You are not a camel

Part IV: Continuing with Type II diabetes signs. Besides obesity.

In addition to being obese, you are...

Thirsty. Thirsty. Thirsty. You carry a bottle around with you. And you are constantly checking around to see where the nearest restroom is. You hate car trips. You hate plane trips. You hate ANYTHING that keeps you away from a bathroom for more than 30 minutes.

When there is 'way too much glucose in your bloodstream, and your cells can't move it out (either because they don't need it or because you have insulin resistance or because you don't have enough insulin PERIOD), then the only recourse your body has is to let it spill over into your kidneys. You pee a lot to get rid of the excess sugar. I mean glucose. And because you pee a lot, you are always thirsty. Always. You wake up at night with cotton mouth.

It takes a terrible toll on your kidneys until they are no longer able to adequately filter your blood and you have to have it filtered externally with a process called "dialysis." When that happens, and your kidneys are shot, you are then in what is known in the medical profession as "end-stage renal failure."

Would you like to guess why they call it "end-stage"?

Try an experiment: [if you are obese and are thirsty all the time] just eat protein only for one week. No. Five days. Try it. Nothing but meat with no sugar added. 0 carbs on the label. Hamburger patties. Chicken without breading. Turkey. Fish. Force yourself. Nothing but meat. Five days won't kill you.

At the end of those 5 days, you won't be drinking like a camel and peeing like a racehorse. And you won't even be afraid to go for an hour car trip. What does that tell you? Oh, and you will weigh 5 pounds less than you did 5 days ago, too.

If you take in less sugar, you will have less sugar to get rid of and less sugar to turn into fat. Glucose, I mean. Damn.

Type I diabetics are seldom fat, not if they have survived childhood. They know. Oh, they know! Type I diabetics are insulin-dependent and have been injecting since the time they could walk, or before. Sometimes a child is born with a few beta cells in his pancreas and it doesn't hit until they are a teenager or even in their 20s. But if your pancreas is not making any insulin, then you are Type I.

The ability to inject insulin yourself, and therefore keep sugar out of your blood, within reason, does two things. One, it makes you be able to be thin. Two, it sometimes gives you a false sense of security and you think you can eat anything you want - all you have to do is inject more insulin.

But that is killer thinking. That is suicide thinking. If you are Type I, thank God you are still alive, and then eat right and exercise. Too much sugar in your blood will kill your tissues just as surely as it does for people who don't inject insulin. Why? Because it gets high for a while before you can bring it down and, over time, the damage is still done. Not to mention that you will still get fat, because the insulin you are injecting is still working to turn the excess sugar into fat.

You have an advantage, admittedly, if you don't abuse it. You can have that piece of cake or go out for ice cream or pizza ONCE IN A GREAT WHILE and get away with it as long as you "cover" (shrewdly calculate the amount of fast-acting insulin you need for the expected load.) But don't make a habit of it. Some would caution that you are playing with fire by doing it EVER.

Type II diabetes sufferers will almost surely eventually burn out the rest of their Beta cells and become Type I. Fact of life. Expect it. Try to delay it or even avoid it by starting to maintain your weight early on and eat right and exercise. Please.

Yes, more to follow.

Get with the program

This is part three of a series of non-consecutive posts which attempt to explain in the simplest of terms the nature of a disease called diabetes mellitus.

Those of you who read the previous post on this subject will remember that an important hormone called insulin is needed in order to "escort" glucose molecules through cell membranes. Most cells. An important exception are muscle cells which have the ability to uptake glucose without the presence of insulin. As I am so fond of saying, more on that later.

Right now I would like to introduce a new fact: insulin has another function besides running an escort service. Insulin's other job is turning sugar into fat for storage.

Up until now, I have avoided using the word "sugar" because most people think of white table sugar when they see the word. Admittedly, everyone - including doctors - lazily say things like "Your blood sugar level is too high, Mabel. You need to cut down on the banana cream pie." Or such. Or, "I check my blood sugar level 11 times a day, by god." Or, "If your sugar level gets too low you will pass out right on the street, Milly."

What all of these things REALLY mean is your GLUCOSE level is too high, or was checked 11 times, or it may get too low. There are many types of sugars. We eat them. Dextrose. Fructose. Maltose. Lactose. YadaYada. But when the digestive juices have run their course and the fat lady has sung (that is probably an inappropriate thing to say in a diabetes post) and when the rubber meets the road, it is the simple sugar called GLUCOSE, which has been "distilled" out of everything carbohydrate, which is now coursing through your bloodstream.

Glucose. On the loose. Yearning to breathe free. Looking for an insulin molecule to bind onto and ride the wild surf in search of a hungry cell. Something like that. But let's face it: often, there is much more glucose in your bloodstream than even a brontosaur would ever need. Especially the bloodstreams of those of us who enjoy moist German chocolate cake with whipped cream on top. What then?

"What then" is that the insulin facilitates the chemical changing of the extra glucose into fat, and your body stores that fat in specialized cells called adipose cells and a giant magnet attracts them to your ass. In a picturesque, if somewhat incomplete, manner of speaking.

Adipose cells are wondrous things which enabled our caveman ancestors to survive, and deserve to be spoken of more completely elsewhere. I'm sure they will be.

But, all joking aside, being obese is not all that it is cracked up to be, and hasn't been since our caveman ancestors had to go without eating for a couple weeks at at a time. You don't. You eat every single week. You eat every single day. You eat 3 times a day. You eat...

Well, you get the picture.

Ever wonder why the truck stops serve huge platters of food to truck drivers, as if they were lumberjacks instead of Jabba-the-Hutts who can barely squeeze behind the steering wheel of their truck so they can sit on their behind all day and and listen to country music on the stereo and cut you off in traffic and go up long hills side by side? I have never figured that out either. I DO know a ton (even more) of truck drivers have Type II Diabetes.

All this is to say that obesity begets insulin resistance. So your first mission to take on, if you want to survive the onset of your diabetes, is to lose your ass. Exercise. Eat protein. Forgo the sugar. Walk. Lift weights. Eat chicken. Walk some more.

Lose the weight and you will lose the insulin resistance your cells have built up. The damage done by all your tissues soaking in a sea of sickly sweet sugar over the years CAN be reversed to a large extent. And the less sugar you eat, the less will be extra that can and will be turned into fat. Are you a marathon runner by trade? No? Then carbs are the enemy.

It is truly a vicious cycle: your cells don't get the nourishment they need, so you feel hungry. You eat. And you eat. And all that sugar turns to fat and you gain weight and your insulin resistance increases and even less glucose is allowed into your cells and so you feel hungry and you eat. Okay, I will stop. You get the picture.

If you are obese, or quickly becoming so, don't wonder if you are becoming diabetic. I assure you, you are - simply because obesity promotes insulin resistance. In fact, there is a really good chance that the reason you are obese in the first place is because you are becoming insulin-resistant. Well, that and all the damn pie. The chance of you having an out of whack thyroid is too slim to contemplate. But have a thyroid-function blood test anyway. Why not? - since you already have the blood drawn for other tests anyway. As Forest Gump might say, "One less thing."

Don't believe me? Do yourself a favor and start checking your blood glucose levels. Make it a habit. A meter is non-prescription and can be bought at Walgreens for under $25. The test strips cost more, but you don't have to test 11 times a day (that was an exageration.) Go ahead - I dare you to find out. Test your blood first thing in the morning when you get up once, after you haven't eaten anything all night. Or go have that big piece of pie and then test a half hour to 45 minutes later. Then, more importantly, how long does it take to come back down? Test again two hours later. Four hours later?

Don't be afraid to find out. Know your enemy.

More to follow.

Special note to diabetics who are injecting insulin or who are taking prescription drugs of the sulfonylurea class (such as Glipizide or Glyburide): Do NOT begin a strenuous exercise program or begin a high protein - low carb diet without adjusting your insulin dosage or your oral meds dosage. Consult with your physician before doing any of the things in this post, and learn what adjustments need to be made to the quantities of your medications. Be mindful that if you are injecting insulin or taking sulfonylurea meds, or both, you CAN induce hypoglycemia by changing your exercise and/or diet patterns without also adjusting your dosages. But you already know that, and are too smart to make changes in diet and exercise without experimenting little by little and testing constantly with each step. Aren't you?

If you are not on diabetic medication, or if you are only taking prescription Metformin, you are not going to go hypo. Still, a wise person would start an exercise regimen, or a new diet, gradually and should STILL consult with their physician to make sure they are fit enough for the program contemplated. If you stick to it and lose weight and increase your skeletal muscle mass, you will surely be rewarded by needing to inject less insulin.

Part two: insulin resistance

This is part two of a series of non-consecutive posts which attempt to explain in the simplest of terms the nature of a disease called diabetes mellitus.

Defined in the simplest terms I can think of, the disease we call diabetes occurs when the glucose in our bloodstream is unable to get inside the cells to provide the energy the cells need to carry on their essential life processes. The cells "starve" and die.

As the disease progresses, every system in the body begins to suffer. When small blood vessels block, terrible things happen to body tissues from lack of blood supply, and secondary diseases flourish. Some of these things will be covered in other posts.

The two reasons that glucose doesn't get into the cells are either that the pancreas is no longer making sufficient insulin to accompany the glucose, or a phenomenon called "insulin resistance" is occuring. Insulin resistance means the cells no longer properly "recognize" the insulin's "password", and will not allow the glucose to enter. More on this later as well.

Although the end result can be the same, there are two variations of the disease. You have probably heard of "Type I" and "Type II" diabetes. Again, trying to be as simple as possible, "Type II" is often self-inflicted, caused by poor diet and a sedentary lifestyle. "Type I" you can't prevent: you are born with a pancreas that doesn't produce insulin.

Type I was simply fatal in childhood in the old days. The increasing prevalence of "Type II" has prompted many advances in the treatment of the disease, although it is also still fatal pretty quickly if left untreated. Since the fairly recent ability of laboratories to synthesize human insulin, the days of early death for people born with "Type I" diabetes are over. This series of posts, however, is intended to talk more about the "self-inflicted" kind of diabetes. More to come.

This is a very important subject to the author of these posts. Because diabetes is important in today's world, your comments are encouraged even more than usual. However, I plan little actual interaction, comment-wise, until the entire series has been presented. This is because I realize how easy it will be to take "side trips" or, horrors!, to turn this into a medical text. The author intends to be ruthlessly simplistic in order to make the principles of the subject as clear as possible to those readers who don't already have a working knowledge of the disease, and, most of all, to explain to many of my readers who (whether they even know it or not yet) are now in the early stages of diabetes themselves, and what they need to do NOW to fight back.

Since, at the end of the series, I want very much to have step-by-step discussions, won't you please continue to comment anyway, so that we will have "notes" to go back to when it is discussion time? I am counting on you!

Part one: the cell

This is part one of a series of non-consecutive posts which are intended to explain in the simplest of terms the nature of a disease called diabetes mellitus. Although I will often grossly oversimplify in these posts, I will promise to still be factual. I will also try to present it in smaller chunks than my usual long posts.
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Your body is made up of tiny little building blocks called "cells." Inside cells, the construction and demolition work of running your body takes place. There are different kinds of cells, such as muscle cells and nerve cells. Your body's blueprint, a substance called "dna," is stored in your cells.

In order to do their work of carrying on the life processes of your body, the cells need raw materials and an energy source. They also need their trash picked up. The delivery of raw materials and the collection of waste are taken care of by the bloodstream.

The raw materials are chemicals. These chemicals come primarily from the food you eat. Molecule chains are constructed or broken down, as needed. This is the constant work that goes on in the cell. When the cell is constructing, the process is called "anabolic activity." When the cell is taking molecules apart to use their parts, the process is called "catabolic activity." In both cases, heat is given off as a byproduct of the chemical reaction and the "burning" of the fuel. The overall process of either building something or taking something apart is called "metabolism."

Cells need fuel to carry on these life processes. This fuel is called "glucose." Glucose is an end-product of the digestion of food substances called "carbohydrates."** Digestion means the breaking down of complex molecules into their simpler components. Eventually, they are simple enough to enter the bloodstream.

Cells won't allow just any substance to enter. In order to cross the cell's membrane, the substance must be recognized by the cell. Glucose, for example, must be attached to a special substance the cell recognizes, a hormone called "insulin." Then the cell will allow the glucose to pass through a special portal in its membrane. Without insulin, the cell won't allow glucose inside, even though the cell might need glucose very badly.

If the glucose can't get into the cell, it keeps building up in the blood until dangerous life-threatening levels are reached. At the other end, the cell is starving in the midst of plenty, and will malfunction and eventually die. This hormone called insulin is very important to us all. It is one of the things produced in a large gland called the "pancreas."
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**Although glucose is normally obtained from the digestion of carbohydrates, the body can also make glucose out of protein, though much less efficiently. This means if you deprive your diet of carbohydrates, you body will begin breaking down protein to make glucose. Your body doesn't make glucose out of fat. If you don't eat protein either, then your body will begin breaking down its own protein: skeletal muscles and organ tissue. When your body does this you are in a condition called starvation. When the organs can no longer function, you will die.
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Next: exactly what is diabetes?