My parents used to tell great grandma to "stay out of the sugar!" whenever we left her house.  I wasn't sure why they said it, but everyone got a kick out of it.  Great-grandma, I came to find out had 'the sugar diabetes' (pronounced dia-BEE-tuzz by my family) so she wasn't allowed to eat a lot of sugar (horrors).  Anyhoo, years passed before I understood why.  It's pretty confusing so I thought I'd do you a quick little lesson, in layman's terms, on what diabetes is, and what the different types mean.

What is diabetes?

When you eat carbohydrates (mainly sugars and starches), your body digests the food and the glucose (sugar)  is sucked from your small intestine into your bloodstream.  The glucose goes into your bloodstream so it can be delivered to cells throughout your body.  The cells then convert the glucose to energy and you get to live a little longer.   

When the glucose enters your bloodstream, your blood sugar (aka blood glucose) levels rise, triggering the production and release of a hormone called insulin.  Insulin is made by beta cells scattered throughout your pancreas and, among other things, it tightly controls the level of sugar in your blood stream at any given time.  It does this by telling your muscle and fat cells to pull the glucose (sugar) from the blood into the cells, out of the bloodstream. 

It stands to reason, then, that if your body is unable to produce insulin, or can't produce enough insulin, or can't properly use the insulin, then you will have too much sugar in your blood and that's a bad thing.   When you have elevated levels of glucose (sugar) in your blood you are said to have hyperglycemia or you are "hyperglycemic" (low blood sugar is hypoglycemia).   If the sugar in your blood tests out at consistently high or above average levels, then you are diagnosed with a certain type of diabetes.  Diabetes is a chronic disease meaning that once diagnosed it lasts a lifetime, although it can be controlled. 

What is Type 1 Diabetes?

You have type 1 diabetes (aka insulin dependent diabetes or juvenile onset diabetes) when your pancreas cannot produce insulin at all.  This happens when your body's immune system malfunctions and mistakenly manufactures antibodies (proteins in the blood that are part of the immune system) that attack the beta cells in its own pancreas, rendering it incapable of producing insulin.  Any time your immune system attacks your own body tissues it is called an autoimmune disease.  That's what type 1 diabetes is.  This tendency to produce abnormal antibodies is beleved to be, in part, genetic, although it is not fully understood.

Type 1 diabetes is the least common, and it is found primarily in young, lean people under the age of 30.  Screening for certain types of antibodies is encouraged for individuals who have a parent or sibling with type 1 diabetes. 

What is Type 2 Diabetes?

Of the people who have diabetes, 90% have type 2 and it occurs later in life.  It is sometimes called non-insulin dependent or adult onset diabetes and it is characterized by the fact that you can still produce insulin.  The problem is, you don't produce enough, or your body doesn't correctly use the insulin it produces.   Your body's cells may be insulin resistant.   This is the primary problem in type 2 diabetes.  Insulin resistance is when your cells don't respond normally to a given amount of insulin, meaning that higher levels of insulin are needed in order for insulin to have its effects.  In type 2 diabetes, there is also a steady decline of beta cells (they produce the insulin in the pancreas), which causes less insulin to be produced, thus contributing to worsening glucose control. 

How Insulin Resistance Leads to Type 2 Diabetes

Insulin resistance precedes type 2 diabetes, sometimes by years.  In fact, your blood glucose and insulin levels may be normal for years and then, bam! you become insulin resistant.  At this point, you will often see an association of high insulin levels, abdominal obesity, cholesterol issues and/or high blood pressure.  When you have all these issues, you have metabolic syndrome.  Insulin resistance has a strong genetic factor and can also be caused by some medications, but it is often seen in people who have metabolic syndrome, are obese, pregnant, severely ill, stressed or using steroids. 

Here's how it works:  One of insulin's jobs is to tell your muscle and fat cells to pull glucose from your blood so it can be used by the cell.  This is one way that insulin "controls" your blood sugar levels.  Insulin basically attaches itself to the surface of the fat and muscle cells, knocks on the cell's door and says "okee dokee, open up".  The cells hear the knock and says "come on in you beautiful sugar baby" (it lets the glucose in, thereby removing it from the blood stream).  Then the cell uses the glucose to provide energy to the body.  With insulin resistance, the muscles don't even hear the knock and so the pancreas is notified to make more insulin, which increases the levels of insulin in the blood that causes a louder knock.  The resistance continues over time and as long as the pancreas can create enough insulin to open the cells doors, then you're okay.  Once the pancreas can no longer keep up, the blood glucose levels begin to rise - at first only after meals when your glucose levels are highest but eventually when you're fasting too.  At this point, you have type 2 diabetes.

How can you tell if you have diabetes?