What is Diabetes?


A quote from the website "Vocabulary.com": https://www.vocabulary.com/dictionary/diabetes

Diabetes has been known since the first century B.C.E., when a Greek physician, Aretus the Cappadocian, named it diabainein, meaning "a siphon," referring to the excessive urination associated with the disease. The word diabetes was first recorded in 1425, and in 1675, the Greek mellitus, “like honey,” was added, to reflect the sweet smell and taste of the patient’s urine. An unrelated and rare disorder, diabetes insipidus, is usually caused by a hormone deficiency: vasopressin (the pituitary hormone that regulates the kidneys).

Diabetes Insipidus is really rare. Looking at Diabetes Mellitus, however, we note that it is becoming a really big disease worldwide:

http://care.diabetesjournals.org/content/27/5/1047

The prevalence of diabetes for all age-groups worldwide was estimated to be 2.8% in 2000 and 4.4% in 2030. The total number of people with diabetes is projected to rise from 171 million in 2000 to 366 million in 2030.

People with diabetes needs medicine every day. With figures like these, it is obvious that the Pharmaceutical industry stands to make millions of dollars/euros/pounds/rands every day as long as these diseases continue to exist. They make more if the disease gets bigger.

 

How the kidneys play a role:


Now to understand a bit about how the kidneys work: They consist of 2 functional parts, called the Glomerulus and the Tubule. The Glomerulus indiscriminately filters the blood that flows through it, producing a staggering volume of "primary filtrate:

https://labtestsonline.org/understanding/analytes/gfr/tab/test/

..the National Kidney Foundation (NKF) suggests only reporting actual results once values are < 60 mL/min (they state normal values as 90-120 mL/min).

This means that healthy glomeruli produce up to 200 litres of "primary urine" per day. It is then up to the tubules to pump back into your blood, the fluid you need to keep it flowing. If there is blood sugar (glucose) in this "primary urine" it undermines the ability to perform this "pumping back". Thus a larger volume of urine is formed, and it contains glucose (blood sugar).

Your glomeruli normally prevents this sugar from being filtered off into the "primary urine". But if the concentration of sugar in the blood is really high, this ability gets overwhelmed. Furthermore, the cells of the tubule is not designed to pump sugar back into the blood. Excess sugar in the "primary urine" then "traps" more water there (an osmotic process). Thus less water can be re-absorbed back into the blood. Thus more urine passes to the bladder. The body dehydrates. That makes you thirsty. This thirst is often the first sign that something is really wrong.

What is wrong in this scenario, is that the blood sugar remains in the blood instead of moving into the cells. All our body cells are designed to prefer blood sugar as their source of sustenance. When they "think" they are starving, they send out hormonal messages requesting the body to put more sugar into the blood. If they "think" this is not forthcoming, they send out messages to call for the backup energy source: Ketones.

Unfortunately your cells know only their own sugar content. If the sugar in the blood cannot get into the cells, the cells may think there is not enough in the blood, even if there is too much there. Thus the "plea" for more sugar continues, and the blood levels increase.

Once the cells are convinced that the sugar is not forthcoming, they fall back on an ancient survival mechanism called Ketones. What happens here is, the cells now "ask" your body to break down the reserves of fat. When fat is converted to a form of energy your body can actually use, it forms 2 kinds of substance: A little bit of Blood Sugar again, plus a lot of Ketones. Ketones can enter the cells without the need for insulin.

If you have both a lot of glucose, AND a lot of ketones in the blood, the blood becomes "hyper-osmolar". That is, there are just too many molecules dissolved into the blood. Such blood then "sucks" water out of the cells. This causes the cells to shrink and start making "short circuits". The condition is called "Diabetic Keto-Acidosis" and has a high rate of mortality.

If you have EITHER high glucose alone, OR ketones against a background of normal glucose, the cells would not dehydrate and the condition is much less dangerous. Actually, having lots of ketones in the blood is normal under fasting conditions and holds a lot of benefits... provided it is not accompanied by dehydration or a high level of glucose also.

What kinds of Diabetes is there?

There are 2 types of Diabetes Mellitus, called very imaginatively, Type 1 and Type 2.

In the case of Type 1, the body cannot make (enough) insulin.

In the case of Type II or 2, there are not enough insulin receptors. This kind of Diabetes Mellitus will be the focus of this dissertation as it makes up by far the bulk of cases:

http://www.sciencedirect.com/science/article/pii/S0092867400811253

Type 2 or noninsulin-dependent diabetes mellitus (NIDDM) accounts for >90% of cases

An Insulin receptor is a little "pump" that sits in the membrane of most cells in the body. Its function is to move glucose from outside the cell to inside the cell. Thus most cells will "starve" if there is either no glucose available, or it cannot get into the cell. Remarkable exceptions include the hart and brain.. the "last bastion" in staying alive:

http://diabetes.diabetesjournals.org/content/51/12/3384

...studies in humans, however, have shown no effect of increasing insulin levels on global brain glucose uptake (22,19), and, based on the lack of effect of hyperinsulinemia, it has been concluded that human brain glucose metabolism is not insulin sensitive.
Well, either that, or the brain makes a bit if insulin itself.. or both. Whatever the case, it reflects one of the wonders of Creation: Homeostasis.

Homeostasis - your body in balance

http://global.britannica.com/science/homeostasis

..any self-regulating process by which biological systems tend to maintain stability while adjusting to conditions that are optimal for survival. If homeostasis is successful, life continues; if unsuccessful, disaster or death ensues.

We experience homeostasis all the time: When you make someone hot (sauna, anyone?) that person will sweat to cool down. If you make someone cold, they will shiver in order to heat up. (Incidentally, shivering "burns" more fat than any other activity!) If you keep someone awake all the time, they will fall asleep even in the most inappropriate of circumstances. If you try to keep someone sleeping, they will soon be unable to.

It is this phenomenon, homeostasis, that underlies all life as we know it.

In the case of blood sugar, homeostasis is maintained by insulin and insulin receptors. You may consider an insulin receptor a little "pump" that "pumps" glucose into the cells, and Insulin is the "electricity" that makes the pump work. No electricity (insulin) = Type 1 Diabetes; no pumps (insulin receptors) = Type II (2).

Our bodies have been craftily designed to survive. Thus, when there is too much food around, we change any "leftovers" into fat - to be used when the next "famine" strikes.

Diabetes and Fat


https://www.jci.org/articles/view/10842

Insulin promotes adipocyte triglyceride stores by a number of mechanisms, including fostering the differentiation of preadipocytes to adipocytes and, in mature adipocytes, stimulating glucose transport and triglyceride synthesis (lipogenesis), as well as inhibiting lipolysis...

Adipocyte = a fat cell. Triglyceride(s) are the most common form of fat in the human: That layer under your skin.... We have been designed to make fat to store energy, because fat contains about twice the density of energy found in carbohydrates or proteins. (Two times more energy per weight).

When cells become too big, they don't want any more substances to enter them. Thus they de-activate the insulin receptors on their membranes. Thus blood sugar (glucose) stops entering the cells. Thus the blood sugar level increases.

The poor pancreas then blames itself for the situation, believing it was not making enough insulin. It starts making more. That forces more glucose into the cells. The cells become even more over-filled and then even more aggressively de-activate their insulin receptors.

The only way to reverse this process is to empty (or at least partly empty) the so affected cells. We need to put less energy into the body, so that the body can start using the "reserves" it so diligently accumulated.

http://diabetes.diabetesjournals.org/content/61/4/778

.. calorie restriction in type 2 diabetes, which resulted in a fall in liver fat, normalization of hepatic insulin sensitivity, and fasting plasma glucose,...

If we do not do this in time, the Pancreas eventually reaches the end of its tether, "burns out" and can no longer make (enough) insulin. We call that, Type 2 Diabetes Mellitus.

The answer of the modern pharmaceutical industry to this problem is simple: They gather another lifelong source of income - by selling medicines.

Why is there so much diabetes around today?

It is a phenomenon we observe in medical practice daily: When a patient becomes insulin resistant, we usually don't know it before the blood sugar starts increasing, because the rising insulin levels keep the glucose in check.

Once the blood glucose starts increasing, we then prescribe medicines that "whips" the pancreas into making more insulin, and/or medicines that makes the remaining insulin receptors "pump" more glucose into the cells. The cells become bigger. The vicious cycle continues. But not to worry, one day you'll just have to start injecting more insulin....

Mother Nature has always had another answer to this: Only VERY recently in the history of mankind, was it possible to eat every day. During periods of famine or when the hunt was unsuccessful, our ancestors used their fat reserves. The cells shrunk, they became more sensitive to insulin. When this continued for some time, even the pancreas could take a sabbatical, as the body was sustained on ketones. This allowed the pancreas to do some much needed "maintenance work", thus remaining healthier for longer.

Perhaps this could explain our experience of reversing Type 2 Diabetes by employing inter alia periods of fasting. That is, if we caught it in time... before the pancreas has totally given up its efforts to keep up.

Addendum: Carbohydrates, Protein and Fat. (The simplified version)

ALL foods, ALL nutrients "start life" as carbohydrate. More specifically, Glucose. This forms when Carbon Dioxide and Hydrogen meet each other in a fascinating microscopic little machine called "chlorophyll". Their "matchmaker" is sunlight.

Chlorophyll is what makes leaves and even plankton (Phyto-plankton to be more precise) green. It is capable of mediating the liaison between Carbon and Hydrogen to turn these two lifeless atoms into a living molecule. Carbon+ Hydrogen = CarboHydrate.

Carbohydrate is a rather alkaline substance. When it is further processed by certain bacteria (notably those that grow on the roots of legume plants), it can become acid. The bacteria squeezes a Nitrogen atom into the carbohydrate, to turn it into an Amino Acid. Linking a lot of these acids together, we now call it a polipeptide. Linking polipeptides together results in a chemical called a Protein.

If there is too much carbohydrate in a system, the excess is stored in a very concentrated form: Fat. Most animal fats are "Saturated". That means, that all the available spaces on the carbon atoms are taken up by Hydrogen.

From this perspective, the most concentrated form of energy is fat, and the most pristine form of energy is a carbohydrate. If your body wants to get energy from a protein, it first have to get rid of the Nitrogen. This is typically released in the form of Nitrogen bound to Hydrogen... also known as Ammonia. Quite toxic. Transformed in the liver and eliminated by the kidneys. That might help explain the increase in kidney disease:

http://jasn.asnjournals.org/content/17/11/2967.full

The study by Hsu et al. (23) suggested that there was a 25% increase in CKD as defined by an MDRD GFR of <60 ml/min per 1.73 m2 from 1978 to 1991,

CKD = Chronic Kidney Disease.

BUT your body needs micro-nutrients to properly process carbohydrate to energy. Just like the fuel of your car: Even if it is 95% Octane (Another "carbohydrate" or HydroCarbon) the other 5% is what makes it work and what makes it safe. Without the additives, petrol would blow the top off your poor car's engine.

The same with our fuel: Carbohydrate is best, but it has to be balanced with micro-nutrients, as is is in fruit and vegetables. (Purified) starches, although also a form of carbohydrate, does not typically contain the "additives" or micro-nutrients that makes it safe and healthy.

 

Case Study: The effect of fasting on Insulin Sensitivity:

Ms PD, 63 year old lady has been diagnosed with Type 2 Diabetes a few years before our encounter.

16 December 2007 - Day 1

Insulin 9.4

 

21 July 2010 - Day 948

Glucose 6.9

Insulin 34.1

QUICK Index 0.28

Did a 4-day fast before the next measurement

 

19 October 2010 - Day 1038

Unsulin 17.1

Insulin sensitivity improved but not resolved

 

26 October 2011 - Day 1411

Glukose 5.4

Insulin 20.2

QUICK Index 0.3

 

10 April 2013 - Day 1942

Glucose 4.6

Insulin 35.2

QUICK Index 0.29

 

28 May 2013 -Day 1990

Insulin 54.5

Started fasting for 10 days

 

5 June 2013 - Day 1998

Glucose 4.6

Insulinn 7.2

QUICK Index 0.36

Notably the blood sugar (Glucose) levels were practically always recorded as normal but this was achieved at the cost of having to make very high concentrations of insulin. Her medical insurance refused to pay for more than one insulin measurement, reasoning that "the value is now known".

As seen from the table, her body had to produce a very high concentration of insulin before being able to normalise the blood sugar. If left alone, this typically leads to the pancreas "burning out".

The orthodox medical approach to this situation would typically be to "graduate" the patient onto insulin injections.

A period of fasting on the other hand obviously restored the cells' sensitivity to insulin, lowering the burden of demand on the pancreas and likely prevented the "burnout". Now is this not much preferable to simply move on to the next step?

Comments & Conclusions:

Of course not everybody will be healed this way. Diabetes is on the one hand a very simple group of diseases but on the other hand there are delicate and complex interactions and relationships between diet, exercise, weight, genetic make-up, age, existing damage to the system and a host of other known and currently unknown factors.

For example, insulin is the only hormone known to reduce blood sugar. It can, however be increased by inter alia

* Dietary intake

* Growth Hormone

* Stress related factors such as Cortizone, Adrenalin and numerous others

* Glucagon

* Somatostatin

* Thyroid hormone

and likely a few currently unknowns.

Physical activity (Exercise) burns blood sugar whilst being passive causes it to accumulate in the blood, waiting for the cells to use what's already in them before it would typically be invited in.

What is needed to prevent a global catastrophy is obviously a holistic approach including medical and non-medical interventions such as diet and exercise. Whilst diabetologists do an admirable job of managing the epidemic with the tools at their disposal, other modalities need to be deployed in tandem. A team approach is necessary. The leader of this team has to be the party most affected: The patient. We as medical professionals are, after all, in the employ of our patients.

Sometimes a bit of "experimentation" will be needed. Not all people respond the same way. We should learn from experience, individualise the treatment but never rob the patient of their autonomy.

For those where a period of fasting is employed, this should be considered a single piece in a complex puzzle, done under expert, experienced supervision with adequate investigative and medical backup.

With an appropriate, scientific and wholistic team approach, we can join forces to beat this epidemic.