By Tedler D. Depaynos, MD
Many times elderly coffee mates of mine inquire, what is Diabetis? They never felt anything and suddenly when they decided to consult their physician for hypertension, loss of weight, blurring of vision, numbness, etc. which they always attribute to old age, they are diagnosed to have uncontrolled Diabetis Mellitus! I always emphasize to them that Diabetis is a very insidious disease. One does not feel anything until complications set in usually after 5 to 10 years of being diabetic. What they are feeling when they related their problems are already complications and most of the time they are irreversible. The damage is already done! They may be lessened but they could not completely disappear.
From my professor, Dr. Ricardo Fernando during our medical student days many decades ago, diabetis is hereditary. If both parents are diabetic, the children sooner or later will also be diabetic. He lectured, however, that there is one in the family who will be lucky and will be exempted. If only one parent is diabetic, there is still 60% chance that the children will also be diabetic. I don’t know if newer studies and statistics have changed this concept. But definitely, it is still hereditary.
Diabetis is characterized by excess glucose in the blood. This is easily determined in the laboratory. The carbohydrates and sugar we take in are converted to glucose which is supposed to enter our cells to be used for energy with the aid of insulin. Insulin is secreted by our pancreas and the taking of food will automatically stimulate the production of insulin. Without insulin therefore, the sugar cannot enter our cells and will just be accumulated in our blood. Some will be excreted thru the kidneys making the urine highly colored and prone to infection. In Juvenile or Type 1 Diabetis, this is the main pathology. Due to a poorly understood auto immune mechanism, the cells in the pancreas secreting insulin are destroyed at a young age. Treatment obviously is insulin injection.
In Type 2 Diabetis which is developed later in life, insulin may be secreted by the pancreas but inadequate. It may also be abnormal so that it cannot do its function very well and the liver may be manufacturing excessive glucose so that even if one reduces their sugar intake, their blood sugar levels are still high. Of course the above mechanisms may all be present at the same time. The extent or degree of the defect and their concomitant presence will define the seriousness of the disease.
This is the type of diabetis mellitus found in the elderlies.
With the above probable mechanisms, drugs acting on the different mechanisms may be prescribed. There are drugs that stimulate the pancreas to secrete enough insulin. There are also drugs that aid the function of insulin in facilitating the entry of glucose into the cells and there are drugs that control the liver function in manufacturing glucose. To control the absorption of sugar in the intestine, various drugs are also prescribed. In short the different anti-diabetic drugs have different mechanisms of actions. And this is the reason why multiple drugs are prescribed by your doctor in treating your diabetis.
At present with intensive medical research, newer drugs with more complicated mechanisms are now available. They are found to be more effective and with much lesser side effects and they are usually prescribed by doctors who took additional studies in diabetis. However, if the condition cannot be controlled adequately and the blood sugar is persistently high, these specialists usually go back to the basic of injecting insulin.
In two or three instances, some coffee colleagues of mine showed me drugs they were taking for their disease sold by “friends”. Recently, one even visited me in my clinic with all smiles claiming vast improvement of his sickly feeling after just two weeks more or less of intake. Since my ignorance on their drugs was obvious, I just advised them to test their blood sugar and ask their drug peddler “friends” the mechanism of action of their medicine especially so when one of them even claimed a cure all effect. They may make you “feel good” but do not treat your diabetis.
Of course, before and after anti-diabetic drugs are prescribed, patients are advised that both strict dieting and doing more exercise are a must. The response of the body to the anti-diabetic medicines prescribed is definitely enhanced with the change of lifestyle resulting in weight reduction.
One main objective in diagnosing and treating diabetis early is to prevent complications. The mechanism of their appearance is really complicated. It worsens the effect of other diseases and reduces one’s resistance making one look pale, sickly and prematurely old.
In layman’s terms, one of the mechanisms of diabetic complications is the reduction or even obstruction of the lumen of the blood vessels. If the micro blood vessels in the retina are obstructed, blindness occurs. If the ones supplying the nerves are affected, numbness, tingling sensations and even pain especially in the lower extremities are felt. The blood vessels carry oxygen and if the tissues are devoid of oxygen, non-healing wounds and even gangrene results. This happens if the bigger blood vessels are affected. If the heart or coronary vessels are unfortunately involved, ischemia or lack of oxygen occurs and chest pains which may be severe are experienced. Renal failure also slowly occurs deceitfully and late manifestation maybe a persistently very high blood pressure.
Do not take diabetis for granted. One cannot do anything if one is destined to be diabetic. But the appearance could be delayed and the complications can be lessened or even prevented. **
