No. 6 - Diabetes simples
Tldr
As doctors we need to be able to explain diabetes in the language of a 12 year old, so that our patients have the best chance of understanding their health and taking charge of their health and, hopefully, long life.
Why do you need to know how to explain type 2 diabetes mellitus in simple terms?
T2DM is associated with obesity, however, not everyone who is overweight will get diabetes or that you even need to be that overweight to develop it. Your family inheritance, genes, diet, environment and bad luck all play a part. It is important to remember that anyone could potentially be unlucky enough to develop T2DM.
It is widely reported that the average reading age for people in the UK is that of a 12 year old. Therefore, if you really do want the best for your patients then you will want them to understand their own health and to do that you will need to explain diabetes in language they understand and use.
Talking in “medicalese” (jargon) is what doctors often do because it is how we are taught and it is an easy habit to fall into. It takes practice to talk simple.
If you are a healthcare practitioner that works in “deprived areas” or the inner cities, then you are more likely to come across patients who require simple language explanations than Profs who you can talk medicalese with.
The other benefit of “talking simple” is that the act of translating jargon into everyday language really forces you to think about the processes involved in what you are trying to explain and therefore, helps your own learning and will aid anyone you are trying to teach.
What is my simple explanation for diabetes?
We (doctors) say that you have type 2 diabetes when your body can’t produce enough insulin to keep you blood sugar levels low. The specific causes and mechanisms can be quite complicated, but the important point is that we know that if you don’t take back control of your blood sugar then you are more likely to die younger, probably of a heart attack.
How does your body use sugar?
Every cell in your body has a part called a mitochondria, these are the engines of your cells. These engines can use two types of fuel, sugar or fat. You can imagine that sugar works a bit like petrol, whereas, fat is more like diesel. Your body finds it easier to burn sugar, because it is cheaper, easier and faster.
All food that you eat is essentially made up of carbohydrate (sugar), fibre, fat and protein, plus water, vitamins and minerals. Fibre goes right through you so we don’t need to worry about that. Fat gets used for energy as fat. Carbohydrate gets broken down into sugar and burnt in the mitochondria. Protein can be turned into sugar if you eat too much of it or its an emergency.
How does your body move the sugar from your stomach to your cells?
Once you have eaten and digested your food, it goes through your bowels and into your blood. Your body is able to measure how much sugar is in your blood and release insulin from your pancreas. The insulin pushes the sugar out of the blood and into your cells - mostly into muscle, fat and liver cells.
Why is high amounts of sugar in your blood bad for you?
Have you ever tried to pump strawberry jam down a house pipe? I doubt it, and neither have it but it would be a bad idea. Now jam is thick and sticky because it contains lots and lots of sugar. This is effectively what would happen to you blood if your body didn’t have insulin and get the sugar out of your blood.
The more sugar is in your blood, the thicker and stickier it gets. This means that your heart has to work harder to push it around and puts more pressure on your blood vessels which then get damaged. When these blood vessels get damaged the organs that they are pumping blood too can’t get enough fresh blood and they get damaged as well. This often leads to heart attacks, strokes, blindness and foot amputations.
The other issue with lots of sugar in your blood is that if you get any infections then the bacteria who get into your body have a lot more sugar to eat and can grow much faster causing a worse infection.
Why can’t my body control the amount of sugar in my blood?
This topic is a bit more complicated and there are more reasons why things go wrong.
The most basic explanation is that your pancreas is designed to produce enough insulin for an 11 stone (70kg) caveman, eating a bit of meat and some vegetables. The female equivalent would be about 8 stone and 50kg. (Your genetics and family inheritance does alter this equation).
If you are someone with the body frame of a 70kg man, and yet you weight 100kg then you pancreas is going to have to worked harder and will burn out sooner, producing less and less insulin as the years go on - unless you do something about it.
T2DM is just your pancreas not being able to cope with your diet and weight.
The other main cause of diabetes is the modern diet. If you live in America it is known as SAD - the Standard American Diet. This diet involves too much sugar, too much starch, too much processed fat, processed meat and salt. Our pancreases just can not cope with the amount of sugar that we are putting in our blood.
Imagine taking a car and filling the tank with petrol, and then continuing to fill the inside of the car with petrol once the tank is full and then getting in your car and lighting a cigarette. Would you be surprised if you suddenly caught fire and exploded?
What can you do about it?
This bit is really simple.
If you want to live a long, happy, health life then you need to look after your pancreas and give it a rest.
Firstly, you can stop eating as much sugar and carbohydrate. If your body doesn’t need to process as much sugar then your pancreas doesn’t need to make as much insulin.
Second, you can lose weight. The closer your are to your “ideal body weight” or BMI then the more likely your pancreas will be able to cope.
The third step, is to do more exercise because even just increasing your step count with a bit more walking will mean that your muscle cells get better at dragging sugar into the cells and taking it out of the blood.
The fourth and last step, is that you start taking medication. Previously, this was seen as the only treatment for T2DM but we now know that it doesn’t have to be. We know that if people lose weight they can stop being diabetic and that is the best approach because it is a life long cure. Taking medication doesn’t fix the problem, but it can keep your pancreas working harder and prevent your organs being damaged.
Prevention is the best medicine. If you are worried that you might be at risk of becoming diabetic then please do visit your GP/Family doctor and get your HbA1c check ASAP, especially if other people in your family are diabetic. The sooner you find out, the sooner you can change your lifestyle and protect your pancreas.
As always, many thanks for reading and please do leave any feedback in the comments section below…