## From Sweet Treats to Losing Feet

An understanding of Diabetes, the world’s 6th deadliest disease.

# Introduction

In the United States, 1 in 10 Americans have some form of diabetes. Among the US population overall, crude estimates for the prevalence of diabetes in 2018 were as follows:

• 34.2 million people of all ages—or 10.5% of the US population—had diabetes.
• 7.3 million adults aged 18 years or older who met laboratory criteria for diabetes were not aware of or did not report having diabetes. This number represents 2.8% of all US adults and 21.4% of all US adults with diabetes.

Additionally, the percentage of adults with diabetes increased with age, reaching 26.8% among those aged 65 years or older.

These statistics not only justify the need for diabetes awareness, they also serve as a tool for advancing the awareness. According to Healthline, diabetes is the world’s 6th deadliest disease. For some people, this disease is completely controllable or even preventable. This article seeks to increase awareness by explaining what diabetes is and why it is so deadly.

# Typical Body Function

Our bodies require nutrients in order to survive. The nutrients fall into 3 major categories:

• Carbohydrates
• Fats
• Proteins

Carbohydrates (carbs) are used for energy in the body. All carbohydrates can be broken down into one key molecule: Glucose. Glucose is the simplest carbohydrate and is primary source of energy in the body. More specifically, it is the main energy source for the brain.

## How Do Carbs Equal Energy?

When we ingest food, it gets broken down to simple nutrients by our digestive tract. These molecules then get absorbed into the bloodstream where they get transported all over the body. As mentioned before, carbohydrates get broken down into glucose. The glucose is what is getting absorbed into the bloodstream. When glucose reaches the cells, some of it moves into the cells passively. Some cells are exceptions to this. Instead, these exceptions utilize an active transport mechanism and are what we call insulin dependent. This means that insulin is required to be present in order for the glucose to be taken in.

You can think of insulin as a key to a glucose lock on the cell. Insulin is a hormone produced by the pancreas. Insulin plays a crucial role in understanding diabetes.

Once the glucose is in the cell, it gets metabolized, or undergoes a bunch of chemical reactions to generate a molecule called Adenosine Triphosphate (ATP), the primary energy molecule in living organisms.

# Atypical Body Function

In the simplest terms, diabetes is a disease that is a result of some abnormality with insulin. There are two primary types of diabetes: Type 1 and Type 2. Type 1 diabetes is typically onset in children prior to, or at the beginning of adolescence. Type 1 diabetes occurs when the body fails to produce insulin. Type 2 diabetes is typically onset in adulthood and is when insulin becomes less effective. In severe Type 2 diabetes, insulin may no longer be produced. When a Type 2 diabetic stops producing insulin, they become classified as insulin-dependent.

Diabetes is one of the most complex diseases there is. We can treat it, however, there is a lot we don’t know yet.

## Symptoms of Diabetes

Diabetes can produce an array of symptoms which may depend on the severity of the disease, or even just the complexity of the patient’s other diagnoses. Common symptoms include:

• Increased thirst
• Frequent urination
• Extreme hunger
• Unexplained weight loss
• Ketones in the urine
• Fatigue
• Irritability
• Blurred vision
• Slow healing wounds
• Frequent infections

### Dehydration, Thirst, and Frequent Urination

In order to understand these symptoms, we should have a general understanding of one other concept. That concept is osmosis, a process by which molecules of a solvent tend to pass through a semipermeable membrane. In most cases, the solvent is water. Semipermeable means that some stuff can pass through it but not everything. Our cells and most tissues are semipermeable in the same way.

Dehydration, Thirst, and Frequent Urination are due to osmosis. When glucose levels are high in the blood, water moves from the cells to the blood to try and balance those high levels. This results in dehydration, which also causes thirst. Excess water in the blood causes increased filtration in the kidneys, and as a result, more urine is produced.

### Ketones, Fatigue, Weight Loss

When insulin becomes less effective, or is not present, insulin dependent cells are unable to get the glucose they need to make energy because insulin isn’t doing it’s job. As a result they have to change the way they make energy. The lack of energy production leads to fatigue.

When they do this, they switch to a method that does not require glucose. Often times, this involves breaking down fats to produce energy. By breaking down fats, we are still able to get molecules such as carbon dioxide, water, and ATP just like we do from glucose. When your body relies on breaking down fats, you tend to lose significant amounts of weight. This is the basis of the Ketosis diet. However, this method also creates unhealthy byproducts such as ketone molecules and lactic acid.

Ketones are a group of molecules with a “ketone body”. This simply describes a particular component to the molecule. The ketone molecules are harmful in larger amounts, as they can be very acidic. When they get released into the blood, it causes the blood to become more acidic as well. Additionally, the production of lactic acid perpetuates this. Acid in the blood can lead to organ damage, organ failure, and eventually death.

# Common Complications of Diabetes

Diabetes is complex, and we see this as we look at the gamut of complications that come with it. To fully understand the process that causes these complications is outside the scope of this article. However, heres a list with brief explanations:

### Neuropathy

• Death of nerves as a result of high sugar levels in the blood.
• Results in lack of feeling and numbness in feet and hands.

### Decreased Circulation

• Result of the imbalance, damages your arteries.

### Higher Blood Pressure

• A result of narrowing blood vessels.

### Wound Complications

• Lack of feeling and decreased circulation leads to wound problems.

### Increased infections

• Due to less nutrient availability from decreased blood flow.

### Diabetic Ketoacidosis

• Occurs when glucose in the cells is critically low, usually when glucose in blood is critically high
• Body resorts to breaking down fat instead of glucose
• Byproducts include lactic acid and ketones, which are life threatening in high concentrations.

# Importance of Diabetes Awareness

## Fast Facts from WHO:

• The number of people with diabetes rose from 108 million in 1980 to 422 million in 2014.
• The global prevalence of diabetes among adults over 18 years of age rose from 4.7% in 1980 to 8.5% in 2014 (1).
• Between 2000 and 2016, there was a 5% increase in premature mortality from diabetes.
• Diabetes prevalence has been rising more rapidly in low- and middle-income countries than in high-income countries.
• Diabetes is a major cause of blindness, kidney failure, heart attacks, stroke and lower limb amputation.
• In 2016, an estimated 1.6 million deaths were directly caused by diabetes.
• Another 2.2 million deaths were attributable to high blood glucose in 2012.
• Almost half of all deaths attributable to high blood glucose occur before the age of 70 years. WHO estimates that diabetes was the seventh leading cause of death in 2016.
• A healthy diet, regular physical activity, maintaining a normal body weight and avoiding tobacco use are ways to prevent or delay the onset of type 2 diabetes.
• Diabetes can be treated and its consequences avoided or delayed with diet, physical activity, medication and regular screening and treatment for complications.

The total estimated cost of diagnosed diabetes in 2017 was $327 billion which includes$237 billion in direct medical costs and $90 billion in reduced productivity (the cost of covering expenses for those out of work). The largest components of medical expenditures are: • Hospital inpatient care (30% of the total medical cost) • Prescription medications to treat complications of diabetes (30%) • Anti-diabetic agents and diabetes supplies (15%) • Physician office visits (13%) ## Why Awareness is Important As with any disease, there is a financial cost. This has two sides to the coin, patient costs and healthcare system costs. We can’t easily change drug prices, insurance costs, and other industry expenses as individuals. Therefore, we have to do what we can do individually, which is prevention. Understanding diabetes and all that encompasses it, including what the disease is, the symptoms that present, the risks involved, and the impact it has on the healthcare system helps us understand why awareness is so important. People with diagnosed diabetes incur average medical expenditures of$16,752 per year, of which about \$9,601 is attributed to diabetes. On average, people with diagnosed diabetes have medical expenditures approximately 2.3 times higher than what expenditures would be in the absence of diabetes.”

American Diabetes Association