The Facts on Diabetes

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Most people know diabetes as the body's inability to process sugars and starches properly. Your body digests a meal and converts all the carbs into glucose—blood sugar. It then becomes the job of your pancreas to detect this sudden infusion of glucose and, in response, produce the hormone insulin. The insulin is needed to allow your body's various organs—brain, muscles, liver, and so on—to extract the glucose from your bloodstream and either use it at once or store it for future use. The body's need for sugar is constant—without it in sufficient quantities you will become dizzy, faint, go into a coma, and before long, die.

Imagine that each cell in your body has a lock on it, and insulin is the only key that fits. If the cells remain locked, the sugars can't enter, and they remain circulating uselessly in your bloodstream, where they do you no good and cause considerable harm.

But what most people don't realize is that diabetes isn't just about how we process sugars: it's also the inability to properly process the fats we eat.

When we eat fats, whether from flesh, vegetable oils, or dairy products, it is also insulin's job to transport the fatty acids (the basic component of fats) from the bloodstream into the body's tissues, where they belong, to be used immediately for fuel or stored for future use in the form we know as triglycerides or simply as fat.

In fact, diabetes can be seen as the body's inability to manage its fuel supply well. Obesity, too, is just a matter of bad fuel management, due to a combination of genetics and lifestyle. Our bodies are designed to store excess energy (which we call calories) for a very good reason. For most of humanity's existence, securing a steady and sufficient supply of food has been our biggest, most important challenge. Feast or famine prevailed, and to adapt, our bodies would save the energy from today's feast, knowing that tomorrow it would need to burn saved fuel in order to survive. That's why this particular brand of obesity concentrates the fat in the midsection—it leaves the extremities lithe and muscular, for ease of manual labor and, especially, flight. Advanced civilization has done a great deal to eradicate famine, but at the expense of our waistlines and our cardiovascular systems, which now suffer from stored fat that we no longer need. We would be better off if our bodies eliminated excess energy as if it were waste, but they don't.

This is exacerbated by the physiology of the fat cell. When we gain weight, we're not creating new fat cells—their number remains constant from childhood. No, what happens is that the fat cells themselves get fat. That's why in overweight people the insulin has trouble attaching to the fat cells—they've grown too big. As a result, when an overweight person overeats, it's like trying to fill a gas tank that's already at capacity—the excess spills over. In your body, that means the sugars and fats circulate in your blood longer than they should. When your body cannot properly transfer the glucose and fatty acids from your bloodstream into your tissues, it's the beginning of trouble. Left untreated, serious cases of diabetes are fatal.

But there are two types of diabetes, and these differ in important ways.

Juvenile (or type 1) diabetes usually strikes during childhood or adolescence. It's caused by some damage that's been done to the pancreas—pos-sibly by a virus. As a result, the organ produces too little insulin to do the job of getting sugars and fats from the bloodstream into the proper tissues. It's an incurable disease at this point and can be treated only by replacing the insulin with daily insulin injections. That's why eating carefully and measuring blood sugar level are so important to a diabetic's well-being and why insulin is such a lifesaving drug.

We don't even have a proper name yet for the other form of this disease; hence its working title: type 2 diabetes. This is also called adult-onset diabetes, because that's when it usually shows up. As we've said, there's no virus to blame, just who we are (genetics) and what we eat. A surprisingly large percentage of us are genetically predisposed to diabetes of this kind. But the predisposition is just that—the potential for diabetes—until poor diet and lack of exercise do their damage. We can't control our genes. But if you can keep from making bad food choices, you can prevent this form of diabetes.

Both these diseases go by the same name, but the causes are opposite. Juvenile diabetes is a result of the pancreas's inability to produce insulin. In type 2, your pancreas is fully functional and is actually making too much insulin. When you carry excess body fat, you make it difficult for insulin to do its job. So the blood sugar level doesn't drop as quickly as it should, prompting your pancreas to pump out even more insulin in order to unlock your cells and let the glucose in. Your pancreas sends out insulin until finally it overshoots the mark, which is why the blood sugar level drops so low. It's the high level of sugar in the bloodstream and then the rapid plunge (when you finally produce enough insulin) that causes your sharp food cravings. The cravings cause you to eat more carbs, and so the vicious cycle goes around and around.

All of the above is a good explanation for why obesity makes you overeat, and why eating carbs, rather than satisfying your hunger, makes you hungry for more. But we still haven't answered this question: What do obesity and type 2 diabetes or prediabetes have to do with heart trouble?

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