Diabetes is one of the most common and yet, misunderstood diseases in the United States, according to Jon Baird, MPAS, PA-C, ATC, and faculty of Master of Physician Assistant Studies at Rocky Mountain University of Health Professions (RMUoHP). The two most common types of diabetes are Type I and Type II.
Type I amounts to a failure of the body to produce insulin. You have cells within your pancreas that produce insulin and those that aide digestion. If your pancreas doesn’t produce insulin, you have a problem. Insulin is necessary to allow blood glucose to move inside of cells and make energy. Without insulin, blood glucose stays in the bloodstream, and it builds up until it can become toxic. “It might as well be poison in terms of its effects on our nerves, kidneys, eyes, and its influence on things like increasing the risk for heart attack or stroke,” said Baird. “The crux of the problem is that you don’t make insulin.”
Baird says there seems to be an autoimmune component to the cause of Type I diabetes, but experts are not entirely sure what triggers the pancreas to stop making insulin.
“We can see that Type I diabetes runs in families, but why? We don’t know that is a predictor of the disease,” he said. “There is more that we don’t know than what we do know in terms of what causes it.”
Type II diabetes is similar yet different from Type I. With Type II, people start becoming more and more insensitive to the insulin they already make. To compensate, your body continues to increase the levels of insulin. By increasing the levels of insulin, your body can maintain the status quo of standard blood glucose control and so forth. Up to a point.
“At a certain point you fail to meet the demand of insulin needed,” said Baird. “Classically, when you talk about Type II diabetes, we’ll talk about an association with obesity. Every cell in your body is going to need insulin, and the more cells you have, the greater the demand is placed on the pancreas. We continue to spiral and spiral upwards until we can no longer produce insulin and the body begins to fail.”
According to Baird, being overweight does not equal a diagnosis of diabetes, but it is a substantial risk factor. What many people don’t realize is that when most people are diagnosed with Type II, they have usually had it for five or six years before it is recognized. With Type II, the complications with eyes, the kidneys, the feet and hands, and so forth are all still in play.
“Is this genetic? The answer is, it depends,” said Baird. “I think the one statement that I can make with a fair degree of confidence is that it is not written in your stars.”
Diabetes affects and damages nerves, which isn’t limited to hands and feet. It can affect the autonomic system supplying the internal organs. It can affect how your body moves food from your stomach to your intestines and can have a profound effect on your other internal organs. “We don’t know why it does this, but we know there’s a clear association with high blood glucose and these issues.”
“The fact is with diabetes, you start seeing stuff in the urine that you shouldn’t see,” said Baird. “You see larger proteins that should stay in the bloodstream but aren’t. It’s like holes punched in the filter, that’s coming from damaged vessels. All of this compromises the function of your kidneys. It is slow and insidious.”
When patients are diagnosed with Diabetes, Baird doesn’t get into the game of blaming patients. “Remember Diabetes is a jerk,” said Baird. “It doesn’t care about you; it doesn’t care about your kid or that it’s hard for you to do this. Diabetes just is. We could talk about what could have been, what should have been, things like that, but at the end of the day, I find all of that from a practical standpoint is counterproductive. I don’t blame patients for what their disease did to them.”
Regarding Type II diabetes, someone can be doing everything right – they’re going in regularly to visit their doctor, they are doing all of their checking, and taking all of their medicines, and pancreas function continues or starts to decline. It can make your medications look like they aren’t working, which can be frustrating. Then you blame yourself. But it’s not you. “Diabetes is a jerk,” and we need to adjust and adapt. You can control what you can control. If you take care of the big three – blood sugar, high blood pressure, and the lipids (cholesterol) – then you’re doing most of the work that you can do in terms of making sure that however many more years you have, they are quality ones.
“[diabetes is] a disease. It’s not a lifestyle,” said Baird. “If I can leave people with one real good take-home point, it’s that people with diabetes would not choose to have it. Don’t think for a minute that they sat there thinking, ‘well, you know, I could choose to do this, or I could choose to have diabetes.’ People don’t choose to have it.”
