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 V.19 No.44 | November 4 - 10, 2010 

Miss Diagnosis

Insulin Shock

“Left Over Bits”
“Left Over Bits”

Some diseases, like people, just have a special “it” factor that captures the imagination of the public. For instance, Ebola erupted on the scene with unprecedented dramatic flair. The virus achieved fame by learning to demolish the inner layer of human blood vessels. This little trick causes hemorrhagic death grisly enough to put all those horror-movie faux grotesqueries to shame. Or consider the case of last year’s media darling, the dreaded H1N1 “swine” flu. Like a sadistic serial killer with major mommy issues, this disease made a name for itself by killing off children and pregnant women faster than you could say “front page news.”

But what if I told you about a disease with enough destructive force to make those look like B-movie amateurs? A disease that rivals Ebola in the yuck department, with bleeding retinas, festering foot ulcers and brain clots? More persistent than swine flu, it attacks women and children—and everyone else. This disease upstages other epidemic evildoers by blinding its victims, maiming their kidneys and scrambling their nervous systems. Many people with this disease die only after a prolonged torture of amputation and dialysis.

Diabetes is like the global warming of diseases.

Unfortunately, what’s described above isn’t some reclusive virus that crops up briefly, goes on a rampage and then slinks back into obscurity before wearing out its welcome in the headlines. It’s not some pandemic that can be controlled with vaccination and hand-washing. In fact, it’s not an infection at all. It’s that familiar, stealthy old juggernaut known as type 2 diabetes mellitus. And with a bag of Halloween candy still lying around, the Thanksgiving feast being planned and Christmas cocktail parties just around the corner, ’tis the season for elevated blood sugar.

Diabetes is like the global warming of diseases. Its mechanism of planetary destruction is elegantly simple. When you eat, your body breaks down food into sugar molecules that are absorbed into your bloodstream. Sugar in the blood is then sucked up by all the little cells in your body that use it for energy.

Essentially, the extra sugar tears through the body’s most delicate parts like tiny shards of glass.

However, sugar molecules need a doorman to let them into the cell. Insulin, a hormone produced by the pancreas in response to rising blood sugar, unlocks the little doors on the outside of the cell, allowing sugar to enter. Without insulin, sugar is left out in the cold, knocking hopelessly on a locked door.

If sugar can’t get inside the cell, it just loiters around in the blood stream. Unfortunately, sugar is a clunky molecule, and it likes to stick to the inside of your blood vessels. This damages them the way that rust can damage a shiny piece of metal. Essentially, the extra sugar tears through the body’s most delicate parts like tiny shards of glass.

Excess weight, poor diet, a sedentary lifestyle and genetics can cause metabolic changes in the body that alter the way cells respond to insulin. In type 2 diabetes, the cells gradually become unresponsive. The pancreas reacts by dumping even more insulin into the blood stream, trying to overwhelm the unresponsive cells. But eventually the insulin-producing cells in the pancreas become exhausted and burn out.

This is not just about people drinking too many sodas and watching too much television.

These changes happen gradually, and damage from rising blood sugar accumulates almost imperceptibly. This is why diabetes lacks the shock value of Ebola. If you tell someone, Hey, in one week you’re going to start hemorrhaging massively out of your face and ass, the motivation to change is pretty strong. But telling someone that they are going to lose a leg and kidney in 25 years doesn’t quite pack the same punch.

Most cases of type 2 diabetes are directly related to weight and lifestyle, although there is a strong genetic component. Not everyone who has the disease is overweight or sedentary. The last guy I took care of with type 2 diabetes was probably 125 pounds dripping wet. Certain minority groups are more likely to get the disease, even when matched for weight and age to their Caucasian counterparts. Minorities also tend to develop a more aggressive form of the disease. Add this to the fact that minorities are less likely to have access to insurance and health care, and you’ve got a recipe for disaster.

Despite the genetic component, type 2 diabetes is almost completely preventable. Diabetes is the seventh leading cause of death in this nation, and it affects nearly 8 percent of the general population. Can you imagine if 8 percent of the population was hooked up to life support and dying of respiratory failure like H1N1 victims? What do you think people would do?

In 2007, diabetes cost our country $174 billion dollars. The Centers for Disease Control and Prevention projects that rates of diabetes will double or triple by 2050, and that as many as one in three Americans will be afflicted by the disease. What would we do if one in three Americans started bleeding out of their eyeballs and vomiting up blood like Ebola victims?

Clearly, diabetes is a public health issue that raises more questions than answers. This is not just about people drinking too many sodas and watching too much television. This disease is steeped in cultural and economic factors like poverty, education, family structure, employment opportunities and access to care. It’s easy to tell people to diet and exercise. It’s hard to create an environment in which people actually have the knowledge, motivation, and social and financial resources to make it happen.

Diabetes won't abdicate its destructive throne on its own. We, as a society, must empower one another to make the necessary changes. So our first challenge, as we move into a future in which one in three Americans could develop diabetes, is to make this real to people. If this means I have to rant and rave about gross amputations, pustulant ulcers and ugly death in my column, so be it.

Despite its brilliant name, this column is not intended to prevent, diagnose or treat herpes. Or any other diseases, for that matter.

Whitny Doyle is a family nurse practitioner grad student.

The opinions expressed are solely those of the author.
 
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