Diabetes: So What Is It Really?

First published in Beyond India, September 2016 edition.

Dr Rahul Barmanray

Diabetes. Some people think of piles of tablets and injections. Others might think of all the mithai and jalebi their wife won’t let them eat. Some may think of that uncle who had a heart attack or the aunty who had her leg amputated. Diabetes means very different things to different people. In this article from the Australian South Asian Healthcare Association (ASHA) we try to sort out what diabetes is and why it’s a problem. Next time we’ll discuss how a doctor finds out if you have diabetes and what to do about it if you or someone you know has it.

Ma, today in school we learned about diabetes. Baba has it so does that mean I’ll get it when I’m older?

There are two main types of diabetes mellitus (it’s Latin for ‘sweet urine’). Type 1 is due to the body’s own defence system attacking one of the digestive organs, the pancreas. It occurs mainly in teenagers and requires treatment with injections right from the start. When we talk about diabetes we’re usually talking about the much more common type 2.

As odd as it may sound, your body runs on sugar. Sugar, either eaten directly or as a breakdown product of many foods we eat is the main supply of energy to your brain, muscles, and vital organs. Except for the brain, sugar cannot get through the tight walls that surround your body’s cells. There are doors in the walls and these can be opened by a key, which is the hormone insulin. Insulin is produced by the pancreas, a small organ that sits behind the stomach.

When a person is overweight, body cells try to stop further weight gain by making the doors fewer and more difficult to open. But now the only way to get sugar into cells is by making even more insulin. The cells react by reducing the number of doors even more and we get the cycle of insulin resistance. Eventually the pancreas cannot make enough insulin to allow sugar to enter cells, so sugar builds up in the blood and starts causing problems.

Oh bhaiya! These stairs get higher every day!

When sugar gets wet it becomes sticky, attaches to the sugar jar, and you have to throw it out. Sugar in the blood is also sticky and attaches to the insides of the blood vessels. This attaching damages the cells that make up the blood vessel. Fortunately they can usually be repaired or replaced before any lasting damage occurs. In diabetes there is too much sugar in the blood and it damages the vessels faster than they can be repaired.

The most important blood vessels affected and the problems caused by them are in the: heart (heart attacks), brain (strokes), legs (pain, swelling, ulcers, infections), kidneys (kidney failure), eyes (cataracts, blindness), and nerves (pain, dizziness). Luckily, with early diagnosis and proper treatment, these problems can be reduced and even avoided before they happen.