Mar 7, 2011
By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy
I had a really good time at the Diabetes Expo held at the Seniors Center on Feb 26/11. The turn out for the Parkland Chapter of the Canadian Diabetes Associations Education event was close to 150 people! That is the largest audience in its 16 year history! Kudos to all the organizers. I got to be one of the experts on a panel with Dr. Scott Kish, Dietician Janice Brackman and Optometrist Dr. Randy Ashcroft. The panel tried our best to answer diabetes questions from the audience. When I was talking to people after the panel around the Dauphin Clinic Pharmacy display, I also got asked a lot of interesting questions. There were people who had diabetes for 30 years and knew far more about the disease than I did. There were also a lot of people who didnt know very much about diabetes. So I thought Id do a diabetes primer today.
What is diabetes? Diabetes is when your body has trouble using sugar. There are 3 main types of diabetes: type 1, type 2, and gestational diabetes. Type 1 diabetes is when your pancreas doesnt produce insulin. You must inject insulin or you will die. Type 1 accounts for about 10% of diabetics. In Type 2 diabetes, your body may produce normal, or even above normal amounts of insulin. However, other parts of the body like your muscle and fat cells arent listening to the insulin signal. Type 2 diabetes can be treated with diet, exercise, pills or insulin. Type 2 accounts for about 90% of diabetics. Gestational diabetes is a temporary condition that occurs during pregnancy. It affects approximately 2 to 4 per cent of all pregnancies. Gestational diabetes increases the risk of developing diabetes for both mother and child.
Lets start with a person without diabetes. They eat something. The carbohydrates in their food get broken down into sugar. That sugar goes into the blood. The pancreas produces insulin in response to the sugar. The insulin is a signal to all the cells in the body. I think of insulin like a key. It goes into locks in the cells. When the insulin key goes into the lock, little doors open in the cell. These open doors let the sugar leave the blood and get into the cell. The cell then burns the sugar to produce energy.
What is happening in diabetes? In Type 1 diabetes, the body cant produce any insulin keys. So there is no way to open the doors in the cells. The sugar stays in the blood stream. That means the blood sugar level stays high, but the cells have no energy to use. Type 2 diabetes is a little different. The pancreas produces insulin. It may even produce higher than normal amounts of insulin. The problem seems to be with the little locks on the sugar doors in the cells. The little locks seem to have gotten rusty. Even if insulin keys go into the locks, the keys cant turn and the doors wont open. We call this insulin resistance, and we think this is the main problem in Type 2 diabetes.
Now it should make sense why we inject insulin for Type 1 diabetics. The pancreas doesnt produce any insulin so we inject it. In Type 2 diabetes it is not as straight forward. We can inject insulin. With enough insulin keys, we can force those rusty lock open. We can give pills that force the pancreas to produce more insulin. They have names like glyburide. They work well, but eventually the pancreas will get tired an stop producing insulin. Or we can give medications like metformin which act like WD-40. This makes the locks easier to turn.
Diabetes is a complicated condition. Diet and exercise should always be part of any diabetes treatment plan. My little stories about locks and keys are a very overly simplified sketch of diabetes. But I hope they shed a little more light on a disease that effects around 9 million of us Canadians.
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The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.