he had diabetes, but Sal refused to believe it. He left the doctor’s office angry but vowed to lose weight and did so successfully. On a repeat visit to the doctor, a random glucose was 167 mg/dl (9.3 mmol/L). Sal told the doctor that he knew he didn’t have diabetes, but his resolve to eat carefully didn’t last, and he was back six weeks later with a glucose of 302 mg/dl (16.8 mmol/L). Finally, Sal accepted the diagnosis and started treatment. He rapidly returned to his usual state of health, and the fatigue disappeared.
Debby O’Leary’s active sex life with her husband was continually being interrupted by vaginal yeast infections, which resulted in an unpleasant odor, redness, and itching. Over-the-counter preparations promptly cured the condition, but it always rapidly returned. Finally, after three of these infections in two months, she decided to see her gynecologist. The gynecologist told her she needed a prescription drug. The cure lasted a little longer this time, but the infection promptly returned. On a return visit, the gynecologist did a urinalysis and found glucose in her urine. A random blood test showed a glucose of 243 mg/dl (13.5 mmol/L). He sent her to an internist, who ordered a variety of tests including a fasting blood glucose, which was 149 mg/dl (8.3 mmol/L). The doctor told her she had diabetes and recommended exercise and diet change to start with. She followed his advice, and as a result she not only lowered her blood glucose to the point that she no longer developed yeast infections but also lost weight and increased her energy, making her sex life with her husband even more satisfying.
Chapter 3
Recognizing the Various Types of Diabetes
In This Chapter
▶ Paying attention to your pancreas
▶ Comparing type 1 and type 2 diabetes
▶ Being aware of other types of diabetes
Ladies and gentlemen, I’d like to introduce you to your pancreas. This shy little organ – to which you’ve probably never given any attention – can rear its lovely head at entirely unexpected moments. (You probably didn’t even know that your pancreas has a head and a tail, but it does. Now you’ve broken the ice!) Most of the time, your pancreas hides behind your stomach, quietly doing its work by assisting with digestion first and then helping to make use of the digested food. The information in this chapter should put you on closer terms with your pancreas, which is good, because you need your pancreas as much as it needs you. In one way or another, the pancreas plays a role in all of the various types of diabetes.
Here’s the good news: You can prevent diabetes. Here’s the bad news: You can’t do so quite as easily as you may like. Your best method for preventing diabetes is to pick your parents carefully, but that method is slightly impractical, even with modern technology.
In general, you can prevent a disease if it meets two requirements. First, you have to be able to identify if you are at high risk for getting the disease. Second, some treatments or actions must exist that can definitely reduce the occurrence of the disease. This chapter shows you how to identify whether you’re at risk for type 1 or type 2 diabetes, and it covers definite actions that you can take to prevent both of these types of diabetes.
This chapter helps you get a clear understanding of your type of diabetes, how it relates to the other types of diabetes, and how the failure of your friendly pancreas to do its assigned job can lead to a host of unfortunate consequences. (I cover these consequences in detail in Part II.)
Getting to Know Your Pancreas and Its Role in Diabetes
You don’t see your pancreas very often, but you hear from it all the time. It has two major functions. One is to produce digestive enzymes, which are the chemicals in your small intestine that help to break down food. The digestive enzymes don’t have much relation to diabetes. Your pancreas’s other function is to produce a hormone of major importance, insulin, and to secrete it directly into the blood. The following sections explore the ins and outs of your pancreas and insulin so that you’re well acquainted with both.
Figure 3-1 shows the microscopic appearance of the pancreas. The following list explains the different cells found in the pancreas as well as their functions:
✔ B cells: The insulin-producing pancreas cells (also called beta cells) are found in groups called Islets of Langerhans.
✔ A cells: These cells produce glucagon, a hormone that’s very important to people with diabetes because it raises blood glucose when the glucose level gets too low. A cells are present in the Islets of Langerhans.
✔ D cells: These cells make somatostatin (a hormone that blocks the secretion of other hormones but doesn’t have a use in diabetes because it causes high blood sugar and increased ketones by blocking insulin as well). Like the cells described above, D cells are also found in the Islets of Langerhans.
Illustration by Kathryn Born
Figure 3-1: The pancreas and its parts.
Think of your insulin as an insurance agent who lives in San Francisco (which is your pancreas) but travels from there to do business in Seattle (your muscles), Denver (your fat tissue), Los Angeles (your liver), and other places. This insulin insurance agent is insuring your good health.
Wherever insulin travels in your body, it opens up the cells so that glucose can enter them. After glucose enters, the cells can immediately use it for energy, store it in a storage form of glucose (called glycogen) for rapid use later on, or convert it to fat for use even later as energy.
After glucose leaves your blood and enters your cells, your blood glucose level falls. Your pancreas can tell when your glucose is falling, and it turns off the release of insulin to prevent hypoglycemia, an unhealthy low level of blood glucose (see Chapter 4). At the same time, your liver begins to release glucose from storage and makes new glucose from amino acids in your blood.
If your insurance agent (insulin, remember? – stick with me here!) doesn’t show up when you need him (meaning that you have an absence of insulin, as in type 1 diabetes) or he does a poor job when he shows up (such as when you have a resistance to insulin, as in type 2 diabetes), your insurance coverage may be very poor (in which case your blood glucose starts to climb). High blood glucose is the beginning of all your problems.
Doctors have proven that high blood glucose is bad for you and that keeping the blood glucose as normal as possible prevents the complications of diabetes (which I explain in Part II). Most treatments for diabetes are directed at restoring the blood glucose to normal.
Understanding Type 1 Diabetes and You
