What makes us diabetic - understanding the 10 key mechanisms

Have you read medical explanations of diabetes and found them a little hard to understand, yet you wouldn't mind knowing "what's going on inside" but can't find the right level of explanation?

I've read many explanations, many times, and if you Google around you'll find lots.  But I thought that what's needed is something simple as possible, but no simpler, which includes explanations of some of the fundamentals.

So here is my attempt which is a step-by-step functional flow intermingled with explanatory statements:

1. The body secretes insulin in response to rising levels of blood sugar - after we eat.
2. The purpose of the sugar going into the blood is to be taken to other places, where it can be used.
3. The blood itself does not need sugar and in fact if it is not removed it becomes harmful - which is of course one of the harmful effects of diabetes.
4. The body pumps the insulin into the blood, sensing the rising blood sugar, in order to tell the blood to get rid of that sugar by delivering it to where it is needed.
5. The insulin binds to the surfaces of cell membranes to stimulate the cells to take in more blood sugar and hence to remove it from the blood.
6. So the insulin has a double effect, it helps the cell to pump in more glucose (blood sugar) for its necessary functioning, and as a consequence lowers the level of glucose in the blood.
7. There is other "stuff" which assists insulin in stimulating the cells and pumping the glucose from the blood and these are called glucose tolerance factors - a "factor" here used in a classic sense of the word meaning "an agent" (see Wikipedia GTF).
8. Insulin does other work such as helping shift fatty acids from the blood into cells, which is essential for the functioning of muscles for example.
9. Cell membranes have insulin receptors - these receptors are welcoming committees for insulin and grab the insulin in as it circulates in the blood - think of the sprukers on the footpath in front of some restaurants - waving in the insulin.
10. When the insulin "shakes hands", or binds, with these receptors then the combination of the two creates an active gate for the flow of glucose and other materials into the cell, that is the binding of the insulin "activates" the receptor and gets the transfer process going.

They are the 10 key things that a normally functioning system does.

Here are the basic three things that go wrong for us diabetics:

1. We don't produce insulin - that's a "Type 1" problem which requires insulin replacement and injections on a strict regime.
2. We produce enough insulin but the cell receptors no longer want to shake hands and engage with our insulin to activate the transfer of glucose from the blood - this is "Type 2" insulin resistance.
3. We produce insulin but not enough and also we become resistant - this is also Type 2.

Knowing this allows us to understand the rationale behind various ideas and suggestions and treatment strategies, for example:

1. We might want to try reducing the blood sugar levels so as to not overload any insulin that remains - or slow down the release of glucose through dietary selection - this works when you still have insulin but not enough to clear the blood of harmful quantities.
2. We might want to try treatments which can stimulate or help activate the cell receptors and raise their interest in grabbing hold the existing insulin - think of this as "Viagra" for diabetes - for example chromium binds to the insulin receptor and enhances its activity and this is how chromium availability can help relieve impaired glucose tolerance and Type 2 diabetes. (Chromium sources include whole grain products, broccoli, green beans, and spices).

I think that understanding this basic underlying mechanism is helpful in understanding what various treatments, supplements, and other advice is trying to effect - to get the insulin working again to transport blood glucose out of the blood and into cells.

Knowing this also makes clear where some of the terms come from, such as "glucose intolerance" which is when the action in point 7 above doesn't work and "tolerance" becomes "intolerance".

It gets a lot more complex, because for one thing the walls of the blood vessels themselves get damaged by the excess blood glucose (seen high levels of high-sensitivity C-reactive protein or interleukin-6 - markers of systemic inflammation), which then becomes a vicious closed loop because it makes things even harder for the insulin to work. And then, Vitamin E has been found in mice to reduce these protein markers of inflammation - etc etc etc it gets too complicated; so that's why I've kept the focus on the clear 10 points of what makes us diabetic.

And also bear in mind that some easy comments in my description, such as the help chromium gives, are not yet understood medically, meaning for example that how chromium serves as a "cofactor" for insulin action is yet to be fully understood. That's all for another time.

Given the direct mention of chromium above, I'll discuss more about that in another post.

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