What is Diabetes, and How Does it Develop?

The Road to Diabetes

Woman using diabetes test kit
Type 2 Diabetes. Blend Images - Jose Luis Pelaez Inc / Getty Images

What is Diabetes?

Diabetes is defined in a few different ways, but it all comes down to difficulties in processing carbohydrate in the diet. In Type 1 diabetes (which is usually but not always diagnosed in childhood), the pancreas is unable to make insulin, the main hormone that facilitates glucose metabolism in the body. In Type 2 diabetes (which accounts for 90% of diabetes and usually occurs in middle-aged and older adults), the problem starts as a defect in the body's ability to use insulin.

This condition is called insulin resistance. Over time, damage occurs to the cells of the pancreas. When this gets bad enough, the person has Type 2 diabetes, which eventually may progress to the point where the pancreas doesn't make enough insulin and injections are needed. Thus, we have a whole spectrum of problems dealing with sugar, from mild insulin resistance to complete dependence on injected insulin. Somewhere in the middle comes the diagnosis of diabetes. The important point is that the process of diabetes in the body begins long before the diagnosis of diabetes.

Ruth's Story

Let's look at Ruth, a 20-year-old woman. There are many overweight people in her family and some of them have Type 2 diabetes, so she could be at some genetic risk for problems with glucose tolerance. But at age 20, she's basically fine, and can pretty much eat all the carbohydrate she wants (remember that all carbohydrate breaks down into sugar in the body, so for the purposes of Ruth's story, carbs=sugar).

However, by her mid-20's Ruth has picked up a few extra pounds. This could signal the beginning of insulin resistance. (There is still argument about whether insulin resistance causes weight gain or the other way around, but they probably trigger each other once the cycle gets going, and so both get worse.) If, at this point, Ruth were to cut back on her intake of high glycemic carbohydrates, she could potentially reverse the process, or at least slow it down.

But let's say Ruth continues to eat a high carb/sugar diet.

By the time Ruth has reached her 30's, the insulin resistance has increased and is starting to cause some other changes. Ruth, who has always had a "pear" shape, with most of her excess weight being around her hips, starts to collect more belly fat. Alarmed, she goes on a diet and cuts out most fat, but unfortunately for Ruth, this also means more carbohydrate, and her particular body has a hard time with sugar. She loses weight but is generally cranky and hungry and she quickly begins to regain weight to a higher point than before. Over the years, her body is having to pump out more and more insulin to keep her blood glucose in a normal range. She begins to have too much insulin in the blood (hyperinsulinemia).

By her mid-40's, Ruth has begun to have some of the other problems that go along with insulin resistance - high blood pressure and high triglycerides (signs of metabolic syndrome). Her fasting blood glucose has also started to rise - whereas 15 years earlier it was 85, it is now 95. This is still considered "normal", but the trend is not good. Ruth's body is having more trouble processing sugar. It is working harder and harder to get enough insulin out but is beginning to lose control of the battle.

At age 50, Ruth's fasting blood glucose is 101. After crossing the invisible line of 100, she is now officially prediabetic (also called impaired glucose tolerance). Her body is not managing carbohydrate intake well, and her blood sugar has greater rises after each meal. There is deterioration in the insulin-producing cells of her pancreas. She is put on a low-fat high-carbohydrate diet to lose weight, and she starts an exercise program. She has the usual response to the diet - it works in the short run, but after a few months, she loses steam and feels worse and worse.

At age 53, Ruth officially develops diabetes.

Her fasting blood sugar is 130 (the cutoff is 126), and it goes up over 200 when she gets a glucose tolerance test. She begins to take medication to help control her blood glucose. Exercise helps as well. She is determined to avoid the complications of diabetes that her older diabetic relatives have begun to experience. She finds that reducing carbohydrate in her diet is a great help in controlling her blood glucose.

Lessons From Ruth's Story

  1. It is worth figuring out whether you are on Diabetes Road. If you are likely to be insulin resistant or prediabetic, there are steps you can take to lower your risk.
  2. People who respond well to low carb diets often have difficulties processing sugar. This in itself could be a sign that you are on the road to diabetes.
  3. Take this seriously. This is not something to ignore or be in denial about. Insulin resistance itself is associated with a higher risk for not only diabetes, but certainly heart disease, stroke, and possibly Alzheimer's disease and some cancers. Diabetes has many more complications. The more you can preserve the cells in your pancreas, the better off you will be.
  4. Different people who are at different points along the road may respond to different amounts of carbohydrate reduction. Reducing high glycemic carbohydrates such as added sugar and refined white grains such as products made with white flour is a good place to start. You can learn more about carbohydrate reduction on this site.

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