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Annals of diabetes

A heavily simplified fact sheet

By FPublished 3 years ago 6 min read
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Photo credit to Diabeteswise

As a pharmacologist working in tissue engineering with an interest in pharmacokinetics and business, I recognize that that entire line was a mouthful. I am also a type 1 diabetic, which allows me the enjoyment of knowing a good number of things in varying depths. In most situations this is usually not helpful information.

While I could open the annals of my mind (wow, that can be read in a lot of different connotations – get your mind out of the gutter!) to many different areas and share how the compound responsible for farts is called skatole and is the result of gut bacteria, or that humans circa 1920s used amniotic fluid from births as a medicine, I will keep this one focused instead on the experience of diabetes. I’ll start easy.

1. Diabetes is diabetes mellitus. The reason you hear that there are different types are because this disease was named for the manifestation of high glucose such that people can excrete sugar in their urine. Way back before insulin (1920s) and measurement systems, doctors diagnosed diabetes by tasting people’s urine. If you find this absolutely disgusting, I agree – I wouldn’t have wanted to be a doctor back then either.

2. Delving into the types, type 1 is elevated glucose because the pancreas becomes a useless organ. This can be for a number of reasons – typically the immune system attacks it, or a cell signaling defect due to genetics.

3. Type 2 is elevated glucose due to insensitivity of glucose receptors to insulin that is being produced. This takes time to manifest, which is why there is a tendency to see it in older people rather than younger. Of course, there’s tons if different dietary and exercise/lifestyle aspects to changing insulin sensitivity, and that matters for both type 1 and type 2. The difference is that no matter how much type 1s exercise and change their diet, they’ll still need insulin because they simply don’t produce it.

4. Speaking of – before insulin was created, type 1s usually had a very short lifespan, and a low quality of life. These kids were put on an essentially no carb diet, eating only protein, and then in no small part due to the hunger, but also the insane amount of stress that their kidneys were under from glucose and protein, died early. Not so much fun. The more important question here is why in this age of analog insulins, continuous monitoring devices, pumps, and artificial intelligence, is why are people still dying from hyperglycemia?

5. Which brings me to – the diabetic care landscape has changed a lot in the last century. The first insulins weren’t very good, being purified from pig pancreas using a long complicated list of chemical reactions. I can actually perform this, and should have a copy, along with all the ingredients, hidden in some underground bunker, but I don’t. I guess I’ll just wing it if I have to. Since it was pig derived, the human body sometimes reacted badly. It still improved life by a lot. Since then there’s also recombinant human insulins – these are most similar to what a normally functioning pancreas makes, and are now available as generic medicines. Price still sucks, but not as bad as the analogs. You’d think – great, I’m using the same thing as what I’d have if my pancreas worked, right? Wrong – drug adsorption, distribution, metabolism, and elimination plays a huge role here. In a diabetic, injected insulin needs to be absorbed by the fat cells and then distributed to the muscle before it can work. Recombinant insulin has the advantage of not having that nasty immune reaction like xenograft insulins, but suffers from having an incredibly long absorption and distribution profile. Enter analog insulins – these babies are absorbed super fast, and work even faster. Different formulations speed it up or slow it down. Unlike a normal human where insulin is produced in response to rising glucose, and in the expectation of increased glucose so that muscle can just absorb it, diabetics not only need to think about how much insulin to take, and then wait impatiently for it to be absorbed and distributed before seeing it work.

6. Perhaps the most growth in technology has been in the last 20 years or so. Enter pumps, continuous monitoring, and artificial intelligence. We have technology that can do all the work for us – but can we trust it? Pumps clog and people don’t get their insulin due to bent cannulas. Continuous monitor probes get inserted onto nerves and into blood vessels to give really incorrect readings. In the meantime, the companies that supply these gadgets are paring down their customer service budgets, and less willing to replace defective hardware.

7. For instance, Dexcom’s platinum sensor technology – platinum is a fairly valuable metal. But instead of introducing methods for customers to save money by charging transmitters or making those batteries replaceable, they’re more interested in making them impossible to replace and running $5 million Superbowl commercials – a move that I find really tacky.

8. In business, they teach us that all of our money creates “dollar votes” – that the companies that survive, and thrive get customer dollar votes because they are providing something of value. There are a lot of different monitors and insulins for diabetes management. But most diabetics don’t have much choice – insulins are not equivalent in their pharmacokinetic profiles and a lot of the time, it’s a choice dictated by insurance plan, not by what works best for the patient. This is true even for those in countries having coveted universal healthcare plans.

That’s a lot to unpack about type 1 diabetes. Let’s unpack more information and uncommon knowledge on one of the points about diet and exercise, and add in some metabolism:

Healthy food and exercise are good things. That’s a statement where even the most healthy human might have some mixed feelings on if they’re feeling slumpy. Like watching TV, there needs to be a balance – too little is bad, too much is bad, and what type is it?

Insulin sensitivity can erode over time, leading to type 2 diabetes. Our bodies digest different foods differently, and the composition of different foods changes our metabolism and insulin sensitivity. Proteins and fats tend to take a long time to digest. While they have the advantage of lacking carbs (except nuts), this means that they might lead to long term blood sugar elevation (insulin insensitivity). A great thing for body builders seeking to put on more muscle, but not so good if you’re a diabetic using ultra fast acting insulin – first you drop then you go sky high. Nuts do both – carbs at first, then keep sugars up. Starchy foods like potatoes and bananas do the same because it takes a long time to bring sugars down.

Contrary to trendy belief, simple carbs like those in plants, fruits, and bread are not necessarily the devil. Complex carbohydrates and starches lead to elevated blood sugars because they take longer to digest. Delving into ketogenic diets that avoid these things as though they were created by Satan himself – that works if body fat is high enough for someone to access their fat energy stores. For anyone who doesn’t, they need an easily accessible source of energy – food, or they risk becoming lethargic without any change to their body weight or composition, plus additional kidney stress. It’s all about moderation.

What’s the point to working out all the time anyways? Don’t get me wrong – I love a good swim, and lift weights. But I’d never want to be in the gym for hours each day. For those of you where this is your livelihood and passion – my kudos to you. For anyone who does it to lose weight or control blood sugars, it’s got to be insanely frustrating to pour in all that effort without results.

Hope you all learned something. XOXO,

Felicia

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