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A Primer on Diabetes
DIABETES
PREVALENCE BY AGE
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Type
I, also called juvenile onset diabetes or insulin dependent diabetes mellitus (IDDM)
accounts for about 10% of the total cases of the disease and afflicts the sufferers quite
early in life. IDDM is caused by an individuals inability to make insulin. Type
II or maturity onset diabetes, also called non-insulin dependent diabetes mellitus
(NIDDM), accounts for almost 90% of the diabetes cases. It is associated with a defect in
insulin secretion as well as insulin resistance. Individuals who are abdominally obese
(central obesity) tend to have diminished capacity to utilize glucose. They also have high
levels of circulating free fatty acids (which impairs glucose metabolism) and a low number
of insulin receptor sites.
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Depending
upon the nature of the disease, insulin and certain synthetic drugs like sulphonylureas,
biguanidines and acarbose are widely used in its treatment. Before the discovery of
insulin by Frederick Banting and Charles Best in 1921, patients with severe cases of
diabetes did not survive. Today, although seldom fatal, diabetes is a dreaded disease on
account of the related complications. Careful management of diabetes, including control of
high blood pressure, can delay some of the serious complications associated with the
condition, which include eye diseases, disease of the peripheral blood vessels and kidney
failure. In recent years, evidence of cases of "insulin resistance" and the
occurrence of side effects from prolonged administration of conventional drugs have
triggered the search for safe and effective alternatives. Several plant extracts and
isolated phytochemicals have been examined for antidiabetic activity with a view to
identify alternative treatment strategies for diabetes. It has been observed that certain
resistant cases of diabetes that do not respond well to conventional drugs often respond
well to supplementation with natural remedies.
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Diabetes
is a chronic disorder characterized by high blood sugar levels and abnormal metabolism of
carbohydrate, protein and fat. The disease is a result of the failure of the body to
control blood sugar levels adequately. The normal fasting blood sugar levels are in the
range of 75-115 mg/dl (milligrams per deciliter of blood). After a meal, the body
tightly regulates increases in blood sugar to a level not exceeding 180 mg/dl in people
without diabetes.
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In
a normal person, food which is made up of protein, carbohydrate and fat is digested by the
enzymes in the digestive tract. Glucose, a simple sugar is an important end product of
digestion. It is absorbed into the bloodstream and transported to the various cells in the
body where it is utilized as a fuel to provide energy for the various life activities.
Insulin is a hormone which acts as a key that opens the doors of the cells to allow
glucose to enter. Insulin is produced in the body by beta cells, specialized cells located
in the islets of langerhans of the pancreas.
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The
islets of langerhans are little islands of cells, named after their discoverer, Paul
Langerhans. The islets of Langerhans contain three types of cells that help in glucose
metabolism: alpha cells which make glucagon; beta cells which produce insulin; and delta
cells which secrete somatostatin, a hormone which regulates the production of insulin and
glucagon.
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Normally,
insulin and glucagon regulate blood glucose levels, causing almost all carbohydrate and
about 50 to 60 percent of protein to be converted into glucose. Glucose is consumed as
fuel by almost every type of body cell. In a person suffering from type I diabetes, there
is an insufficient or no supply of insulin. In type II diabetes, insulin may be present in
sufficient quantities, but it is unable to unlock the doors of the cells. In the normal
case, insulin "fits" on to specific sites called insulin receptors located on
the surface of the cell (the key holes) and unlocks the "doors" to let glucose
enter. If the insulin cannot fit in properly due to lack of insulin receptors on the cell
surface, the "doors" remain locked, causing a condition called insulin
resistance. In such cases of diabetes, administration of insulin does not help because
there are few receptor sites. If the doors of the cells remain unopened, due to lack of
insulin or difficulty in utilizing insulin, glucose cannot enter the cells and remains in
the blood. This causes increases in blood sugar levels even if no food is eaten.
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Urine
sugar levels increase when some of the excess blood sugar is excreted. The body begins to
use alternative fuel souces (e.g. body fat and protein) for energy. The patient
therefore loses weight, tires easily and has an increased appetite (polyphagia).
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Excess
glucose in the blood is harmful too. Sugar accumulation in the blood results in increased
work load on the kidneys and increased sugar levels in the urine. The sugar enters the
urine in solution form, draining water from the cells. This causes an increase in the
volume of urine which triggers frequent urination (polyuria), and induces thirst
(polydipsia) in the patient. High blood sugar levels over protracted periods of time
causes "glycation" of key body proteins inducing secondary symptoms such as
retinopathy which may lead to blindness, neuropathy (nerve degeneration) which may lead to
gangrene, and nephropathy which may lead to kidney malfunctions.
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©
Sabinsa Corporation 2000 |
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