news: Diabetes

Know your enemy and control it, don’t let it control you!

LET’S START with a little bit of a history lesson to see how diabetes was discovered as I find it very interesting and hope you do too.

The earliest known record of diabetes was in 1552 B.C. by an Egyptian physician named Hesy-Ra, who mentioned polyuria (frequent urination) as a symptom. In the 1st century A.D. Arateus described diabetes as “the melting down of flesh and limbs into urine”. Up to the 11th century “water tasters” commonly diagnosed diabetes, as the urine of people with diabetes was thought to be sweet tasting. The Latin word for honey, mellitus, was added to the term diabetes as a result.

In the 16th century, Paracelsus identified diabetes as a serious general disorder and, in the early 19th century, the first chemical tests were developed to indicate and measure the presence of sugar in the urine. In 1870, French physician Bouchardat noticed the disappearance of glycosuria (sugar in the urine) in his diabetic patients, through the rationing of food in Paris, during the Franco-Prussian war and formulated the idea of individualised diets for his diabetic patients.

More research followed which eventually linked the pancreas to diabetes and, on October 31 1920, Dr Frederick Banting, a Canadian physician, conceived the idea of insulin which consequently was “discovered” in the summer of 1921. A 14-year-old boy was the first to be successfully treated with an insulin extract in 1922.

In the 1940s, a link was made between diabetes and long-term complications (eye and kidney disease) and, in 1944, the standard insulin syringe was developed helping to make diabetic management more uniform. Oral medication was introduced to help lower blood glucose levels in 1955 and in 1959 two major types of diabetes were recognised; type I (insulin dependant) type II (non-insulin dependent).

In 1983 the first biosynthetic human insulin was introduced and in 1986 the insulin pen delivery system was developed.

Of course, there were many other ‘steps’ that had to be climbed to reach where we are today in what concerns the treatment and management of diabetes. We are forever moving forward with research, now concentrating on a cure for this disease. In order to understand a potential cure, it is necessary to look briefly at the cause.

In insulin-dependent diabetes, the diabetic’s body fails to make insulin, a hormone essential to the metabolism of glucose. Glucose enters the blood stream from the food that we eat and, in the presence of insulin, is taken up and “burned” by cells that require this essential fuel. In the absence of insulin, however, glucose accumulates in the blood causing the condition known as high blood sugar (hyperglycaemia), while the cells starve for fuel. Without taking insulin injections, the diabetic will slowly starve to death, despite abnormally high blood sugar levels.

Why does a diabetic’s body fail to produce insulin? Within the pancreas, the Islets of Langerhans produce insulin in response to blood glucose. These islets are tiny insulin factories that sense the level of glucose in the blood stream, and produce insulin in precise proportion to that level. Therefore, following a meal, blood sugar levels will rise significantly, and the islets will release a large amount of insulin. This insulin will cause body cells to take up the sugar, causing blood sugar to quickly return to its normal range. Once blood sugar is in the normal range, the islets will reduce the output of insulin to an idling state. In this way, the islets adjust their production of insulin on a minute-by-minute basis, always producing just enough insulin to deal with the amount of blood sugar presently in the blood stream.

In insulin-dependent diabetes, the islets are destroyed by the person’s own immune system, which mistakenly identifies these essential cells as foreign invaders. This self-destructive mechanism is the basis of many so-called autoimmune diseases. Once the islets are killed the ability to produce insulin is lost and the symptoms and consequences of diabetes begin.

Some people think that injecting insulin is a cure for diabetes. Unfortunately it is not. Insulin allows a diabetic to survive, but the effects of crudely controlled blood sugar levels lead to the many devastating consequences of the disease. Unlike the precise matching of blood sugar and insulin levels that occurs normally, a diabetic’s insulin injections cannot be precisely and continuously adjusted to maintain safe sugar levels.

When an excess of injected insulin drives blood sugar levels too low, the diabetic risks an immediate dramatic reaction that may include confusion, loss of consciousness, coma and even death. When injected insulin is below the required amount, blood sugar levels rise, leading to damage to eyes, kidneys, nerves, heart and blood vessels. Most diabetics are forced to operate at abnormally high blood sugar levels to avoid the more immediate and dramatic consequences of low blood sugar.

Insulin is not a cure for diabetes. A cure must restore the person’s ability to adjust insulin production minute-by-minute to precisely match the uncontrollable variations in food intake, exercise and stress, all of which are a normal part of living. This is where islet transplantation comes in and I will be explaining a little bit about this in my next article, along with the current approach to this chronic disease.

Niki Medlock

Luzdoc Practice Nurse

Diabetic Clinic Nurse