What is a Diabetes
Diabetes is the condition in which the body does not properly process food for use as energy. Most of the food we eat is turned into glucose, or sugar, for our bodies to use for energy. The pancreas, an organ that lies near the stomach, makes a hormone called insulin to help glucose get into the cells of our bodies.
The effects of your stroke depend on the type of stroke, the part of the brain that was damaged and the amount of damage.
Dr. Akshay Jain MD, FRCPC, FACE, CCD, ECNU, DABIM, DABOM, Clinical and Research Endocrinologist, talks about what diabetes is and what the differences are between type 1 and type 2 diabetes.
Dr. Alice Cheng, MD, FRCPC, Endocrinologist, discusses the different types of insulin and their role in the treatment of diabetes.
Understanding Type 1 and Type 2 Diabetes
What is diabetes? There are two kinds of diabetes: type 1 and type 2 diabetes mostly. And they’re interrelated but not similar, and that’s related to insulin.
So first let’s talk about insulin. Everyone knows insulin is related to diabetes. But what is insulin, how does it work? Well, insulin is a hormone, it’s a messenger. It means that it has a message to give to the body.
Insulin is secreted by the pancreas, which is big like my hand, it’s right in the back of the stomach, and when we eat, the food is absorbed, goes next to the pancreas that sees the food, and sends insulin with it in order to inform the whole body that the food is in the blood. So the role of insulin is a little bit like the helper that would go from the milkman’s truck, ring the doorbell of the house and say “You know what? There’s milk on the street ready to be stored in your refrigerator. Do you want some?” And you’ll say “I want two bags”, they’ll give you the two bags and then they go to the next house.
Insulin works the same way: it rings the doorbell of a cell, whether it’s a fat cell, whether it’s a muscle cell, or a liver cell, and says “There’s food in the blood. Do you want to store it?” And the cells say “Yes, I’ll take some food and I’ll store it.” And all this allows that all the food we absorb after a meal is stored in our body within about two hours.
Now there are two diseases where this can go wrong, and the first one, type 1 diabetes, there’s no insulin being produced or all the milkman’s helpers have been laid off. So what happens is that the food is absorbed normally with the meal, goes in the blood, but the cells never see it. So they don’t see it and they don’t try to store it.
So the food just circulates, nobody takes it, in comes the next meal, more food goes in the blood, and the next meal, more food – so the food accumulates in the blood without ever going anywhere. Up to the point where the kidney sees that and goes “Whoa, the sugar levels are really too high, it’s becoming maple syrup more than blood, let’s get rid of the sugar.” So it takes the sugar and sends it into urine, in order to get rid of it. If we urinated little cubes of sugar that would be painful. So the kidneys, when they expel the sugar, make sure they send a lot of water to dilute it.
That’s what causes the classical symptoms of urinating a lot, because all the water comes out with the sugar, losing water causes thirst so people drink a lot, and they urinate a lot. So that’s the classic symptoms of diabetes. At the same time when people with type 1 diabetes are diagnosed, they lose a lot of weight, because all the food they eat ends up in urine, not in their cells. So, these are the classical signs of diabetes at first, and the only treatment that we have is to give insulin, and try to coordinate it with the food to reproduce what’s normal. So people with type 1 diabetes need to take insulin many times a day in order to have the normal physiology restored. Type 2 diabetes is totally different. In type 2 diabetes initially, the pancreas is okay, and it’s related to being obese. So what happens there? Food is absorbed, insulin goes with the food, rings the doorbell, “Do you want to store food?” But there, the cells say “No. I’m full.” The person is obese, all the stores of fat are full.
So the cell resists, the same way as if the milkman comes to your house and says “Do you want milk?” Your fridge is full of milk. You’ll say “No, no, no, no, no. I resist you, I don’t want to have any food, any milk, go and sell that to my neighbour.”
So the cells resist insulin. They say “No, no, no, I don’t want any food, go and store it elsewhere.” Now if the body has difficulty finding a few cells to serve food, well of course the food stays in the blood for a longer period of time, because there’s no place to store it, the next meal arrives, and the next meal, and it starts accumulating and it does a little bit like it does in type 1 diabetes, that is the kidney sees that, sends the glucose into urine, sends water with it, causes thirst, so people pee a lot and drink a lot.
Except that here what’s different, is the fact that if we want to treat the best way, is to make the cells more able to respond to insulin, and that’s why making them leaner, so by losing weight, by lifestyle, whether it’s by doing exercise or by dieting, if you lose weight the cells are more empty, and they’ll say yes to more insulin and they’ll store the food, and that’s the way diabetes can disappear with lifestyle.
There are other ways, other medications that can be given that increase the action of insulin, but initially the importance of lifestyle comes from the basic causes of type 1 and type 2 diabetes. Diabetes Now Local endocrinologist Diabetes Treatment Patient Communication System
Presenter: Dr. Akshay Jain, Endocrinologist, Surrey, BC
Local Practitioners: Endocrinologist
Sarah Blunden, PDt CDE CPT, Dietitian, discusses the importance of making good lifestyle choices when managing diabetes.
Dr. Dean Johnston, MD, MHSc, FRCPC, Neurologist, discusses How to Prevent a Stroke from Happening to You.
Diabetes and Insulin Treatment.
So insulin is one of the options to treat diabetes, and there are many different types of insulin in order to be able to mix and match so that we can best suit the patient’s needs.
There are three broad categories of insulin, and the categories are divided based on the time/action profile, so when the insulins work. So, one category is the bolus insulin. The bolus insulin’s also known as the mealtime insulin. And as the name would suggest, it is designed as a fast insulin, so that it works at the same time as the food will. So it starts quickly, it peaks fairly quickly, and it runs away quickly, so that it matches a meal.
Another type of insulin, or the second type of insulin is a basal insulin, also known as a background insulin, meant for background. So it is a flatter, longer-acting type of insulin, so that it can serve the needs of the body all day long.
Remember that even if one has not been eating, we still need insulin, because insulin is a necessary hormone to move sugar from the blood into the cells, so that the cells can use it as energy. So therefore we also need that type of insulin.
And then the final type of insulin is called premixed. So premixed is premixed, so therefore it’s a mixture of bolus, and a basal insulin together, and it gives the advantage of convenience, because it’s one type on insulin, one injection, giving two types of insulin within it. However, you lose flexibility when one uses a premixed insulin.
So insulin is administered as an injection, and it’s administered through a very small needle, and that needle just goes just under the skin, or what we call subcutaneous. Now often when insulin is mentioned to someone they immediately picture a vial, and a syringe, and it’s often a needle that looks like the flu shot needle for example, which is the one that people are very familiar with. But it is nowhere close to that. The needle that is used is much, much smaller, much, much thinner, and shorter, and actually just goes under the skin.
The insulin itself also is not coming out of a vial, again what people tend to picture. But actually nowadays insulin looks nothing like that. Insulin is actually available as a pen device, and the insulin itself is in cartridges that could be installed into the pens, or the pens may already be prefilled, so it’s really easy to carry around.
And then the only part that needs to be added is the needle tip. Now the needle itself is actually much, much smaller than what most people imagine, and they’re also much more narrow. And then people often ask “well, does it hurt?” to actually do an insulin injection. Well if somebody is able to poke their finger to get blood to test their sugar, then they are more than able to do an insulin injection, because the insulin injection is actually less painful than poking the finger to test the blood. Local endocrinologist Diabetes Educator
So I think nowadays the administration of insulin is far simpler, people can carry it around very easily and the needle itself is much, much shorter and less painful than they ever were before.
If you’re a patient living with diabetes and interested in learning more about insulin, the best thing to do is to contact your local health care team, starting obviously with your family doctor, or a local endocrinologist, or the diabetes education team, or any other health care provider that may be available to you. Diabtetes Now Diabetes Treatment Patient Communication System. Local Endocrinologist.
Local Practitioners: Endocrinologist