Dr. Toshi Is In! "What is Diabetes?"

Dear Dr. Toshi,

What is diabetes?

Have you ever wondered what diabetes really is, what insulin is and what glucose is? Today, I'd like to talk a bit about those things.

Last week, I talked about the organs in your abdomen. Do you remember that one of the organs is the pancreas and it's located a little below and behind your stomach? It is where your insulin is made and released to be used throughout your body. You may know someone who has to inject insulin because they don't make enough insulin on their own.

Insulin is a hormone which helps with the energy that's produced from carbohydrates. Carbohydrates you eat like sugar and starch are broken down and become glucose (sugar) in your blood. That blood glucose then gets used by cells in your body as a basic source of energy. But for the cells to get the glucose, you need insulin. Insulin does lots of complicated things in your body, but generally speaking, you can think of insulin like a special key that opens a door in your cells to let the blood sugar (glucose) in. For example, when you're working hard, your muscles need a lot of energy, so insulin opens the door to your body's muscle cells so they can get the energy from glucose that they need. (Yes, muscles are made of muscle cells!)

If you have diabetes, you either don't make insulin (you don't have the key that lets glucose into the cells, and that's called Type 1 diabetes) or your body can't use insulin as well as you're supposed to (it's like having the key but the lock in the door doesn't work very well, and that's called Type 2 diabetes). When your cells can't use insulin well, that's called "insulin resistance," and when that happens, your body puts a lot of glucose in the blood to supply energy to your cells, but since it can't get into the cells, you just end up with a lot of glucose in your bloodstream. Over time, a high blood glucose level can cause such serious health issues as heart disease, blindness, kidney disease, nerve problems, dementia, or stroke.

People with Type I diabetes have a pancreas that doesn't make insulin, so they need to inject insulin every day to survive. About 5-10% of all Americans who have diabetes have this type of diabetes. Most Americans who have diabetes have Type 2 diabetes, so they have high levels of glucose in their blood.

Now there are lab tests that your doctor or health care provider can perform to diagnose diabetes and "prediabetes." If you have symptoms that are common in diabetes such as urinating a lot, being very thirsty, losing weight without trying, being very hungry, blurry vision, numb or tingling hands or feet, feeling very tired all the time, very dry skin, sores that heal very slowly, having more infections than usual, nausea, vomiting and abdominal pain, then those labs might be ordered. Of course, these symptoms aren't just found in diabetes, but they can be, so It's important to check.

Your doctor or health care provider can order one of these lab tests to diagnose diabetes: the hemoglobin A1c level, fasting blood sugar test, glucose tolerance test, and random blood sugar test. The hemoglobin A1c test measures your average blood sugar level over the past 2-3 months. An A1c up to 5.6% is normal, but if it's between 5.7 and 6.4% it means you have prediabetes, and 6.5% or higher means you have diabetes. Fasting blood sugar test is measured after fasting (not eating) overnight. A fasting blood sugar level up to 99 (mg/dL) is normal, between 100 and 125 means you have prediabetes, and 126 or over means you have diabetes. In the glucose tolerance test, your blood sugar is tested before and after you drink a liquid that has a known amount of glucose in it. Your blood sugar level is checked 1 hour, 2 hours and sometimes 3 hours afterwards. A random blood sugar test measures your blood sugar at a random time without fasting, so your blood sugar level might be relatively high if you ate something before the test. A blood sugar level of 200 (mg/dL) or higher means you have diabetes.

I hope this helped give you a big picture about diabetes.

Dr. Toshiko ("Toshi") Luckow, MD, is a Family Physician at the West River Health Services Hospital and Clinics.