Diabetes―the Silent Killer

The onset of type 2 diabetes is gradual, with most individuals progressing through a state of prediabetes, a condition now striking approximately 1 in 3 Americans, but only about 1 in 10 even knows it.

Video 1.  How to Prevent Prediabetes from Turning into Diabetes (YouTube link)

Type 1 vs Type 2

• Type 1 diabetes
• Occurs when the pancreas doesn't produce enough of the hormones needed to alert the body to sugar
• Is now widely treated by supplemental insulin
• Type 2 diabetes (aka age-associated diabetes)
• Occurs when pancreas is able to make enough insulin but the body is deaf to it.
• The 9 percent of all adults globally with this disease need a drug (i.e., metformin) that restores their body’s sensitivity to insulin so cells take up and use the sugar that’s coursing through their bloodstreams. That’s important for at least three reasons:^[4]
• It gives the overworked pancreas a rest
• It prevents spikes of freely floating sugar from essentially caramelizing proteins in the body. 
• Recent results indicate high blood sugar can also speed up the epigenetic clock (i.e., aging).

Complications of Diabetes

Diabetes itself has few symptoms, but its consequences can lead to disability and death.

Complications develop because diabetes and its high blood sugar levels lead to a breakdown of multiple body systems that usually maintain a healthy energy balance. Among other problems, this breakdown creates inflammation throughout the body, especially in blood vessels.

A few of the complications include:^[1]

• Heart and brain 
• By irritating blood vessels, diabetes accelerates damage caused by cholesterol blockages in the lining of arteries that bring oxygen and nutrients to all tissues in the body. 
• In the arteries nourishing the heart, these cholesterol time bombs are more liable to burst open to cause a heart attack. 
• This blockage of critical oxygen causes the death of heart muscle tissue. The same thing frequently occurs in the arteries that feed the brain. The resulting stroke kills off brain tissue. 
• Unfortunately, lowering blood sugar is not be enough to prevent these difficulties.
• Some damage to arteries can’t be reversed and diabetes causes injury in other ways beyond blood sugar.
• Kidney
• Diabetes damages kidney blood vessels as well as the filtration system that creates urine. This stresses and overworks the kidney, making kidney failure more likely. Diabetes is the most common reason for kidney dialysis, where a machine is needed to filter the blood after the kidneys fail.
• Cognitive impairment 
• People with diabetes can have difficulties with thinking and memory. 
• As people with diabetes age, diabetes causes a faster decline then normal in mental functioning. 
• Researchers are still learning more about how diabetes affects the brain.
• Depression and fatigue
• Depression occurs twice as often in diabetes compared to other people. 
• Fatigue is also a common difficulty. 
• Both problems can occur soon after diagnosis and arise from high blood sugar levels and blood vessel inflammation as well as the stress and complexities of living with diabetes.
• Nerves
• Damage to leg nerves (peripheral neuropathy) occurs because diabetes damages the small blood vessels that provide nutrition to these nerves, which die off, leaving numbness or pain instead of normal sensation.
• Sexual dysfunction 
• Damage to key blood vessels as well as other diabetes complications frequently lead to sexual problems.
• Eye
• Several forms of eye disease, many related to faulty blood vessels, make blindnessa real threat in diabetes.
• Stomach and intestines
• In diabetes, the digestive system loses the ability to coordinate the passage of food from start to finish. 
• This produces problems ranging from poor emptying of the stomach to constipation.
• Skin
• Foot ulcers are rare in healthy individuals, but common for those with diabetes. 
• Loss of feeling in the feet from nerve damage makes injury more likely and then high blood sugar impairs healing. Problems with the feet and legs can require amputation.

Video 2.  How Not to Die from Diabetes (YouTube link)

This article was extracted from the fourth in a series of eight blog posts discussing pre-diabetes and Type 2 diabetes on the Scope published by Stanford Medicine.^[1] The first installments examined what happens inside the body in pre-diabetes, how to stop pre-diabetes from progressing and how doctors and patients can reframe their approach to diabetes. The next post will focus on treatments for diabetes that extend beyond medications to lower blood sugar.

References

1. Breaking down diabetes: The importance of complications
2. Dr Michael Greger on "How not to die from diabetes"
3. Breaking down diabetes: How to prevent complications
4. Lifespan: Why We Age—and Why We Don't Have To
• Like rapamycin, metformin mimics aspects of calorie restriction. But instead of inhibiting TOR, it limits the metabolic reactions in mitochondria, slowing down the process by which our cellular powerhouses convert macronutrients into energy. 
• Among beneficial effects, metformin helps people living healthier lives, inhibits cancer cell metabolism, increases mitochondrial activity, and removes misfolded proteins.
5. Bright Spots & Landmines: The Diabetes Guide I Wish Someone Had Handed Me