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FEATURE: Diabetes is a hormone illness

DIABETES, also called diabetes mellitus or sugar diabetes, is very common in the CNMI and is a major contributor to long term illness, disability, and death.

To understand diabetes, you need to understand what a hormone is. A hormone is a substance made in one place of the body that acts somewhere else. It is a chemical command from a gland to a distant body part, usually transported by the blood stream. It is like a key made in the machine shop but opens a door at the other end of a building. For a hormone to be effective, it needs to be in the right place, at the right time, in the right amount, and in the right pattern — it needs to be the right key in the right door turned in the correct direction in a lock that is lubricated and able to move. Another example of these chemical messengers that you might have heard of is the hormone, estrogen. Estrogen is made in the ovary (and some in the adrenal gland) and moves through the blood stream to act on the uterus, bones, breasts, skin, and more. The thyroid hormone is made in the thyroid gland in the neck and affects the heart, colon, cholesterol, body weight, and body temperature. Growth hormone comes from the pituitary gland in the skull and it affects multiple areas of the body including muscle, bone, and the immune system. There are other hormones as well like adrenalin, testosterone, prolactin, progesterone, etc.

We eat healthy food that is digested into glucose, proteins, vitamins and more.

Cells are the building blocks of all of our organs and tissue and cells need glucose as fuel. Insulin, the hormone involved in diabetes, is made in the pancreas and circulates through the blood to affect the movement of glucose in and out of the cells all over the body. Insulin is the key that opens the cell to let the food in.

Diabetes is caused by an unreliable, absent, or broken insulin key or a sticky/unresponsive cell lock mechanism. If the insulin key is missing, damaged, does not work at the right time, or if the final lock into the cell is broken, cells do not eat. That is a big problem. That is diabetes.

There are two problems with glucose not moving into the cells — the first problem is fairly obvious — the cells starve and weaken. Our bodies can’t function if the building blocks can’t be kept nourished. The second problem is less intuitive. Glucose that builds up in the blood without the chance to enter cells becomes toxic. This toxicity is mostly seen in nerves (foot numbness), and blood vessels in the eyes (bleeding and blindness), and the kidney (kidney failure). It also poisons the blood vessels in the heart and brain and adds to risk of heart attack and stroke.

Type I diabetes occurs due to a damaged pancreas that doesn’t make enough insulin. This means there are no keys available to open those particular cell-fueling locks. Individuals with Type I diabetes, usually diagnosed in childhood, MUST inject insulin throughout the day to move the food they eat into body cells for nourishment. They don’t have the insulin key to open up the cells to this vital import. Type II diabetes, which is much more common, happens when the body insulin targets are not responding to this chemical messenger. There may be keys but the lock is broken and the insulin key doesn’t always fit. Eventually the body tires of trying to make keys that don’t work, and it may stop making keys all together. Ninety percent of the people with diabetes in the U.S. have Type II diabetes. This is the type of diabetes responsible for killing many people in the CNMI.

The treatment for type I diabetes is supplying insulin that isn’t being made naturally, thus providing the body with lifesaving keys.

The treatment for type II is more variable — losing weight lubricates the locks so the insulin key can turn. Exercise opens the locks even without a key and lets the glucose in to strengthen cells. Eating a proper low-glucose diet can limit the amount of glucose the body, and insulin-keys, have to deal with, and can prevent excessive build up. Medication can help your natural keys to be more effective or your locks to be more receptive. It whatever way it is done, glucose needs to get into the cells. If insulin isn’t working correctly, you, your diabetic educator, and your doctors, need to work together to treat it and avoid complications.