Meet the Diabeteses, By Gary Scheiner MS, CDE | My Baba

At the heart of diabetes is the hormone insulin.  Insulin’s job is to facilitate the movement of nutrients (particularly glucose) out of the bloodstream and into the body’s cells where they can be burned for energy.  When not enough insulin is produced or the body’s cells cannot use the insulin properly, blood sugar levels rise above normal and diabetes develops.

In the vast majority of cases, diabetes can be grouped into two major classes: the kind caused by loss of the ability to produce insulin, and the kind whose underlying cause is insulin resistance (the body’s inability to utilize insulin properly).  Now here’s where it gets interesting.  People who lose the ability to produce insulin can sometimes develop insulin resistance, and those who have insulin resistance sometimes lose the ability to produce insulin.

Confused yet?  Don’t worry.  You’re not alone.  Let’s see if we can sort it all out.

All forms of diabetes cause blood sugar levels to be too high. Hypoglycemia (low blood sugar) can also occur when insulin or insulin-enhancing medications (sulfonylureas or meglitinides) are used in the treatment.  All require careful ongoing management, and all can produce a wide range of health problems (complications). However, the similarities stop there. From a physiological standpoint, the various forms of diabetes and their modes of treatment vary like flavors of ice cream.  First, let’s look at the vanilla, er, type 1 diabetes.

Type 1 diabetes involves damage to the pancreas, a slimy organ nestled below the liver.  At the base of the pancreas is a cluster of cells called “Islets of Langerhans” (named after the person who discovered them), and contained within the islets are “beta” cells.  It is the beta cells that constantly measure blood glucose levels and produce insulin, as needed, to keep the blood sugar within a normal range.  Along with insulin, beta cells secrete amylin, a hormone that, among other things, regulates the rate at which food digests.

In type-1 diabetes, the beta cells are destroyed by the body’s own immune system. Normally, the immune system only attacks things that are not part of your own body, like viruses and bacteria.  In an autoimmune disease such as diabetes, the immune system fails to recognize a part of your own body and attacks it.  In the case of type 1 diabetes, the beta cells are attacked and destroyed over a period of months or years. As a result, the blood sugar level goes up and the body’s cells are deprived of the sugar they need for energy.

Type 1 diabetes is usually diagnosed during childhood and adolescence, but it can also appear during adulthood.  Most people with type-1 diabetes were born with an “overactive immune system”.     Exactly what triggers the attack on the beta cells of the pancreas is not entirely understood.  Viruses, major stress, environmental toxins, exposure to certain foods at a young age, and genetic markers have been proposed as potential triggers.

At the time of diagnosis, a person with type 1 diabetes will likely have a very high blood sugar level and elevated ketones (acids formed from excessive fat metabolism coupled with insufficient sugar metabolism).  Blood sugar levels above 180 mg/dl (10 mmol) also cause excessive urination as the kidneys pass some of the sugar into the urine.  In essence, high blood sugar causes a person to urinate away many of the calories they consume.  Consequently, rapid weight loss can occur.  Frequent urination also makes a person very thirsty. And since you are unable to get sugar into your cells without insulin, your energy level will be quite low and you will be hungry constantly.

Type-1 diabetes can be diagnosed a number of ways:  through a blood sugar and urine ketone screening, by evaluating symptoms, or by testing for certain antibodies in the blood.  Once type-1 is diagnosed, insulin treatment begins immediately. This initial treatment can provide a rest period for any beta cells that have yet to be destroyed by the immune system.  These remaining cells may be able to produce enough insulin to keep blood sugar levels relatively stable for a period of weeks, months, or possibly years. We refer to this as the “honeymoon phase” (or, more appropriately, “the calm before the storm”). Eventually, beta cell function ceases completely and insulin requirements go up and stay up. Without insulin, a person with type 1 diabetes will become severely ketotic (have high levels of acids in the blood), go into a coma, and die.  This is the reason type 1 diabetes used to be called “insulin-dependent” diabetes: You depend on insulin to stay alive.

Approximately 90% of people with diabetes have Type-2 Diabetes.  Type-2 is very different from type-1 in that there is no autoimmune attack, and the pancreas continues to produce insulin.  In fact, for a while, the pancreas may actually produce more insulin than usual.

There are typically three stages to type-2 diabetes:  Onset of insulin resistance (often caused by obesity or genetics), followed by failure of the pancreas to meet the increased insulin need caused by insulin resistance, followed by a reduction in pancreatic function.  Treatment for type-2 diabetes usually begins with changes to diet and exercise patterns (weight-loss efforts), then proceeds to oral meds or non-insulin injectables, and eventually winds up with insulin.

The “Other” Diabeteses (OK, I made that word up)

Remember, diabetes comes in more flavors than just vanilla (type-1) and chocolate (type-2).   There are a host of exotic flavors to choose from.

Secondary Diabetes (Cookies & Cream) involves destruction of the beta cells of the pancreas by something other than the body’s own immune system.  Potential causes include trauma (accidents/injuries), heavy doses of steroids, pancreatitis, alcoholism, cancer treatment, and infection.  Regardless of the cause, the treatment is the same as with type-1: insulin, insulin, and more insulin.

Gestational diabetes (Strawberry) is a temporary form of type-2 caused by insulin resistance that develops during pregnancy.  Women with gestational diabetes usually require insulin to control their blood sugar levels.  This is because oral medications pass through the placenta and may affect the baby’s development.  After delivery, when the production of insulin-opposing hormones drops off and weight comes down quickly, most moms cease to need insulin injections.  However, their risk for developing type-2 diabetes later in life is markedly increased.

MODY (Marshmallow) stands for Maturity-Onset Diabetes of the Young.  Unlike type-2 diabetes, which is typically caused by insulin resistance, MODY is caused by a genetic defect which limits the ability of the pancreas to secrete sufficient amounts of insulin.  MODY is not associated with being overweight or obese.  It is frequently diagnosed during early puberty, perhaps due to the increased demand for insulin caused by pubertal hormone production.  Oral medications or insulin may be required to treat MODY, depending on how defective the beta cells become.

LADA (Mint Chocolate Chip) refers to Latent Autoimmune Diabetes of Adulthood.  Think of it as an incomplete, slowly developing form of type-1 diabetes that is compounded by mild to moderate insulin resistance.  Some people call it “Type 1½” because it shares characteristics with both type-1 and type-2.  In LADA, the immune system attacks the beta cells of the pancreas, but the attack is incomplete.  Many beta cells survive and continue to secrete insulin, sometimes for years.  Many people with LADA can manage their blood sugar with oral medications or low doses of insulin for a period of time, but eventually true insulin-dependence develops and treatment requires intensive insulin therapy.

Neonatal Diabetes  (Butter Pecan) is a rare form of diabetes that occurs in the first six months of life.  Similar to MODY, neonatal diabetes involves an inherited genetic mutation that limits the beta cells’ ability to produce insulin.  In some cases, neonatal diabetes disappears during infancy but then reappears later in life.  In other cases, diabetes persists and remains permanent.  Insulin is almost always required to treat neonatal diabetes and promote healthy growth/development.

TYPES

1) Type-1

Cause(s)

Autoimmune attack on beta cells of the pancreas
 

Treatment Options
Insulin

2) Type-2

Cause(s)
Insulin resistance and progressive beta cell insufficiency

Treatment Options
Lifestyle changes, diabetes medications, insulin

3) Gestational

Causes(s)
Temporary insulin resistance

Treatment Options
Lifestyle changes, insulin

4) LADA

Cause(s)
Partial autoimmune attack on beta cells, and some insulin resistance

Treatment Options
Insulin, possibly diabetes medications in early stages

5) Neonatal

Cause(s)
Genetic defect limiting beta cells’ ability to make insulin

Treatment Options
Insulin

5) MODY

Cause(s)
Genetic defect limiting beta cells’ ability to make insulin

Treatment Options
Lifestyle changes, diabetes medications, insulin

Editor’s note:

Gary Scheiner is owner and clinical director of Integrated Diabetes Services (www.integrateddiabetes.com), a private practice near Philadelphia, USA, specializing in intensive insulin therapy for children and adults. Gary Scheiner is a Certified Diabetes Educator with a private practice (Integrated Diabetes Services) based near Philadelphia, USA.  Gary has had type-1 diabetes for more than 25 years, and is author of several books including “Think Like A Pancreas:  A Practical Guide to Managing Diabetes With Insulin”.  He and his staff of diabetes educators provide diabetes management consultations throughout the world via phone and the internet. Gary recently surpassed his 28-year “anniversary” with diabetes.  

Note: He and his team of clinical experts (all of whom have diabetes) offer diabetes management consultations via phone and internet to insulin-users throughout the world.  For more information, call (877) 735-3648 or e-mail gary@integrateddiabetes.com.

www.integrateddiabetes.com
www.type1university.com
Facebook: Integrated Diabetes Services
Twitter: @Integ_Diabetes

About The Author

Gary Scheiner
Diabetes Educator

Gary Scheiner is owner and Clinical Director of Integrated Diabetes Services (www.integrateddiabetes.com), a practice located just outside of Philadelphia specializing in intensive insulin therapy and advanced education for children and adults. He and his staff provide consultations throughout the world via phone and the internet. Gary is a Masters-level exercise physiologist. He has been a Certified Diabetes Educator for 18 years, and has had Type-1 diabetes for more than 28 years. He has received several awards for his work in diabetes education, most notably Diabetes Educator of the Year in 2013 by the American Association of Diabetes Educators. He has written dozens of articles for diabetes trade publications and six books, including “Think Like A Pancreas”. Gary lectures nationally and internationally for people with diabetes as well as professionals in the healthcare industry

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