3) THE BASIC CAUSES OF TYPE 2 DIABETES
a) Underlying Mechanism of Type 2 Diabetes
By definition a person with diabetes has an excess of "sugar" in their blood (sugar is the simplest form of carbohydrate). Indeed, many people say they have "sugar" instead of saying they have diabetes. There are many sugars. The blood sugar of interest is chemically known as "glucose" and is a "monosaccharide", or a simple sugar that does not break down into other sugars. Table sugar is called "sucrose". It is a "disaccharide" (composed of two sugar molecules combined into one molecule) and breaks down in the stomach into two other sugars; glucose and fructose, both of which are then absorbed into the blood stream. Fructose in turn is removed from the bloodstream and converted by the liver into glucose. "Glucose sugar" is an essential constituent of the blood; it is the primary source of energy for the cells of the body. But too much "glucose sugar" in the blood stream is very damaging. The glucose sugar level is measured as "milligrams per deciliter" (mg/dl). A level of 100 mg/dl is roughly equivalent to 0.100 percent (0.1%) glucose sugar in the liquid portion of the blood or one part per thousand.
The ability of the cells in the human body to absorb sugar (glucose) is regulated by a body hormone called "insulin" and other less known hormones and factors. All the cells in the body are surrounded by a cellular membrane that only admits blood sugar (glucose) at a closely regulated rate. Insulin has been called the "key" that unlocks the cell membrane and allows sugar into the cell so the cell can work and utilize energy. This insulin regulates the permeability of the cell membranes to the sugar in the blood, the more insulin in the blood the more sugar can enter the interior of the cell to be utilized by the cell. Insulin is produced by so called "beta cells" in an organ of the body known as the pancreas after a series of cascading hormone signals are produced by various regulatory glands of the body (the endocrine glands). Insulin has other effects, for instance it regulates the conversion of excess sugar into fatty acids and the storage of those fatty acids in fat cells (adipose tissue). It is important to note that insulin unlocks the cell membranes of both muscle cells and fat cells (adipose tissues). If the muscle cells don't use the sugar in the blood, ultimately the fat cells will absorb it and store it as fat.
If either or both the insulin amounts are low and/or the cells don't respond properly to the insulin, then the level of sugar in the blood gets too high and a person has diabetes. There are two major types of diabetes. Type 1 diabetes typically starts early in life (thus the term "juvenile diabetes") and is characterized by the beta cells in the pancreas being killed by an autoimmune reaction by the body. Individuals with type 1 diabetes need to take insulin injections, do not have insulin resistance and are typically normal to thin in weight. Note that about 10% of the individuals who develop diabetes after the age of 35 have a form of diabetes called "latent autoimmune diabetes of adults" or LADA. These individuals are typically thin, do not have significant insulin resistance and rather rapidly needs insulin injections. These individuals need to treat themselves as though they have type 1 diabetes.
One of the problems with diabetes treatment is that type 1 treatments and type 2 treatments tend to be lumped together into "diabetes treatments". Type 1 diabetes treatments are typically somewhat different than type 2 treatments and need to be treated as such. For instance, typically carbohydrate control is much more important in type 1 diabetes and cholesterol control, weight control and exercise are of lesser importance because there is no heart disease present. We will not look at type 1 diabetes or LADA in this ebook. Type 2 diabetes typically starts later in life (thus the term "late onset diabetes") and is characterized by the cells in the body developing insulin resistance. Type 2 diabetes is almost always accompanied by some degree of heart disease. Type 2 diabetes is where this ebook will concentrate.
Type 2 diabetes also goes hand in hand with a set of blood lipid and fat distribution characteristics known as "Metabolic Syndrome X". Sometimes called simply "Syndrome X", "Metabolic Syndrome" or "Insulin Resistance Syndrome", this is characterized by fat in the abdomen, high LDL cholesterol, low HDL cholesterol and high triglycerides. Type 2 diabetes also goes hand in hand with being sedentary and overweight and has very strong genetic and ethnic connections (Hispanic, Pacific Islanders, American Indian and African Americans with a family history of type 2 diabetes have a very high risk of getting type 2 diabetes).
There are some articles in the literature that attribute some of the health consequences of type 2 diabetes with an excess of insulin in the blood. But this is illogical. Most individuals with uncontrolled type 2 diabetes have insulin resistance as the major underlying problem (i.e. they end up with too much insulin in the blood). There is also a smaller subset (the approximately 10% with LADA) of individuals with uncontrolled late onset type 2 diabetes whose major underlying problem is lack of an ability to produce insulin (i.e. they end up with too little insulin in the blood). These individuals are not insulin resistant. Both groups have the same medical problems, the same nephropathy (kidney problems), retinopathy (blindness), peripheral neuropathy (lack of feeling, impotence), atherosclerosis (hardening of the arteries), etc. What both types of type 2 diabetes share is high sugar levels. So it is only reasonable to assume the major health problems attributed to type 2 diabetes are due to high sugar levels, not high insulin levels.
Current Chapter: THE BASIC CAUSES OF TYPE 2 DIABETES
a) Underlying Mechanism of Type 2 Diabetes
b) Symptoms of Type 2 Diabetes
c) Tests for Diabetes
d) Insulin Resistance
e) The Complexity of Diabetes
f) Poisoning of Body Protein
g) Diabetes, Protein Poisoning and Cognitive Thinking
h) Protein Poisoning and A1c
i) Well Cooked Meat and Protein Poisoning
j) Beta Cell Death in Type 2 Diabetes
k) The Hypoglycemic Spike Effect
l) The "Dawn Phenomenon"
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