is early days but there is promise.
Finally Clustered Regularly Interspaced Short Palindromic Repeats (CRISPR gene editing) is also noteworthy and continuously amazes me with it potential, and diabetes is something that is definitely on its list of known diseases to take down. It would do this by editing the gene to allow it to produce insulin again. With all these things, they are not likely just around the corner and could be more than a decade before we have a mass cure or vaccine for diabetes but I really feel we are on the right track.
Diabetes can and does have a profound effect on people’s lives and should be taken seriously, but we do know how to manage it. It takes time and effort to learn how each individual needs to control it. On a positive note, the future looks bright and hopefully, everyone has learned a little from this.
With a healthy lifestyle and self-care (all things we here at CfG are great at helping people with) then we can push diabetes to the sidelines.
As always, take care of yourselves and happy geeking!
Coach Rob House
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