Sliding into the DM (Diabetes Mellitus)

If one were to ask you now to explain diabetes to them, what would you answer? You would probably immediately think of the words, ‘insulin’, ‘sugar’, or even ‘obesity’, but how do these terms contribute to the science behind this prevalent disease?

A diagram of the insulin-glucagon feedback loop. (Source: ATrain Education)

The International Diabetes Federation (2020) reports that 6.3% of the total population of adults, 20 years old and above, in the Philippines are diagnosed with diabetes. Furthermore, as of 2016, diabetes is estimated to be the 7th leading cause of deaths globally. With the increasing rate of cases, putting more and more Filipinos at risk of detrimental complications associated with the disease, it is significant to educate the people of its nature, prevention, and treatment.

The human body is amazing in that it has developed ways to regulate its mechanisms and functions to achieve homeostasis or internal stability. One of the primary organ systems responsible for this is the endocrine system, which comprises organs that produce chemical messengers (hormones) to stimulate or inhibit certain organ functions. Think of it as a project coordinator that serves as a mediator between the different committees and parts of the project and ensures that their work remains cohesive.

Our body’s energy production is fueled by glucose, a basic unit of carbohydrates or sugars found in food. The endocrine organ responsible for the regulation of glucose levels in the blood is the pancreas which produces insulin or glucagon. At low blood sugar levels or hypoglycemia, glucagon is released into the bloodstream to trigger glucose production either from (1) amino acid molecules, (2) conversion from glycogen stored in the liver, or (3) reduction of glucose consumption in the liver. On the other hand, at high blood sugar levels or hyperglycemia, insulin is released instead, stimulating the liver to convert glucose to glycogen and increasing the uptake of glucose in cells. The latter mechanism of insulin can be likened to that of a key that opens the glucose channels in a cell.

Insulin lock-and-key model. (Source: OnTrackDiabetes.com)

Diabetes Mellitus (DM) is thus characterized by the malfunctioning of this system. In type I diabetes, the body’s immune system attacks the insulin-producing cells of the pancreas, ultimately destroying them in the process. Hence, it is also called insulin-dependent diabetes because the patient will need to administer insulin shots to themselves to supplement their lack thereof. It is still unknown what causes this immune response, but researchers believe it might be influenced by environmental or nutritional factors aided by the patient’s genetic predisposition to be susceptible to these factors.

On the other hand, type II or noninsulin-dependent diabetes is primarily caused by the body developing insulin resistance, i.e. the cells fail to respond properly to insulin. When this happens, patients initially experience hypoglycemia because the pancreas will overproduce insulin to try to induce cellular response; eventually, the ability of the pancreas to produce insulin weakens. Although this type is usually linked to obesity and/or an unhealthy lifestyle, insulin resistance can also occur during hormonal disorders and in pregnancy (gestational diabetes), when the demand for energy is greater. Regardless of type, diabetes cannot be directly passed down to one’s offspring.

However, certain genes can be inherited by children from their parents that increase their likelihood to develop the disease.

Due to the high concentration of sugar in the blood, the body will try to get rid of it through urination, oftentimes excessively (polyuria), leading to abnormal thirst (polydipsia), or even dehydration. Additionally, because of the amount of sugar lost in urine instead of being used in energy production, patients will also experience excessive hunger to replenish these energy sources. Subsequently, other symptoms may arise such as nausea, drowsiness, and blurred vision.

The human body being an interconnected system, diabetes may lead to complications such as hypertension, stroke, heart attack, blindness, liver, kidney, and nerve damage, and severe bacterial and/or fungal infections (e.g. gangrene). Type I diabetes patients are also at risk of a life-threatening condition called diabetic ketoacidosis (DKA) characterized by nausea, fatigue, vomiting, and abdominal pain. This is caused by the increased use of fat as an alternative energy source in place of glucose. The process breaks down fat into acidic ketones which end up accumulating in the blood. On the other hand, type II diabetic patients are at risk of hyperosmolar hyperglycemic state (HHS) wherein extremely high blood sugar levels cause dehydration and confusion, possibly leading to a seizure or a coma.

Besides insulin injections (for type I) and hypoglycemic drugs, one of the key treatments for diabetes is a change in lifestyle. Regular exercise can burn through the sugar in the blood instead of having them stored as glycogen in the liver. Furthermore, actively controlling one’s sugar intake through a proper diet also alleviates the insulin requirement of your body. It is also suggested to avoid smoking and to only drink alcohol in moderate amounts. Because the treatments are highly dependent on the patient’s medical records and general lifestyle, a doctor must immediately be consulted when experiencing any of the given symptoms, and regular general check-ups will also allow one to monitor their blood sugar levels from time to time.

Finally, you can now explain diabetes to whoever asks, although you might have to be in a very specific context for that topic to come up. Now that we have covered the basics of Diabetes Mellitus (DM), it is now up to you to change and save lives by educating your peers and relatives. On November 14, let us celebrate World Diabetes Day by spreading awareness about the disease and how to combat it. Ika nga ni Kuya Kim, “Lamang ang may alam!”

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References:

Brutsaert, E.F. (2020, September). Diabetes Mellitus (DM). Retrieved from https://www.msdmanuals.com/home/hormonal-and-metabolic-disorders/diabetes-mellitus-dm-and-disorders-of-blood-sugar-metabolism/diabetes-mellitus-dm

International Diabetes Federation. (2020, May 14). IDF Western Pacific members: The Philippines. Retrieved from https://idf.org/our-network/regions-members/western-pacific/members/116-the-philippines.html#:~:text=The%20Philippines&text=463%20million%20people%20have%20diabetes,will%20rise%20to%20212%20million.

Paz-Pacheco, E., & Jimeno, C. (2015). Diabetes care in the Philippines. Journal of the ASEAN Federation of Endocrine Societies, 30(2), 118. Retrieved from https://www.asean-endocrinejournal.org/index.php/JAFES/article/view/267/667

World Health Organization. (2020, June 8). Diabetes. Retrieved from https://www.who.int/news-room/fact-sheets/detail/diabetes