Diabetes Information Guide
Diabetes Mellitus as it is known medically is a condition that is characterised by a high or elevated level of blood sugar called glucose. It translates literally to mean ‘urine sweetened with honey’, which pertains to the sweet nature of the urine of diabetic patients. Currently it is estimated to affect over 120 million people worldwide and the number is rising rapidly.
Changes in Blood Glucose Levels
Glucose is a vital part of our diet and is found in many different types of food. When we eat, the carbohydrates we have in our diet are broken down by enzymes in our digestive system, to the smallest unit called, glucose. Once absorbed within our bodies, glucose is broken down to provide our cells with energy to grow and repair.
The enzymes that are involved in this process are called glycosylases and amylases and are produced within the α cells of the pancreas. This organ is located just behind the stomach on the left hand side of our bodies, containing 3 main types of cells, α cells, β cells and γ cells. Each of these cell types produces a different enzyme. The β cells produce insulin, whereas the γ cells are responsible for producing glucagon. Both of these enzymes are responsible for maintaining an adequate blood glucose level.
When we eat a meal, within 15 minutes our body absorbs the majority of the glucose through our intestines and into our blood. This causes our blood sugar levels to rise rapidly, prompting the pancreas to release insulin into our blood. The insulin then binds to specific receptors on our liver and muscle cells, telling them to take up and store glucose, and to stop producing glucose, in the case of the liver. This enables us to store glucose as glycogen, which can then be converted back to glucose in between meals.
As our blood sugar levels reach their peak after a meal, the amount of insulin within our blood begins to fall as the glucose is stored in our cells. The secretion of insulin then stops as the blood glucose levels begin to return to normal. In the time between meals, our blood sugar level can fall. In this case, glucagon is released from the pancreas, which causes the liver to release glucose for our body to use to produce energy. The concentration of glucose in our blood in between meals (3 hours after eating) is known as the fasting blood glucose concentration. Approximately 90% of this blood glucose is derived from stores of glycogen within the liver.
Although there are a number of types of diabetes, the two main forms are so called type 1 and type 2 diabetes. Each of these different types arise due to different types of problems within the body and as such have their own causes, symptoms and treatments.
Type 1 Diabetes
Type 1 diabetes or IDDM (insulin dependent diabetes mellitus) occurs due to the destruction or loss of function of the β cells within the pancreas. This stops the pancreas from releasing insulin into the blood when blood sugar levels rise. As such, after meals the body becomes unable to store any excess glucose we absorb into our blood and begins to release it in the urine. The resulting high glucose levels can then damage blood vessels and organs, especially the brain, eyes and kidneys. In severe cases the high glucose levels can cause unconsciousness and death.
Type 2 Diabetes
Type 2 diabetes or NIDDM (non-insulin dependent diabetes) is a problem that arises when the body loses its ability to respond to insulin. In other words, the pancreas can still release insulin but our cells no longer respond by absorbing and storing glucose. Just like type 1 diabetes, this causes problems following meals when our blood sugar levels rise. In both type 1 and type 2 diabetes, the body tries to release the excess glucose in the urine. This damages the kidney and can lead to kidney failure.
In this guide to diabetes, the different types of diabetes, causes, symptoms risk factors and treatments will be covered, along with a host of other useful information. If you are worried by any of the information you read and think you may have diabetes, please make an appointment with your GP who will be able to give you more information.
- Types of Insulin
- Injecting Insulin
- Side Effects of Insulin
- Measuring Blood Glucose
- Glycosylated Hemoglobin
- Risk of Type 1 Diabetes
- Effects of Type 1 Diabetes
- Macrovascular Complications
- Treating Macrovascular Complications
- Microvascular Complications
- Diabetic Neuropathy
- Treating Diabetic Neuropathy
- Diabetic Retinopathy
- Diabetic Nephropathy
- Diabetic Foot
- Treating Diabetic Foot
- Problems with Diabetes
- Transplantations for Type 1 Diabetes
- Preventing Type 1 Diabetes
- Living with Type 1 Diabetes
- Living with Type Two Diabetes
- Medication for Type Two Diabetes
- Long Term Effects of Type Two Diabetes
Diabetes & Acupuncture
Acupuncture treatment is based on the idea that illness is the manifestation of your body coming out of balance when your Qi (vital energy) is unable to flow throughout the body. The insertion of needles (approximately 4-25mm in length) during acupuncture treatment aims to re-establish the flow of qi around your body and stimulate your body’s own healing and organ function. However, some acupuncture practitioners also use acupressure, cupping or moxibustion techniques (the first two options may suit you better if you don’t like the idea of needles). The needles (or pressure etc) are inserted in several of the 500 acupuncture areas located on your body in order to unblock your qi channels. The choice of which acupuncture points to use is made by your acupuncture practitioner who will feel for areas of blocked Qi (which can be painful or be hotter/colder than the surrounding flesh). Different acupuncture points stimulate different nerves and organs so that acupuncture as a technique can be used to treat a wide variety of illnesses. Stimulation of the pancreas (using several different acupuncture points around your body) is thought to provide benefits to diabetics by reducing the symptoms of diabetes caused by autoimmunity. The stimulation of the nervous system that occurs from acupuncture in the region of your ears is thought to be beneficial for diabetics with type II diabetes. However you need to be aware that there is a wide variety of different acupuncture techniques so you will need to choose your acupuncture practitioner carefully to make sure that they are practising in a way that will most benefit you. Also, for diabetics, you should understand that acupuncture is a complementary therapy and should not be used as an alternative for GP visits and medical treatment.
Diabetes & Aerobic exercise
Aerobic exercise describes any physical movement (exercise) that acts to improve the cardio-vascular system (made up of your heart and blood vessels). The word aerobic illustrates that the improvement to these systems increases the efficiency of the uptake of oxygen into your body. This is important as your body needs oxygen in order to produce energy to carry out all of it’s vital functions (such as pumping your heart, using your brain and moving your muscles). Aerobic exercise is incredibly important in regulation of diabetes. If you are a diabetic then you would greatly benefit from taking regular aerobic exercise! The physical movement involved helps to burn off your excess glucose (sugar) in your blood which will reduce your resistance to insulin. In addition, aerobic exercise improves circulation (by strengthening your heart), lowers your blood pressure, increases muscle strength and energy levels and decreases your percentage body fat. However, if your type I diabetes is not being adequately controlled by treatment, excessive exercise could cause a dangerous build up of glucose in your blood stream so it is important that you discuss your exercise regime with your GP alongside your treatment to manage your diabetes. In addition diabetes type II can be caused by obesity, so partaking in regular aerobic exercise could also reduce the risk that you will develop type II diabetes later in life.
Diabetes & Anaerobic exercise
High intensity exercise can lead to the situation where you cannot replace the oxygen in your body fast enough (as your muscles use up oxygen to function). When this occurs it is known as anaerobic exercise because your body has to use anaerobic metabolism in order to function. You can only carry out anaerobic exercise for short periods of time (up to 2 minutes) because anaerobic metabolism causes the build up of lactic acid in your muscles (which is what gives you a “stitch” if you try to run quickly for too long). Anaerobic exercise builds muscle strength but, due to its short period, it will not strengthen your heart or use up a large amount of glucose (sugar). This means that anaerobic exercise should not be used to try to manage glucose levels in diabetics. However, if you are diabetic then you will still benefit from carrying out regular anaerobic exercise that builds your muscle strength and reduces your risk of obesity.
Diabetes & Auto-antibodies
An antibody is a type of protein (such as the protein known as CD3) that is produced by the immune system to recognise disease causing cells such as viruses and bacteria. Antibodies recognise foreign proteins that exist on viruses and bacteria (etc.) which are known as antigens. Antibodies recognise antigens because they act as a lock (the antibody) and key (the antigen). This allows your immune system to “get rid” of the disease causing cell (that is now attached to the antigen-antibody lock and key). An auto-antibody is an antibody that recognises one of your body’s own cells. When an auto-antibody locks onto one of your body’s cells it stimulates your immune system to destroy the cell. This means that auto-antibodies result in your body attacking it’s own cells which causes a number of auto-immune diseases including diabetes type I. In diabetes type I, your immune system is stimulated by auto-antibodies to destroy your beta-cells (which are located in the pancreas and are responsible for producing insulin). This is why diabetics with diabetes type I do not have the ability to produce insulin and have to treat themselves with insulin injections in order to control their blood-sugar level.
Diabetes & Autoimmune Disease
Autoimmune diseases are caused when your body’s own immune system attacks your body cells. Your immune system is stimulated to attack one of your body cells by auto-antibodies (that recognise the body cell that is to be destroyed). The destruction of your body cells will mean that your body is no longer able to carry out the function of the destroyed cells. In diabetes type I, your body’s immune system destroys the cells (the beta cells) that are normally responsible for producing insulin. This means that diabetics are not able to produce insulin which is the hormone that is responsible for regulating the concentration of glucose (sugar) in your blood. Consequently, diabetics are unable to control their blood-sugar level. This is why diabetes is a disease characterised by the inability to regulate blood-sugar.
Diabetes & Blood Pressure
Blood pressure is one of the vital signs used by medical professionals to assess your basic health and monitor your condition during hospital visits. It shows the pressure that your blood excerpts on the walls of your blood vessels (arteries and veins). Blood pressure is not constant but varies between a maximum (systolic) and minimum (diastolic) pressure over each beat of your heart. When a medical professional takes your blood pressure they usually do so using a sphygmomanometer (the instrument attached to the Velcro straps placed around your upper arm). Your blood pressure is measured both during systole (the period of maximum blood pressure) and diastole (the period of minimum blood pressure) so that it produces a reading that looks something like 120/80 mmHg. (The unit mmHg stands for millimetre of mercury (which has the symbol Hg) so that 1mmHg is equivalent to the amount of pressure exerted by 1mm of mercury.) Blood pressure varies throughout the body, with the highest pressures being found closest to the heart and the pressure reducing as the blood moves away from the heart (through the arteries, arterioles and capillaries into the venules and veins). Local areas of increased blood pressure occur due to valves in your veins, any blockage of the blood vessels and the effects due to gravity. The control of blood pressure is especially important in diabetics due to the increased risk of cardiovascular disease (diseases of the heart and blood vessel) caused by diabets. As a diabetic, your blood pressure will be thought of as being too high if your systolic pressure is above 140 (or 130 if you already have complications) or if your diastolic pressure is above 100. High blood pressure puts you at an increased risk of kidney damage and furthers your risk of developing cardiovascular disease. It can be caused by poor lifestyle (such as obesity, lack of exercise, smoking etc) although other factors such as family history (and diabetes) can also put you at a higher risk. If you are diabetic then you should aim to lead a lifestyle that promotes a healthy blood pressure (which is thought to be around 120/80mmHg although you should discuss this with your GP) by taking regular exercise, eating healthily (and reducing your salt intake), losing weight if you are obese, not smoking etc. If you already have a high blood pressure then your doctor may consider prescribing medication to assist in reducing your blood pressure although you still need to manage your lifestyle.
Diabetes & Carbohydrates
The word “carbohydrate” can mean different things to different people, but in essence all the ‘different’ definitions are in fact all the same. A carbohydrate at the smallest level is a molecule that contains atoms of carbon bound to atoms of hydrogen and oxygen in the same proportion that is found in water molecules (i.e. 2 hydrogen atoms to every one oxygen atom) hence the name “carbo-hydrate” (hydrated carbon). At a larger (some would say, real life) scale, carbohydrates are a type of food that include pasta, rice, bread, potato, fruits and sweets etc and make up the largest source of energy in the human diet. Carbohydrate rick foods are known as carbohydrates for the simple reason that they contain a high amount of carbohydrate molecules in them. Pasta, rice, bread and potato contain more complex carbohydrate molecules than fruits and sweets (which contain simple carbohydrates). Different carbohydrates are broken down by the body at different rates and the glycaemic index is used to compare the subsequent effects of the different carbohydrates on the blood sugar levels. Carbohydrates with a high glycaemic index will cause a more rapid and larger increase in the amount of sugar in your blood and will therefore require more insulin to be released by the pancreas to restore the normal blood sugar levels. This could cause you a problem if you are diabetic and your body is unable to produce insulin and could lead you to have a “hyper”. (A “hyper” occurs when you are “hyperglycaemic” which means that you have too much sugar in your blood). If you are diabetic, you should aim to reduce your intake of carbohydrates with a high glycaemic index and instead use a larger proportion of low glycaemic index carbohydrates (such as oats and beans) to fulfil your energy requirements.
Diabetes & Enzymes
Enzymes are proteins whose function is to increase the rate of reaction between other molecules. For example, molecules known as proteases are enzymes that allow proteins to be broken down and some types of type II diabetes may be caused by faulty proteases breaking down proteins in a way that prevents insulin from entering cells (and therefore stops the body from being able to respond to insulin and subsequently allows the blood sugar level to increase). The pancreas produces numerous enzymes that aid in digestions (digestive enzymes) by breaking down molecules of fat, cholesterol and carbohydrates. In some people, type II diabetes is caused or accompanied by large scale deterioration of the pancreas. This means that the pancreas is no longer able to produce these digestive enzymes which will cause your digestion to slow down or become inefficient. This will make your blood sugar more difficult to control and your GP may suggest that you take digestive enzyme supplements to help your body to break down your food products. However, overuse of these enzymes can be potentially harmful so it is important that you discuss your dose with your doctor and monitor any increases in your experience of heartburn, diarrhoea or stomach cramps.
Diabetes & Glucose
Glucose is often simply known as sugar as it is a sugar molecule found in your body made up of 6 atoms of carbon, 12 atoms of hydrogen and 6 atoms of oxygen bound together. Glucose is produced when food from your diet is broken down by your body’s digestive mechanisms and is an important energy source for your body (especially your brain). It is normally found in the blood within a tightly regulated concentration of between 3.5-6mM so that it is available for use by cells around the body as an energy source whenever they require it. Glucose reaches your blood stream either from the food that you eat (where it is absorbed by your intestines) or when the liver is stimulated to release its stores of glucose into the blood. The hormone insulin (that is produced by the pancreas) removes glucose from your blood by allowing your body cells to absorb it. However, if you have diabetes, you will have a much higher amount of glucose in your blood at any time (known as a high blood sugar level or hyperglycaemia) because you are unable to produce insulin (or because your body no longer responds to insulin) so the cells of your body are unable to absorb the insulin from your blood (so high amounts remain in your blood stream).
Diabetes & Immune system
The immune system describes the parts of your body that allow you to fight disease and tumour forming cells. The cells of the immune system are collectively known as white blood cells, although there are many different types that all fulfil different roles to allow the body to defend itself against the wide variety of disease causing entities that exist (including bacteria, viruses, worms etc.). Your immune response includes numerous different defence mechanisms that work to protect the body from disease causing organisms or particles and includes your outer defences (such as your skin and the mucus in your lungs), the immediate (innate) defences that includes cells in your body known as macrophages and neutrophils and the adaptive defences which includes your B and T lymphocytes (which are types of white blood cell). The adaptive immune system takes longer to respond to an infection but responds in a way that is specific to the particular disease causing intruder (for example, the B cells will have developed antibodies that specifically bind to the intruder to destroy them). If you have type I diabetes, it is very likely that it is caused by a fault in one of your white blood cells from the adaptive part of your immune system that causes it attack your body’s own cells instead of attacking disease causing cells. This is why diabetes is known as an autoimmune disease or an immune-mediated disease. In fact it is one of your T cells that is faulty and it specifically attacks the β-cells in your pancreas which are the only cells in the human body able to make insulin. This is why diabetics are unable to produce insulin and consequently unable to control their blood sugar level.
Diabetes & Insulin Aerosol or Insulin Spray
If you have type I diabetes your body will be unable to produce its own insulin due to damaged pancreatic β-cells (that usually make and release insulin). Insulin is required by the cells of your body in order to allow them to absorb sugar from your blood stream. Without insulin the sugar will build up in your blood until you have overly high blood sugar levels whilst the cells in your body are unable to access any sugar that they require as an energy source. If you have type I diabetes then you are probably currently using injectable insulin in order to control your blood sugar levels. You may find this technique painful and inconvenient, but be hopeful as there are currently numerous companies trying to design alternative methods of getting insulin into your blood without using injections. One of these potential methods that are currently being trialled is using inhaled insulin. The insulin is first made into droplets that can be released in an aerosol and inhaled so that it is absorbed into your blood stream via your lungs (very similar to the inhalers used by asthmatics). However, this delivery method is far less efficient that insulin injection so it is much more difficult to accurately control the amount of insulin that you are putting into your blood stream. This could effectively cause you to have poor blood glucose management which could increase your risk of heart disease and stroke.
Diabetes & Insulin Injection
If you have recently been diagnosed with type I diabetes then your body will be unable to produce its own insulin because of damage that has been done to the β-cells in your pancreas (that usually make and release insulin). Insulin is required by the cells of your body so that they can absorb sugar from your blood stream (that your body cells use for energy). When you have a meal the amount of sugar in your blood will increase (as the sugar is taken out of the food and absorbed into your blood via your intestines). However, this sugar will not be able to enter the cells of your body as there will be no insulin to help them to absorb it. In order for your cells to gain access to this sugar (and the energy that it provides) you will need to give yourself insulin. Your GP will have discussed the use of insulin injection with you (or referred you to a diabetic nurse). Insulin injections allow you to put insulin directly into your blood so that you can control your blood sugar levels. In order to correctly use insulin injections you will first have to measure the amount of sugar in your blood so that you can be sure than you are injecting the correct dose of insulin. If you inject too little insulin then your blood sugar level will remain high because your body will not be able to absorb all the available sugar and you risk becoming hyperglycaemic. If you inject too much insulin then your body will be less able to respond to the reduction in your blood sugar level (when it would usually allow the release of stored sugar back into your blood) and you risk making yourself hypoglycaemic.
Diabetes & Insulin Pump
If you are a type I diabetic then you will need to use some form of device to deliver insulin into your blood because your body will be unable to produce its own insulin due to damaged pancreatic β-cells (that usually make and release insulin). Insulin is required by the cells of your body in order to allow them to absorb sugar from your blood stream so it is vital that you are able to give your body the right amount of insulin when it is required. Most diabetics use injections to give themselves insulin at certain times of the day, but insulin pumps are another device that some people choice to use that can automatically deliver a basal insulin dose and also allows you to alter your dose if your lifestyle changes (e.g. if you have a particularly large meal or long exercise sessions). Insulin pumps are generally worn on your belt and pump a continuous flow of insulin into your body via a cannula (plastic needle that permanently inserted into a vein in your abdomen). The cannula has to be changed regularly (generally every few days) in order to reduce your risk of infection. Whilst insulin pumps are the closest we have to a simulated pancreas, it is important to realise that the pump output still requires careful management. If you are diabetic and considering using an insulin pump you should book an appointment with your GP or diabetic nurse to discuss the pros and cons specific to your particular medical history and lifestyle
Diabetes & Insulin replacement therapy
Diabetes either causes damage to your insulin producing cells in your pancreas (type I diabetes) or reduces your body’s ability to respond to your insulin (type II diabetes). If you have type I diabetes you will need to use a device that allows you to put insulin into your body although you may also have to do this if you have type II diabetes (you will need to discuss your particular requirements with your GP). Insulin within the body is a molecule released by the β-cells of the pancreas that allows the cells of your body to absorb the sugar in your blood stream as they require it. So, without insulin, your blood sugar will increase and your body’s cells will be unable to access any sugar to use for energy. For diabetic treatment, insulin comes in a variety of forms with different strengths, different onsets (how quickly it starts to work once it is in your body), different durations (how long it continues to work once it has started) and the length of time when the insulin is reducing your blood sugar levels most effectively. Your personal insulin replacement therapy plan will take into account your body size, any concurrent medical conditions, your lifestyle and your current blood sugar levels (as you give yourself the insulin). There are numerous difference devices that you may choose to give yourself insulin, the most common method being via insulin injection. If you have recently been diagnosed with type I diabetes then you should expect to have a long meeting either with your GP or with a specialist diabetic nurse who will explain how to measure your blood sugar level and how to give yourself insulin and answer any questions that you have. If you have recently been diagnosed with type II diabetes then the likelihood is that you will not need to use insulin replacement therapy, but your GP will discuss this with you either way.
Diabetes & Intestines
The intestines are a segment of the gastrointestinal tract (that runs from your mouth to your anus). They connect your stomach to your rectum (where your faeces are stored before being excreted via your anus) and include the small intestine and the large intestine (also known as the colon). The small intestine is where enzymes that are made in the pancreas are secreted which allow the chemical breakdown of most of your food (fats, proteins and some carbohydrates) occurs. The majority of nutrients that are produced from broken down food are absorbed into your blood from the small intestines. The colon is the final section of your digestive system and is where the water is absorbed into your blood stream so that any non-digested food is ready to be packed up as faeces and stored in the rectum. When you have a meal, cells of your intestine secrete hormones known as incretins that stimulate β-cells (that are part of your pancreas) to produce insulin. Insulin is required to allow the sugar (transported from your food in your intestines into your blood) to be absorbed by the cells in your body. It is thought that a dysfunction in the production of incretins (or the anti-incretins that are produced to counteract an increase in insulin between meals) could be the cause of diabetes type II in some people.
Diabetes & Ketoacidosis
Fats can be broken down by the body into various molecules that can either be used by cells as a source of energy or stored for later use. One of the intermediate breakdown products is called acetyl coenzyme A and this can be broken down in the liver into molecules known as ketone bodies. During starvation (or if no glucose is available to the cells of your body) your body acts to ensure that your brain has energy so that it can continue to function so your liver will produce ketone bodies that your brain is able to absorb and use as an energy source. However, because ketone bodies are acidic, large amounts of ketone bodies within your blood can overcome your bodies normal buffering mechanisms and cause a number of problems including vomiting, diarrhoea, confusion and coma. Due to the fact that your liver is stimulated to produce ketone bodies when the cells of your body signal that they are low on glucose, ketoacidosis is most commonly seen in diabetes and this is generally known as diabetic ketoacidosis (or DKA). If you are a diabetic, you will not be able to produce any insulin so the cells of your body will not be able to absorb the sugar that is in your blood stream. This means that you have a higher likelihood for your liver to receive the “starvation” signals from your cells that causes it to produce ketone bodies that can lead to ketoacidosis.
Diabetes & Ketones
A ketone (also known as a ketone body) is a molecule that includes a carbon atom bound to an oxygen atom with a double bond and two other atoms. Ketones include acetone, acetoacetate and β-hydroxybutyrate which are produced in the body when fats, carbohydrates and proteins (from food in your diet) are broken down in the intestine. These ketones are broken down further into various molecules that can be used by your body’s cells to make energy to allow them to fulfil their function. In addition, ketones can be produced by the liver from one of the breakdown products (acetyl coenzyme A). Ketones are an important source of energy for some of the cells in your body and the use in the brain is particularly important as it uses ketones as its sole source of energy in the absence of any glucose in the blood. This is important as it explains why the amount of ketones in your blood increases during periods of starvation. If you are diabetic with low levels of insulin in your blood, your body cells will be unable to absorb any glucose in your blood and will signal the production of ketones to ensure that your brain is able to continue to function.
Diabetes & Kidney
You have two kidneys that sit within the rear of your abdominal cavity and (due to the position of the liver) your right kidney will probably sit slightly lower than your left. Your kidneys fulfil a number of important functions within your body that act to keep the substances within your body in balance. Waste products produced from the breakdown of protein during digestion are excreted by the kidneys in the form of urea that is removed from your body along with any excess water in the form of urine. The filtration and excretion mechanism of the kidneys allow them to function to monitor and regulate your blood pressure (which is affected by changing the amount of fluid excreted by the kidneys) and they also secrete a number of important hormones into your blood stream. If you have diabetes you are at risk of developing diabetic kidney disease which occurs when the high levels of sugar filtering through the kidneys damages the filtering structures (called the glomeruli) within the kidneys. This causes the glomeruli filter system to become more leaky so that they allow proteins to pass through them you’re your urine. In addition, some of the proteins within the glomeruli themselves may link together and cause scaring in the local area of the kidneys (known as glomerulosclerosis). If the amount of scaring increases unchecked then it can lead to a loss of kidney function and eventually kidney failure. In addition, if you are diabetic then you are more likely to develop urinary tract infections (due to the larger amount of sugar in your urine) and urinary tract infections can occasionally track up your body and cause infections in your kidneys.
Diabetes & Kidney transplant
Kidney transplants are occasionally offered as a treatment option if you develop end-stage kidney disease to a point that your kidneys have only 20-25% of their filtering ability. The transplanted kidney can either be sourced from a deceased donor or a living donor (who can be related or non-related) found by the transplant service. Diabetes puts you at a higher risk of developing end-stage kidney disease however, it also puts you at a high risk of developing cardiovascular problems. If you have certain cardiovascular problems you may not be allowed to have a kidney transplant due to the increased risk of death during the operation. A kidney transplant involves you having an operation to remove your diseased kidney so that it can be replaced by the (functioning) donor kidney. If you have diabetes type I you might be offered a kidney-pancreas transplant where both your kidney and your pancreas is replaced by a donor kidney and pancreas.
Diabetes & Lymphocytes
Lymphocytes are part of your body’s immune system and are also known as white blood cells. They defend your body from harmful organisms (such as bacteria, viruses and disease causing worms). There are two main types of lymphocytes in your immune system that are known as B cells and T cells. The B cells produce antibodies (chemicals) that they release at disease causing particles in order to kill them. T cells are either able to kill disease causing cells directly or are able to assist the B cells (or other types of white blood cell) to destroy the disease causing cell. If you have a fault in your lymphocytes then you may develop an autoimmune disease where your white blood cells attack your body’s cells (instead of the disease causing cells). Type I diabetes is thought to be an autoimmune disease caused by your T cells attacking and destroying the β-cells of your pancreas. Your β-cells are the only cells in your body able to manufacture and release the hormone insulin which is required to allow your body to control the amount of sugar in your blood. So, if you are diabetic you will be unable to produce insulin and you will consequently have an elevated amount of sugar in your blood due to a fault in one of your lymphocytes.
Diabetes & Liver
The liver is one of the vital organs in your body (as well as being your largest internal organ). It is approximately triangular and lies on the right side of your body behind your ribs and performs a variety of functions including aiding in digestion (by producing bile), storing sugar, breaking down insulin, filtering your blood of harmful substances (including alcohol), breaking down old or damaged red blood cells etc. Your liver receives blood from your intestines (where your food is broken down into useful substances and absorbed into your blood stream) and the spleen (where your white blood cells filter your blood to check for disease causing particles) as well as receiving oxygenated blood from the heart. Your liver cells (hepatocytes) act as a filter for your blood, checking its contents for harmful substances as well as monitoring the sugar level, storing excess sugar as glycogen within the liver itself. The liver responds to insulin in the blood by absorbing more glucose (sugar) from the blood stream and converting it to glycogen so that it can be stored within the liver. If you are diabetic you will have low levels of insulin within your blood and a lack of insulin stimulates your liver to convert glycogen back into glucose and release it back into your blood stream which increases the amount of sugar in your blood. If you are diabetic, the inability of your body to produce (or react to) insulin means that the cells of your body will be unable to absorb the sugar that the liver has released in your blood and your insulin levels will remain low. This causes a vicious circle where your liver will continue to act to increase your blood sugar levels and your body is still unable to utilise the sugar. This can lead to hyperglycaemia.
Diabetes & Mortality rates
Mortality rates describe the amount of people of die from a particular disease (or in general) from a particular population over a specified period of time. This allows us to compare different people’s risk of dying from different diseases depending on where they are from, how long they have had it, whether they have any secondary diseases etc. If the mortality rate of a particular group with a particular type of disease is found to reduce, then it can be thought that either the treatment for the disease is improving or fewer people are developing the disease in the first place. For example, the mortality rates for diabetes can be presented in a number of different ways that show us different things. The mortality rates can be split up to show different rates of death from diabetes by age, by area, by year etc. If you are diabetic and interested in looking up the mortality rates of diabetes then be advised to look very carefully at the population that the mortality rate describes. For example, if you are a healthy eating and active type I diabetic with no secondary medical conditions then you should not be comparing yourself to mortality rates that are averaged for people with type I and type II diabetes. This is because people with type II diabetes are generally older, will generally have secondary medical conditions and will often be obese. However, these are all generalisations further illustrating how statistics can give you information in general, but should not be used to scare you or make you complaisant.
Diabetes & Optician
An optician is a professional who is trained to test your eyesight and prescribe glasses that increase your ability to see. As well as testing your eyesight for long or short sightedness, your optician will also test you for other eye problems such as colour blindness, stigmatism and retinopathy (damage to the retina at the back of your eye). If you are diabetic you will be at higher risk from developing retinopathy due to your high blood glucose level that will tend to increase the amount of water within your eyeballs and even the lens itself. If you have noticed any change in your eyesight such as blurred vision, areas of black patches or flashing lights, you should consider going to get a check up with your optician. They will be able to check your eyes for the types of eye diseases that are common side effects of diabetes and help you to manage any symptoms that you have. The treatments for diabetic retinopathy are highly successful so early diagnosis of an eye disease will reduce the effect of the disease if you are able to treat it immediately.
Diabetes & Renal disease (kidney disease)
Renal disease (kidney disease) reduces the ability of your kidneys to filter your blood allowing waste products (such as urea) which are usually excreted in your urine to build up in your blood. Renal disease can either be acute (occur suddenly and only last for a short amount of time) which is generally caused when the blood supply to the kidneys is suddenly cut off, or chronic (develop slowly and remain for a long time). Diabetes is the most common cause of chronic kidney disease although it can also develop due to long-term high blood pressure (which can also be caused by diabetes). If you are diabetic, your inability to respond to insulin (or your inability to produce insulin in type I diabetes) will cause you to have a higher than normal amount of glucose (sugar) in your blood stream unless you have control of it through diet management or by injecting insulin. If you allow your glucose concentration to increase it might get so high that your kidneys are no longer able to reabsorb it causing glucose to be excreted in your urine. This effects the amount of water that can be reabsorbed by the kidneys (due to osmosis) so that the more glucose that is excreted in your urine, the more water you excrete in your urine. The water lost in your urine will initially be replaced by fluid from the cells of your body, but eventually you will become dehydrated and anaemic (have a lower than normal volume of blood in your blood stream). As your kidney disease develops (i.e. your kidneys become less able to filter your blood), valuable proteins will be lost in your urine and waste products will continue to build up in your blood making you very ill. If you are diabetic your risk of renal disease can be reduced by managing your blood glucose, taking a low protein diet and taking drugs to reduce your blood pressure. However, if you have concerns about your risk of developing kidney disease then you should first discuss the management of your diet and the need for blood pressure drugs with your GP.
Diabetes & TENs
TENs stands for transcutaneous electrical nerve stimulation and is used as a treatment to reduce pain. TENs machines are held against your skin and produce a small electric current either at a low or high frequency which acts to inhibit your nerves that send excitatory signals to your brain and increase the release of signals that inhibit pain reception. TENs therapy is most often used to alleviate long term (chronic) neuropathic pain although it works to different extents for different people. If you are diabetic then your hyperglycaemia may have caused damage to your nerves causing neuropathy that might cause you pain. Depending on the level of pain that it causes you (which will depend on the neuropathy and your personal pain threshold) then you might want to consider using TENs as a pain reliever. It has been suggested that not only could TENs alleviate your pain, but it could also act to stimulate your circulate and thus reduce your risk of developing further neuropathy. However, TENs should not be used over broken skin and you should not use it if you suffer from epilepsy or use a pace maker. The area of skin where you use TENs may become red and sore and you should discontinue use if this area becomes more painful. If you are considering buying a TENs machine then you would be advised to discuss it with you GP first and be sure to follow the manufactures operating instructions to avoid causing yourself further damage
Diabetes & Urine
Urine is one of the waste products that is removed from your body via the kidneys, down the ureter into the bladder and expelled through the urethra when you go to the toilet. The kidneys filter waste products from your blood including urea (which contains the excess nitrogen), urobilin (one of the breakdown products from old red blood cells), inorganic salts (such as sodium and chloride) etc. Urine also contains all the excess water that your body doesn’t need which is why it is liquid. The contents of your urine will change depending on your diet and your bodies requirements. For example, if you don’t drink enough water on a warm day your become dehydrated so your kidneys allow more water to remain in your blood which is why your urine becomes darker (is more concentrated as it contains less water) if you are dehydrated. The composition of your urine could also be affected by a number of diseases which could cause it to contain increased amounts of protein or sugar etc. If you have diabetes then you will find that you urinate more often than normal and your urine will smell slightly sweet (hence the name “diabetes mellitus”). This is because your urine will contain elevated amounts of sugar in it that your kidneys will have filtered out from your blood.
Diabetes & α cells
Alpha (α) cells are found within the region of your pancreas known as the Islets of Langerhans. The Islets of Langerhans contain the endocrine cells of your pancreas that release chemical messengers (hormones) into your blood stream in order to affect other organs of your body. α cells are the endocrine cells responsible for releasing the hormone called glucagon which stimulates your liver (and muscle cells) to turn their stores of glycogen into glucose (sugar) and release it into your blood. In this way, the glucagon released by your α cells acts to increase your blood sugar levels. The glucagon released by your α cells can be thought of as an opposition to insulin (where insulin stimulates the cells of your body to absorb glucose form your blood and thereby reduces your blood sugar level). If you are diabetic then your body is either unable to respond to insulin or is unable to produce insulin so you will have a higher than normal blood sugar level. If the cells of your body signal to your brain that they are not getting enough sugar (either due to low blood sugar level or if you are diabetic and your cells are unable to absorb the sugar from your blood) then your brain will stimulate your α cells to release glucagon to increase your blood sugar levels. In the presence of insulin, your body cells will be able to absorb the extra glucose from your blood in order to carry out their functions. However, if you are diabetic, your body cells will still be unable to absorb the glucose from your blood. This means that the glucagon released by your α cells will have further increased your blood sugar level above the normal range but the cells of your body are still starved of glucose (which is the fuel that they need to carry out their functions). High blood sugar levels causes hyperglycaemia which can induce numerous complications in the short term and increases your risk of developing heart disease in the long term.
Diabetes & β cells
Beta (β) cells are found within the region of your pancreas known as the Islets of Langerhans. The Islets of Langerhans contain the endocrine cells of your pancreas that release chemical messengers (hormones) into your blood stream in order to affect other organs of your body. β cells are the endocrine cells responsible for releasing the hormone called insulin that binds onto the cells of your body (such as muscle cells) in order to allow them to absorb glucose (sugar) from your blood. β cells are stimulated to release insulin into your blood stream when your blood sugar levels are high. This both makes the sugar available for the cells of your body and also ensures that your blood sugar level remains within a normal range (4.4-6.1mmol/L). If you are diabetic then after a meal your brain will still recognise a high blood sugar level and stimulate your β cells to release insulin, but the cells of your body will not be able to absorb any of the sugar either because your body is unable to respond to insulin (type II diabetes) or because it is unable to produce insulin (type I diabetes). This means that the cells of your body will still be signalling your brain that they require more glucose and this could cause your brain to stimulate the α cells of your pancreas to release glucagon (which is a hormone that has the opposite effect to insulin, by stimulating the release of more glucose into your blood stream). This could lead to your blood sugar level increasing further! This is why, if you are diabetic, you will either need to very careful control your diet or inject yourself with insulin in order to manage your blood sugar level in the absence of the ability of your body to manage it itself.
Diabetes & γ cells
Gamma (γ) cells is the name occasionally given to cells within the Islets of Langerhans region of the pancreas other than the α and β cells (than secrete glucagon and insulin respectively) and are generally regulating hormones that help to keep your blood sugar level within the normal range. Now adays these cells are broken up into classes of cells that all have slightly different functions; delta (δ) cells, PP cells and epsilon (ε) cells. The delta cells release a hormone called somatostatin which acts to regulate your hormone system. The PP cells release pancreatic polypeptides (especially after a meal) in order to help to regulate the amount of stored glucose (sugar) released by your liver, although the amount of pancreatic polypeptides in your blood is seen to decrease when your delta cells release somatostatin. Lastly, the epsilon cells release a hormone known as ghrelin which stimulate the feeling of hunger. If you are diabetic, the balance between the amount of insulin and glucagon in your blood will be off due to either your inability to respond to insulin or your inability to produce insulin. This means that your γ cells will also be off balance and your may have feelings of hunger more often (particularly in diabetes type II) or you may find that you lose weight (particularly in diabetes type I).
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