My Explanation of Diabetes

This post is another of the explanations you might hear on any day in room 11. It is about diabetes, what it is and why we go on about it.

One of the problems about diabetes is that there is a huge amount to know. When someone is diagnosed with the condition, there is often an immediate desire from the patient to know as much as possible, and an immediate feeling from the doctor that they need to ensure their patient knows it all as quickly as possible. This can result in a lot of talking by the doctor, and thus, unfortunately, not much remembering by the patient. So I always start by saying “Chill. There is lots to know, and lots of time to learn it. Over the next few months we will sort it all out. What follows is a brief introduction.”

I will pre-empt my explanation by acknowledging that it is simplified and basic. But it works for me, and I hope it works for my patients.

Ok then, diabetes….

Diabetes is a condition in which the body cannot use the sugar that it is given. Sugar is normally turned into energy using a hormone called insulin. In diabetes either the body stops producing insulin (so called Type 1 Diabetes) or the insulin it makes doesn’t work properly (Type 2 Diabetes). Type 1 diabetes is more dramatic: A complete lack of insulin means that the body can’t access any energy, and sudden illness is the result. This is treated by injecting artificially made insulin to replace what the body has stopped making. Type 2 diabetes is much more gradual. In Type 2 Diabetes insulin becomes slowly less effective and the energy that the body can access reduces steadily. There are often no symptoms from Type 2 Diabetes, but if there is, the commonest is fatigue.

“So,” you might say, “if there are no symptoms from Type 2 Diabetes, why do we go on about it?” Well, this is the issue: The inability of the body to use sugar means that the sugar isn’t broken down and levels in the bloodstream actually go up. This extra sugar swims around the body sticking to things it shouldn’t stick to. In particular it sticks to small blood vessels and nerves, and when sugar sticks to things they stop working well. As a result, high blood sugar levels over many years cause damage to any part of the body with lots of blood vessels and small nerves. Diabetes therefore can increase the risk of heart attacks, strokes, eye problems, kidney problems, nerve damage to feet (with problems healing due to blood vessel damage also) and other similar conditions.

And here is the punchline….

Because the damage is caused by excess sugar swimming around sticking to things, the less excess sugar there is, the lower the chance of causing damage. Thus,


And that is why we go on about it.

Diabetes links in with other conditions too: conditions which seem on the face of it unrelated. The 2 main ones are high blood pressure and high cholesterol. Like Type 2 diabetes, high blood pressure and high cholesterol are (in my opinion) not illnesses. They don’t make you feel unwell (OK, T2DM can, but go with me on this). They are, however, risk factors for other illnesses, in other words they increase the chance of things that will make you feel ill occurring. In particular, they increase the risk of heart attacks and strokes.

Because diabetes can also increase the risk of heart attacks and strokes, it is extra important to control blood pressure and cholesterol in someone with diabetes. We’re not just doing it to get nice looking numbers in the notes, the name of the game is to minimise the chance of something that will make you feel unwell happening.

So what do we do about it? Well to start with we try to minimise the amount of sugar the body has to deal with, so the first treatment looks at the diet. Type 2 diabetes can also be helped with medication that reduces blood sugar level, and insulin is always used in type 1 diabetes, and increasingly in type 2 diabetes too. As well as treating blood sugar we also look carefully for any signs of damage from the diabetes so we can act early to minimise its progression. People with diabetes are therefore encouraged to have eye checks, foot checks and blood and urine tests.

And that is my basic first introduction to diabetes. Another good site for information is the Diabetes Australia website.

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