I was probably about nine years old the first time I remember having heard of the phrase “sugar diabetes.” I asked my mother what it meant; she told me that it was a disease that some people get when they eat too much candy, and it causes their bodies to lose the ability to regulate the level of sugar in their bloodstream.

I was probably about nine years old the first time I remember having heard of the phrase “sugar diabetes.” I asked my mother what it meant; she told me that it was a disease that some people get when they eat too much candy, and it causes their bodies to lose the ability to regulate the level of sugar in their bloodstream. I wasn’t sure what that meant, or why it was bad, but at least it was an answer.

It has been known for quite some time that there are two distinct types of diabetes. One type (called Type One Diabetes Mellitus or T1DM) is due to a sudden failure in the body’s ability to produce the hormone insulin. T1DM has a sudden onset, usually before 15 years of age, and is rapidly fatal without appropriate treatment of insulin given usually as shots, multiple times per day. This type is also called childhood onset or insulin dependent diabetes. The cause is unknown, but it is known that there is a strong genetic component. With no family history the chance of an American child coming down with it is about 4 in 1000 (0.4%). If the mother has T1DM the chance of the child getting it is as high as 4%; if the father has it the risk is twice as high. If one identical twin gets T1DM, the chance that the other will eventually get it is more than 50 %.

But there is evidently more than genetics involved. In genetically susceptible individuals one or more environmental agents appears to trigger an immune response that leads to the body destroying the insulin producing cells that reside in the pancreas. The pancreas is a unique organ that is part of the digestive system of the body, and it produces a number of hormones that help the body use nutrients. In order for glucose in the blood stream to be used in the body the cells of the body must receive a signal to take up that glucose. Insulin and only insulin provides that signal. Apart from the brain, which can use other back-up fuel, most of the cells in the body will starve for glucose, even when it is present in high levels in the blood, without adequate insulin to allow the glucose into the cells. That is why people with T1DM go into the crisis that is called ketoacidosis, and will die without immediate and proper care.

Although T1DM is increasing in frequency, it is the other type of diabetes, Type Two Diabetes Mellitus (T2DM) that has had explosive growth in recent years. Although it is not uncommon for people with T2DM to eventually develop insulin dependent diabetes, T2DM begins in an entirely different way from T1DM. Whereas T1DM is due to a complete lack of insulin, people with new onset of T2DM usually have levels of insulin that are normal or high. Their problem is not an absolute lack of insulin, but is due rather – as Cool Hand Luke would say – to a failure to communicate. The insulin receptors of the cells of the body have become insensitive to insulin; they don’t respond normally and the pancreas must produce higher and higher levels of insulin in order to provide for the needs of the body. This condition is called insulin resistance, and it usually results in both the insulin levels and the glucose levels creeping gradually higher and higher until some crisis causes the person to come to the attention of a health-care professional, resulting in diagnosis after many years of damage has been done.

Coming back to my mother’s answer, too much candy and not enough exercise actually CAN cause insulin resistance. I have learned why it is bad for the body to lose the ability to control the level of sugar in the blood, and the answers are complex, but there are good ways to prevent T2DM as well as to control it and prevent much of the damage it would otherwise cause. The most important first step is to diagnose T2DM early, before years of damage have occurred. See this space next week for more information on diabetes, as well as its diagnosis and treatment.

Dr. Bundrant is the chief of staff at Ballinger Memorial Hospital. He is a member of the Health and Wellness Coalition of Runnels County which is comprised of health care professionals throughout the county. Members meet on the first Thursday of the first full week of the month.