Each and everyday, we learn more and more about what causes diabetes, and thus new ways to treat it.  If what you know about diabetes is from observing what your family members do or have done, you are missing the boat.

When a new diabetes patient comes to my office, I try to explain to them what diabetes is and what has caused it.  I try to be as succinct and simplistic as possible, since most people are very overwhelmed and scared, not to mention our time is so limited for a long, drawn-out explanation.  Here is the very simplistic (incomplete) version of how I explain to them what diabetes is:

Type 2 diabetes is:

• A disease of insulin RESISTANCE (your body cannot use the insulin it is making effectively, due to lack of physical activity and excess body weight)                                                                          

                                                                      AND

• A disease of insulin DEFICIENCY (your body no longer makes enough insulin)

AND

• A disease of increased GLUCOSE PRODUCTION by the liver

As you can see, this is a fairly simplistic explanation.  But it is not the complete picture of what diabetes is.  Since the 1970’s, these were the only three “system defects” that were thought to be responsible for type 2 diabetes (and before this there was only two known system defects, and before that only one known system defect).

Today, thanks to the continuous work of Dr. Ralph DeFronzo* of the University of Texas, San Antonio, we know that there are actually EIGHT system defects responsible for type 2 diabetes.  This is a really big deal. Dr. DeFronzo* received the Banting Award which is the highest honor given by the American Diabetes Association (ADA) for dramatically changing current practice guidelines for type 2 diabetes.  The Banting Award is named after Frederick Grant Banting, the surgeon credited with discovering and isolating insulin, which led to him winning the Nobel Prize in Medicine in 1923.

What we know today, thanks to Dr. DeFronzo*, is that In addition to the three mechanisms (system defects) listed above, there are 5 more system defects that have recently been discovered.  Wow….FIVE more than we thought just 40 years ago!  Here they are:

• increased FREE FATTY ACID circulation that interferes with insulin secretion and action
• increased ALPHA CELL SECRETION of glucagon (a hormone produced by the pancreas that raises glucose) (further increasing the increased glucose production by the liver)
• decreased GUT HORMONES GLP-1 and GIP (the incretin effect that helps regulate blood glucose)
• increased ABILITY OF THE KIDNEYS TO REABSORB GLUCOSE (the kidneys normally filter 162 grams of glucose per day)
• decreased NEUROTRANSMITTER FUNCTION from the brain that affects appetite control

It’s not important that you understand all these different mechanisms, but now that there are EIGHT known system defects that lead to type 2 diabetes, it is almost impossible for me to take the time in a brief office visit to explain what causes type 2 diabetes, hence, the reason for this blog and the “Step-Power®” Weigh Ezine that I hope you will sign up for at the right, if you haven’t already.  Patients often wonder why they are on so many diabetes medications, when their family members were not on this many.  The reason is because not one single medication will work on all EIGHT of these system defects.

The good news about now having a better understanding of what causes type 2 diabetes is that we have an amazing arsenal of medications that are very effective in managing diabetes.  So, the next time your healthcare provider prescribes you a new diabetes medication, ask them which defect(s), that medication is aimed to work on.

The bad news, however, is that many people still cannot afford to be placed on some of the medications that we know will help them improve their diabetes.  This is extremely frustrating for me as a healthcare provider to know that there is medicine out there that can help them, but I cannot prescribe it because they cannot afford it.  Of course, I do all that I can to point them in the direction for medication assistance programs.

Another solution for when my patients tell me that they cannot afford their diabetes medications is to make sure that they understand that LOSING WEIGHT and INCREASING ACTIVITY is MEDICINE and will have a huge impact on all eight of these system defects causing type 2 diabetes.  Therefore, if I cannot prescribe them the medication they need (and even if I can), my number one and number two prescriptions for preventing and treating type 2 diabetes is WEIGHT LOSS and PHYSICAL ACTIVITY.

Don’t forget what a potentially devastating disease diabetes is, and that there is no time to waste in getting it under control.  Weight and Exercise DO Matter!

Do you see now why “Today’s Diabetes is NOT your Grandma’s disease?” 

 

* ADDENDUM:

Dr. Ralph DeFronzo and I, dining at the AstraZeneca/Bristol-Myers Squibb Diabetes Speaker Training Program in Orlando, Florida on March 1, 2013, where he participated as an expert panelist, as well as presented the Keynote speech for his research work on the biochemical and metabolic disturbances responsible for insulin resistance in type 2 diabetes.

Imagine my excitement, being among one of 400 participants at this event, and fortunate enough to meet and dine with this amazing endocrinologist, nephrologist, professor of medicine, and researcher—-and a very nice man to boot!