Today, I’m Batman!

I’ve gotten some feedback from some of you, and I don’t think this is the post you are expecting.  But much like Batman, today, I’m going to be the writer you need, and not necessarily the writer you want.  Specifically, I know some of you want to know what happened with Mistake #4 from the Life As a Newly Minted Pharmacist post.  If you are just starting with this post, you might want to click the link to that one after we are done with some serious business. 

Today, I’m going to talk to you about the importance of understanding a bit about Diabetes, Type 2 in particular, aka T2D.  As a healthcare professional, Diabetes is an interesting condition.  There are generally considered to be two major types of diabetes.

1. Type 1 Diabetes is an autoimmune condition which leads to the destruction of the cells which produce insulin.
2. Type 2 Diabetes is a disease of insulin resistance where, because of constantly elevated blood glucose levels, Insulin just doesn’t work as well as it should.

There is also Gestational Diabetes, which can affect pregnant women, and there is building research that insulin resistance in the brain can trigger Alzheimer’s Disease, this is being referred to as Type 3 Diabetes. (That will certainly be a topic for another day!)

As I said above, today, I’m going to focus on T2D (T2DAdventures.com) since it is the focus of this site, and well, I have it…  T2D is a disease of insulin resistance caused by too much sugar.  Seems simple, right?  If it is so simple, why is it so dang hard to treat?

What happens when you add sugar to the body?

Your Pancreas releases Insulin into the bloodstream, and your blood glucose goes back down.

What happens when your blood glucose goes down?

Your brain tells you that you are hungry and need to eat.  So, you eat.

Well, what happens when you eat?

Your blood sugar goes up again.  Insulin gets released, and your blood sugar goes down.

Ok, I think you get the idea, I don’t need to keep repeating this, but this is a cycle that repeats every time you eat sugar, or Carbohydrates (Carbs.) Going round and round like that cat on the exercise wheel, who incidentally gets more exercise than my cats… but I digress.   If you eat sugar regularly, you set this cycle in motion that gradually over time leads to a state where insulin levels continue to rise, in response to higher levels of sugar in the body.  Higher sugar levels lead to higher insulin levels.  Insulin levels take a while to go down, and a “while” is intentionally vague because each person is different.  Some people respond very quickly to an insulin response and insulin levels go down quickly also, but not everyone.  Insulin levels continue to stay high when there is a lot of glucose in the blood.

Insulin:

Insulin is a storage hormone.  It tells your body to store glucose from the blood into various cells and organs as fat.  The first place Insulin tells your sugar to go is into the Liver.  Unless you are a regular consumer of alcoholic beverages, this is the leading way for someone to develop FATTY Liver.   The technical term for this is Non-Alcoholic Fatty Lover Disease (NAFLD).  Quite the mouthful, which is why most people just call it Fatty Liver.  As a very brief side note, if you are a chronic consumer of alcoholic beverages, AND Type 2 Diabetic, your liver function will likely be

significantly compromised.

But I don’t eat sugar all the time, so why does this happen to me?  I haven’t been told that I’m diabetic so why do I need to care about this Todd?

But I don’t eat sugar.  I eat carbs.  That’s Ok, right?  Nope, listen to Batman at the left!

I’m going to continue to refer to Carbs as Sugar in my posts, and in a later one I will go into a detailed explanation as to why, but for now, please just understand that Carbs=Sugar.

Serious Stuff:

Let’s pull over the Bat-mobile for a second here, and I’m going to issue a polite request to read the next couple paragraphs with your “I’m reading some super serious stuff” hat on. (Or your batman mask, if you have one)

According to the American Diabetes Association, in 2015, the most recent statistic listed, there were 30.3 MILLION diabetics in the USA, 9.4% of the population.  While that number is pretty impactful, this number is much smaller than the number of people who are PRE-Diabetic.

81.4 MILLION Americans are considered Pre-Diabetic.

So, what is Pre-Diabetes?  Well, that is a condition in which blood glucose levels are higher than normal, but too low to be considered Type 2 Diabetic.  Hold on a minute… There are 81.4 million people with a condition which consists of elevated blood glucose levels, but we’re not going to call them diabetic? I’m sorry, but that’s like telling someone that they are a little bit pregnant… either you are, or you aren’t.

So, I’d like to dispense a huge dose of intellectual honesty, and a little bit of math to this discussion, 30.3M plus 81.4M equals 111.7MILLION people in the USA are Diabetic. 

Let’s stop lying to ourselves, Pre-Diabetes is Diabetes.  To manage the statistics, and not be blown away by the numbers, many in the healthcare community, are just trying to fudge the numbers to make the problem not look nearly as catastrophic as it really is.

I said above that Pre-Diabetes is Diabetes.  I know a Doctor who scoffed at the notion of Pre-Diabetes.  Why does she scoff at the notion of Pre-Diabetes?  Well…  Very few people who receive a Pre-Diabetes diagnosis revert to non-Pre-Diabetes.  An extremely large proportion of them continue to progress to full Type 2 Diabetes.  So, therefore, in my personal opinion, we really should do away with calling it Pre-Diabetes and maybe say something like:

“Unless you make drastic changes to your diet and activity levels, you are certainly going to become Diabetic.”  Maybe people need a dose of tough love here?  I recall when my Diabetes was spinning out of control that my Dr muttered under her breath, “I guess you’re going to be one of those bad diabetics.”

That was a serious wake up call for me, and I have thanked her for it.

Houston we have a BIG problem:

I’m not going to sugar coat it people, we have a real BIG problem on our hands…  So, if you haven’t been told you’re diabetic, there is greater than a 1 in 3 chance that you might be told that you are.  And folks, that number is growing.

I’m not much of a gambler, but if I hadn’t already lost the coin flip with Harvey Dent, in regard to diabetes, I would certainly be looking at other places to take chances…

If you’re in a room with other people, look to the person to the left of you, now to the person to the right.    One of you likely has Diabetes.

Think about that for a minute.  You carpool to work with 2 other people, likely one of you has diabetes.

You’re in line at McDonalds, the person in front of you, the person behind you, or yourself, one of you has diabetes.  Maybe a bad example, because I can tell you right off that if you are in line at Micky D’s then the odds of having T2D are probably higher than the usual 1 in 3…  just sayin’

The concern about developing Type 2 Diabetes should be significant.  There are many factors which make it more likely for you to develop full-blown T2D.  Over the next few weeks/months I am going to continue to develop the narrative of why this needs to be avoided, but I also want to help you all prevent yourself from hearing that you have been diagnosed with T2D.

Most importantly, even if you are diagnosed, it is not a death sentence.  There are things you can do to live a full and long, healthy life.  You might need to make some significant changes in what you do, how you eat, your activity level, but it certainly does not need to be considered a death sentence!

-Todd

P.S. Here are some links to my most recent previous posts:

A-Ha! Moment #1

The College Years…

Life As a Newly Minted Pharmacist