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Course Coverage 2016

  • Jan Muscles
  • Feb Meals
  • Mar Metabolism
  • April Nutrition
  • May Metabolic Syndromes
  • June Diabetes
  • July Diabetic Complications
  • Aug Longevity
  • Sept Atheroma
  • Oct Carcinoma
  • Nov Aging
  • Dec Mind & Memory
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The metabolic disorder called diabetes involves more body chemistries than a simple blood sugar. Its muddled metabolism complicates pregnancy, surgery, infections, trauma, and even survival. Diabetes has been a problem of humankind from antiquity, known for centuries as The Pissing Disease from its late expression in thirst and urination. Physicians of ancient Greece examining the urine of such patients found it sweet to the taste, naming it the Sweet Pissing Disorder, or in Greek, Diabetes Mellitus.

An elevated blood sugar is the diabetes hallmark and indicates failure of a normal insulin effect. Insulin’s task is to transfer nutrients such as glucose and amino acids into the body’s tissues after a meal. Insulin is a hormone that is made in the pancreas. It enters portal vein blood and flows up into the liver, an organ that receives all nutrients from digestion before processing them for distribution to body parts. Normally, the liver sweeps randomly released insulin up from the portal vein and out of the circulation. But when choked with fat (very common today from visceral obesity) liver cells allow insulin to circulate in the blood to excess. It’s target tissues (muscle and fat) resist being overfed by high blood levels, and insulin’s effect is dampened. Nutrient transfers are delayed, and a state of insulin resistance is said to exist. Patients have no symptoms at this time, but the persistent nutrient back-ups make metabolic processes stiff and slow. Clinical diabetes is coming.

Diabetic ketoacidosis is a metabolic crisis from burning an excess of fat, because sugar cannot be burned. Its blood levels rise while body energy needs are met by burning evermore fat. This leads to partly  burned fat which ‘smokes’ and forms combustion products collectively known as ketone bodies. They depress consciousness and provoke overbreathing. The patient is heading for the coma of keto-acidosis. Insulin and fluids are lifesaving, needing up to thousands of units of insulin and dozens of liters of intravenous fluids.

A second ‘diabetic coma’ can result from simple, severe dehydration. Called hyperosmolar diabetic coma, it does not cause keto-acidosis and patients do not hyperventilate. Usually seen in elderly individuals living alone in a summer heat wave, and often handicapped by a blunted sense of thirst, common with age. The blood sugar rises high to carry much body water away as urine which dries the patient out without prompting any corrective thirst. The patient’s skin and mucous membranes become dry and consciousness is depressed. The need for fluids is greater than the need for insulin, but both are needed for the best management.

Insulin failure can be relative or absolute, and partial or total…the differing degrees of insulin effect failure expressing themselves differently in the clinic. Total insulin failure is most clearly seen after surgical pancreatectomy (perhaps for cancer) or from autoimmune disease as in Juvenile Diabetes. Too little insulin effect allows blood sugars to drift up, to spill into the urine and beginning an excessive burn of fat for energy.

Keeping blood sugars level, where they should be, is a normal liver function. During periods of fasting or starvation the liver makes sugar from proteins for body organs like the brain, distributing its glucose through the blood. With insulin resistance and a muddling of metabolism, the challenge of a glucose load, called the glucose tolerance test, can demonstrate a delayed clearance of sugar from the blood… and the diagnosis of early or ‘chemical’ diabetes is made. Nutrient transfers continue but at slower rates. Patients often feel well or will admit to being a little less energetic. Overnight fasting blood sugars are routinely normal.

A positive Glucose Tolerance Test in a well-fed, fasting individual is early diabetes, or chemical diabetes. It is not pre-diabetes. Such patients’ blood sugars are best kept low after meals with a diabetic diet that spreads complex carbohydrate intakes evenly over the day. Simple carbohydrates, like sugars, are best avoided because they are absorbed too quickly, but complex ones like starches and vegetables take more time to digest, so are preferred in the diabetic diet.

Over the years while insulin resistance develops, the pancreas compensates by overproducing. When eventually defeated, blood sugars begin to drift up after each meal and fail to return to normal in a timely way, even though insulin levels are very high. When blood glucose levels exceed 180 mg % sugar begins to spill into the urine. Normal kidneys can keep it within the blood and out of the urine at levels below 180. Once sugar floods the urine, patients develop the classic symptoms and signs of diabetes: thirst, polyuria, fatigue, tissue wasting, debility. Without treatment they progress to coma and death.

After newly diagnosed diabetics have their blood chemistries restored to normal, they must begin managing life in ways that avoid blood sugars going too low or too high. Too low a sugar can lead to loss of consciousness because the brain needs it to function. Too high a sugar, while less dramatic and may not even spill in the urine, does cause tissue damage over the years. It is the kind of diabetes most commonly met clinically these days and called Type II. Typically, it begins with insulin resistance from the fatty liver of visceral obesity, progressing to an elevation of the blood sugar for a diagnosis.

In summary, a metabolic disease with us from antiquity and called sugar diabetes, has become one of today’s diseases of abundance. It is a product of obesity from abundance… tasty cheap food 24/7, and from the physical inactivity of a digital age. It eventually cripples patients with the complications of blindness and limb loss, or it compromises their lives with heart attacks, strokes and kidney failure. Habits cause much of today’s Type II diabetes. Because diabetes runs in families, we’ve been looking for diabetic genes for 100 years But other things run in families too, like a muddled metabolism, obesity, food preferences, work habits and favorite recreational agents.