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What is Diabetes?

Diabetes is more than some diagnostic term…

Let’s start with a familiar analogy: jumping out of a plane without a parachute. It’s not the fall that kills you. It’s the hard landing that does it. There is nothing inherently wrong with falling, but it leads you to a gruesome conclusion.

High blood glucose and insulin are the fall. Heart disease, Alzheimer’s, neuropathy, nephropathy, retinopathy, and dyslipidemia are the hard landing.

Falling doesn't hurt you - the landing does


Okay, so you’ve been diagnosed with “diabetes.” What the heck does that even imply?

That is a great question because it’s a little harder to define than one might think. It’s more like some nebulous idea than a tangible and focused disease. Would you agree? That’s why we have to give it an entire post to itself. Some people think it is all about blood sugar. Some people think it is, itself, a disease. Some people think it is progressive and incurable.

It is none of those things. First, we break down the standard definitions and look at why they are misleading. Then we build back up with what the true definition is – starting from the root cause.

 

Diabetes is not just about blood sugar

Before we get started, we just want to clarify some terms. Diabetes and diabetes mellitus (DM) are each referring to the same thing. Sugar and glucose are also synonyms. Alright, let’s dive in...

Summary and Conclusion

  • Diabetes is not just marked by high blood sugar. Insulin also plays a major role in diabetes. It is the forgotten part of the story.
  • Hyperinsulinemia precedes high fasting blood sugar by over 20 years. This should be our real measurement of diabetes.
  • Diabetes is not a disease – it is a disease state that leads to actual diseases.

Thus follows our definition of what diabetes is:

Diabetes mellitus is a metabolic disease state or condition, originally marked by hyperinsulinemia, then followed by hyperglycemia that further leads to degenerative and fatal diseases.

Definitions from the Experts

“High blood glucose” – Classic

1) The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDKD) defines diabetes as: “a disease that occurs when your blood glucose, also called blood sugar, is too high.”[1]

First point – don’t you think they could have come up with a less wordy name than NIDDKD? Second point – this definition does not explain it as a disease. You will find this kind of definition anywhere you look online. They are all very similar. It does not explain its direct harm or role as a disease. Rather, it explains it as a current state of being. The point is that this definition does not say what the heck the real problem is. Is high blood sugar the disease? Or does high blood sugar lead to disease?

Numbers to define diabetes

2) The American Diabetes Association sets the standards for quantifying it. Diabetes is having any combination of: an HbA1C level over 6.5%; a fasting plasma glucose level over 126 mg/dl; or having an oral glucose tolerance test reading over 200 mg/dl.[2]

We are getting a bit more technical here. These are just measurements your doctor reads from blood work. We can all be diagnostic doctors then… We just read blood numbers and look at a chart given to us from the “almighty experts” to see what matches. The problem with having definitions like these is that they wrongly put people into categories they don’t belong to. They also exclude people who should be diagnosed but don’t meet those requirements. It’s good to have some general outline for this stuff, but to categorize people as groups rather than individuals (and give them subsequent meds) is dangerous. More on that later.

Diabetes as a disease hangout

3) The Mayo Clinic talks about diabetes in a little different sense. They say, “Diabetes mellitus refers to a group of diseases that affect how your body uses blood sugar (glucose).”[3]

Okay, now we’re getting somewhere! This definition implies diabetes is more than “diabetes.” It encompasses a group of diseases. The Mayo Clinic comes at it from a different angle. Yes, diabetes is really the path to disease. However, they believe the diseases are not the result of high glucose – but rather, the diseases affect the high blood sugar. They interfere with the way your body uses energy. We like the point of view here, but it’s still not quite “there.” Blood sugar does cause many of the diseases, but the diseases also ruin the metabolism of glucose. It is really both. But, I do not want to confuse you too much now.

Diabetes is a hangout of diseases

These are all pretty interesting points of view, right? At least they get us thinking about what the real problem is. We just need to dive in a little deeper.

What about insulin?

We know insulin is tied closely to glucose, right? It’s a part of the common vernacular of diabetes. Well then we believe it’s smart to take a look at it. No other organization seems to care much for it. Why wouldn’t people be more concerned about the flip side of this glucose coin? Who knows. But it turns out, it plays a pretty important role in disease.

Insulin is a hormone released from your pancreas. It has several roles, most importantly of which is to regulate blood glucose.[4] Glucose can be used as energy by your cells. You have it floating around in your blood when you eat carbohydrate and sugar. Insulin is the substance that opens up your cell so you can actually get use of the glucose. That’s a very delicate role. So wouldn’t you think maybe a disease of glucose metabolism might have some relationship to insulin?

Insulin injections

It does, and to be fair, a lot of researchers understand there is a problem with insulin in somebody with diabetes. They know it as “insulin resistance.” Your body does not respond to insulin for one reason or another.[5] You gain high blood sugar when your cells do not open up from the hormone signaling. That’s the connecting bridge. But they still only look at it from the glucose point of view. Glucose, glucose, glucose. It’s still all about your blood sugar to define diabetes. It does play a part, but there is more too it.

Insulin Resistance / Hyperinsulinemia

Insulin resistance is the disease state in which your body doesn’t use insulin well. Hyperinsulinemia is the disease state in which you have too much insulin floating around in your blood.[6] We have a blog post relating to this very topic that goes into detail about the relationship and problems associated with hyperinsulinemia and insulin resistance. You can check it out here if you are interested in the specifics.

There are two very good, related questions surrounding the insulin balancing act:

1) Does insulin resistance cause high blood glucose? Or does high blood glucose cause insulin resistance?

2) Do high insulin levels cause insulin resistance? Or does insulin resistance cause high insulin levels?

This is getting deep… These are somewhat rhetorical questions made to make you think. There are proposed mechanisms for each situation. Our final conclusion: diabetes is all one big, cyclical and festering disease state. There is really no clear-cut answer, but we will do our best to dissect it.

The Cylce Continues

Insulin resistance causes high blood glucose – because your cells are not able to take it in. High blood glucose causes hyperinsulinemia – because your body keeps producing insulin when your blood is full of glucose. Thus, insulin resistance and high blood glucose cause hyperinsulinemia.[6]

High blood glucose causes hyperinsulinemia – because your pancreas secretes a lot of insulin to take care of the large amounts of sugar. Hyperinsulinemia causes insulin resistance – because your cells’ receptors of insulin are then depleted. Thus high blood glucose causes insulin resistance.[6]

The vicious cycle of diabetes and insulin resistance

See how this can get confusing? It is one large cycle – that’s it. It feeds back into itself. One way to stop the cycle from continuing onward is to stop your consumption of carbohydrate and sugar. Get your body to rely on a different (and better) source of fuel, and you won’t have this problem. The idea that glucose must be the energy we use is ridiculous! Not only is that not true, there are better sources out there – like fat. This is the reason we promote a ketogenic diet. You are switching your main fuel source from glucose to “ketones.” You can find out more about it here!

Insulin’s role in diabetes

High blood sugar is the way doctors diagnose diabetes. If you have insufficient or ineffective insulin, then you will have high blood sugar. That’s why it’s so important to look at insulin alongside blood glucose. Insulin problems may very well be one of the root causes of diabetes. But high blood glucose can also cause insulin problems… It is a very tricky subject. Researchers should at least look at it from the insulin perspective – not just the glucose perspective.

In fact, high blood sugar seems to be the more salient, but not real, problem. It is the fruit produced from rotten roots. The rotten roots are not seen for years until the horrid fruit is ready for harvest. The fruit seems to be the obvious problem, but really we must look at the root cause of the bad fruit.

Hyperinsulinemia precedes hyperglycemia (high blood sugar) by over 20 years![6] [7] [8] [9] This is a huge finding. Hyperinsulinemia can go hidden for so long. It is only apparent later down the line when fasting blood glucose levels are tested as high. At that point, it is too late – you are a part of that vicious cycle.

What if we instead measured insulin responses to glucose tests? Do you think it would be possible to catch the disease early on and prevent it from turning into full-blown and “diagnosable” diabetes? We don’t think so. We know so. This is why it is dangerous to diagnose people based only on their blood glucose. There is much more to it than that, and there is even a predecessor to the high blood sugar. Shouldn’t we look at the root cause rather than the rotten fruit? Fix the roots and you fix the fruit.

Diabetes as a highway to disease

Okay, so now that we’ve looked into the both sides of diabetes (glucose and insulin), let’s get more specific as to what “diabetes” really is. It is not a disease itself. There is nothing inherently wrong with lots of glucose or insulin in your blood. The problem is everything affected by the high blood glucose and insulin. Yes, indirectly, high glucose and insulin are part of awful diseases, but they are not the disease…

Some diseases that come from diabetes: cardiovascular disease, Alzheimer’s, neuropathy, nephropathy, retinopathy, and dyslipidemia.[3] [6] These are common complications people with diabetes see. The most popular and common one is cardiovascular disease. We go into this topic in great detail in another post of ours. Check it out here. For right now, understand that diabetes is not a disease – it is a disease state. High insulin and blood sugar are not good, but they are not the problem in and of themselves.

Falling doesn't hurt you - the landing does

Let’s go back to that original analogy: jumping out of a plane without a parachute. It’s not the fall that kills you. It’s the hard landing that does it. There is nothing inherently wrong with falling, but it leads you to a gruesome conclusion. High blood glucose and insulin are the fall. Heart disease, Alzheimer’s, neuropathy, nephropathy, retinopathy, and dyslipidemia are the hard landing. Is it starting to make more sense?

Our Definition

Now that we have done a fair amount of dissecting of this topic (and believe us – we could go on forever), let’s funnel all this information into one definition:

Diabetes mellitus is a metabolic disease state or condition, originally marked by hyperinsulinemia, then followed by hyperglycemia that further leads to degenerative and fatal diseases.

This is the definition we like to use because it encompasses everything. Although it still is very broad and somewhat nebulous, it does a good job for being one sentence long. Entire books have been written on this single topic alone, so there is much more to get into than we talked about. But we hope you took away some general understanding of what diabetes really is.

There are also many types of diabetes out there: types 1, 1.5, 2, 3; gestational; prediabetes. Although types 1 and 2 are the most commonly talked about, the other kinds affect many people in the world. We do not go into the specific kinds of diabetes here. We only talk about the general topic as a problem of metabolizing glucose. For more information on the different types, check it out here.

References:

[1] “What is Diabetes? | NIDDK”. National Institute of Diabetes and Digestive and Kidney Diseases. 2018. [Online]. Available: https://www.niddk.nih.gov/health-information/diabetes/overview/what-is-diabetes. Accessed: 04 May, 2018.

[2] “Diagnosing Diabetes and Learning About Prediabetes”. American Diabetes Association. 2018. [Online]. Available: http://www.diabetes.org/diabetes-basics/diagnosis/?loc=db-slabnav. Accessed: 04 May, 2018.

[3] “Diabetes – Symptoms and causes”. Mayo Clinic. 2018. [Online]. Available: https://www.mayoclinic.org/diseases-conditions/diabetes/symptoms-causes/syc-20371444. Accessed: 04 May, 2018.

[4] Utiger R. “Insulin | Definition, Structure, & Function”. Encyclopedia Britannica. 2018. [Online]. Available: https://www.britannica.com/science/insulin. Accessed: 04 May, 2018.

[5] Reaven GM. 1988. Role of Insulin Resistance in Human Disease. Diabetes 37(12): 1595-1607.

[6] Crofts C, et al. 2016. Hyperinsulinemia: A unifying theory of chronic disease?. Diabesity 2(2): 19-29.

[7] Dankner R, Chetrit A, Shanik MH, Raz I, Roth J. 2012. Basal state hyperinsulinemia in healthy normoglycemic adults heralds dysglycemia after more than two decades of follow up. Diabetes/Metabolism Research and Reviews 28(7): 618-624.

[8] Weir GC, Bonner-Weir S. 2004. Five Stages of Evolving Beta-Cell Dysfunction During Progression to Diabetes. Diabetes 53(suppl 3): S16-S21.

[9] Zavaroni I, et al. 1999. Hyperinsulinemia in a normal population as a predictor of non-insulin-dependent diabetes mellitus, hypertension, and coronary heart disease: The barilla factory revisted. Metabolism 48(8) 989-994.

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