what diabetes ACTUALLY is

wigglyflippingout:

collegefatty22:

wigglyflippingout:

for @polyglotplatypus and various other people who are confused. this aims to stop the spread of misinformation. this is not a comprehensive guide, nor should this be substituted for advice from your doctor about your circumstance.

what is diabetes? diabetes is when your body does not have insulin that can handle the sugar in your blood. because of this, sugar in your blood builds and builds to dangerous levels. diabetics are people who know that their body does not have insulin available to handle their blood sugar, so they have to help out managing it.

what is blood sugar? it is what your body runs on. it’s not inherently bad. everyone has it and needs it in normal amounts. if you have very low blood sugar, it’s a good way to be dead! your body needs fuel to run. 

everything you eat is converted into blood sugar. the cells in your body only accept glucose to run off of. (if you’ve taken high-level biology, you’ve probably diagrammed how glucose is turned in your cells into ATP.) some foods are broken down into glucose very quickly, or don’t really need breaking down at all – candy, cake frosting, the sugar in fruit. some foods take a little longer to break down – we call these “complex” carbohydrates. these include things like whole grains, peas, and beans. fat is also broken down into blood sugar: you can think of fat chemically as very similar to a sugar, but in big long chains, even bigger than a complex carbohydrate. finally, proteins take the longest amount of time to break down at all, because they’re the least similar to that little glucose that your body wants, and so it takes your body awhile to hack them all down to size.

what’s supposed to happen with blood sugar? well, it’s supposed to get into your cells to help power them. however, the glucose molecule is kinda big. it needs somebody to hold a door open for it. insulin is a hormone that your pancreas produces; it runs ahead of the glucose and holds open the door.

what can go wrong with how blood sugar is supposed to get in there? the two ways this can go wrong are the defining features of the two types of diabetes.

in type one diabetes, insulin just… ain’t there. most people who have this end up developing it in early childhood. many others who develop it later have had damage to their pancreas in some way – like they have had pancreatitis, or pancreatic cancer. if the pancreas isn’t functioning, it can’t make insulin for you, so you get type one diabetes. since a type one diabetic has no insulin (or really not enough), they must take insulin. this usually means by injection before every meal.

in type two diabetics, insulin is around, but doesn’t want to work right. think of it like insulin is at the door, but has the wrong key. this can develop gradually over time, and usually develops in adulthood.

how does someone get diabetes? for type one diabetes, it seems to be straight-up luck of the draw with a heavy genetic component. there’s nothing really you can do to prevent it. most of the time it happens because it is actually an autoimmune disease. in other words, your body flips out and goes after your own pancreas. there’s a lot of research going on about how maybe we can help prevent that from happening, at least for the people where it seems to just happen (instead of having another definite cause, like an infection or cancer of the pancreas).

for type two diabetes, there are also many different factors. it also has a genetic component, but there are many other risk factors.

risk factors for type two diabetes include:

• your ethnicity.
• your age. (the older you get, the more likely you are to get it, as your body may stop making effective insulin.)
• taking certain psychiatric medications.
• taking steroids for medical conditions, especially long-term.
• high blood pressure or high cholesterol.
• having polycystic ovarian syndrome.
• having gestational diabetes, or giving birth to a kid weighing more than 9 lbs at birth.
• a family history of diabetes.
• having acanthosis nigricans (thick, darker skin of a different texture around your neck and armpits)
• and finally: being overweight.

no one single factor is wholly to blame. often in people with type two diabetes, there are a lot of these things all working at once.

type two diabetes is something where you can try to avoid it, and it will still get you. you can eat right and do all you can, but if you have other risk factors, you can still get it. there are many risk factors that simply cannot be avoided.

“but aren’t type two diabetics just gluttons who gave it to themselves?”

NO. this is a dangerous way to think about this disease! although being overweight IS often a factor, it is not the ONLY factor by far. people who have type two diabetes did not cause it all by themselves, it is not a “just punishment” for them; it is not a sign they are lazy, or gluttons, or sign of a moral judgment against them!

DIABETES CAN HAPPEN TO ANYONE WITH ANY ONE OF THE RISK FACTORS!

(that also assumes that being overweight means somebody must just be “eating bad”. there are many reasons someone can be overweight, many of them totally out of their control. to say someone should be able to control that one variable absolutely, and thus that diabetes is their punishment, is to have a very cruel and wrongheaded idea of how the human body works!)

“it’s just too much sugar, right?”

NO. diabetes is a more complex disease. if it were just too much sugar, we could solve it a lot more easily. it’s not too many people trying to come into the nightclub – it’s the bouncer being asleep and not letting anyone in.

“can you cure diabetes?”

NO. DIABETES HAS NO CURE. this does not mean that you will die if you get it, however! diabetes is like having an allergy, for example. it is something you will have to manage your entire life. however, diabetes can be effectively managed very easily. it is a very common illness and we have pretty good knowledge about how to manage it, and you can absolutely lead a happy, long life if you are diabetic. the idea that you will be “finished” managing your diabetes, however, is a very dangerous one. managing it is very doable, but if you decide to stop managing it, you can hurt yourself very badly, leading to consequences like losing limbs, having to rely on dialysis (since your kidneys are too damaged to work), going blind, or even just straight-up dying.

“how do you manage diabetes?”

type one diabetes has basically one treatment: type one diabetics must take insulin. this is usually by injection – controlled before meals, or done throughout the day by an insulin pump, or sometimes both. there are not any other treatment options right now for type one diabetes; you cannot control type one diabetes with diet, or exercise, or right now even taking a pill once a day.

type two diabetes has more treatment options. often treating type two diabetes means a combination of things like a regular diet, exercise, oral medications, injected insulin (both short and long acting), and injected medications that are not insulin (and are usually taken once-weekly). most type two diabetics use a combination of these options to manage their diabetes.

being able to control type two diabetes through diet and exercise alone is rare. although these things help, most people still have to take a medication of some sort. this is not because they are lazy, this is not because they have failed to manage their illness properly. on the contrary, someone who takes medication is very interested in managing their diabetes properly! one should not make moral judgements, nor should one say that everyone can treat their type two diabetes with diet and exercise alone!

“okay, so diabetics need to avoid sugar, right?”

nope! diabetics can have sugar – they just need to PLAN for it. this includes things like taking more insulin to compensate, eating less of other carbohydrate foods to ‘make room’, and so on. a diabetic is not banned from eating all sugar forever. the goal of diabetes management through diet is balance, not strict elimination. the other key is appropriate portion sizes. someone who isn’t diabetic can sit down and eat an entire bag of gummi bears and be okay, though they probably won’t feel that great. someone who is diabetic and eats an entire bag of gummi bears is going to be in serious trouble, and might have to go to the emergency room for help.

“what is the goal for a diabetic diet and treatment of diabetes, then, if it’s not avoiding all sugar?”

the goal of well-treated diabetes is blood sugars that are steady and in range. 

blood sugars being within range are important because too much blood sugar can cause permanent damage to your body. you can think of glucose as being a little jagged or stabby. when there is too much glucose in your blood, it means it scrapes around places where your blood vessels get very delicate and fine. for example, in your eyes, those blood vessels may be damaged if you have had high blood sugar for a long time, causing blindness that is irreversible. it can also damage the delicate blood vessels that your kidneys use to filter things through, leading to damage there. in addition, nerve damage can result, leading to something called diabetic neuropathy, where nerves hurt because high blood glucose has damaged them (particularly in places like your hands and feet). on top of that, too much blood sugar can just ‘gunk up the works’, meaning wounds that you get heal up more slowly which means you are much more likely to deal with infections.

blood sugars being steady are important because it is easy to get into a cycle of peaks and valleys, and these can be very dangerous immediately. while high blood sugar over the long term can cause damage, it can also be something to look out for in the short term, too. when you go too high, your body tries to compensate for that ‘spike’. that can lead to it scrambling to make stuff that will then make your blood sugar too low. then it tries to correct that, and your blood sugar gets slung all around. this feels really really awful! it is also dangerous because low blood sugar can kill you. it can make you dizzy, irrational, irritable, and disoriented; it can also cause people to pass out or faint. and if it goes too low, your body just doesn’t work, like a car running out of fuel. if your heart doesn’t have any way to get more glucose to it so it can keep beating… it doesn’t beat!

although high blood sugar is still really not good, a blood sugar low is often an immediate crisis. this is why, if you’re diabetic, you need to carry something with you at all times to get your blood sugar up quickly – something like glucose tablets, hard candies, or even a small tube of icing for decorating. (something you can hold under your tongue is ideal, because that will be where it is absorbed most quickly.)

“how do you plan a diabetic diet around those goals, then?”

working with a dietician is the best way to get some insight to this, but a diabetic diet is mainly about balance – avoiding things that spike your blood sugar up high and will then slam you back down into a low. instead, you look for pairing “quick” foods with “slow” ones. that way instead of a peak and immediate valley, you get a gradual tapering off – a nice gentle slope. this way, there’s no overcompensation that sends you into a dangerous low. you also need to avoid making that spike up after a meal too large, so that you are always within a safe blood sugar range that is not too high.

you can know how quickly a food is turned into blood sugar by looking at its glycemic index. a high glycemic index means that a food becomes blood sugar very quickly. these are “simple carbohydrates”, things like candy, a sugary coffee drink, white bread, and pasta. generally these are the foods that a diabetic has to eat with caution. many times a simple carbohydrate can be swapped out for a complex carbohydrate, which has a lower glycemic index – stuff like eating whole wheat instead of white bread. proteins and fats generally have much lower glycemic index.

that’s why it’s a good idea to pair proteins and carbs. this helps even people who aren’t diabetic. if you’ve ever felt a “crash” after a sugar buzz, that’s your body going “ooergh, we kinda made too much insulin after that sugary thing, guys, and we don’t feel so good”. non-diabetics are able to just get through this without intervention, but hey, if you can avoid feeling a tad icky, that’s a pretty good thing, right? follow the diabetic idea of making sure you pair something quick with something slow: for example, if you’re having a banana for a snack, put some peanut butter on it. the fat and protein in peanut butter will give your body something to work on when it’s all finished with the banana. or instead of having some toast with honey – two quick things paired together – have a slice of cheese toast instead, since cheese is more ‘slow’.

“what should i do to help my diabetic friends? what are some things i really need to know?”

you need to know that:

• DIABETES IS NOT A MORAL FAILING. if your friend has diabetes, it doesn’t mean that it’s because they are fat and lazy. it just means they have diabetes.
• DIABETES IS NOT BECAUSE YOU ARE FAT. that is one risk factor for one type of the two types. you can be diabetic and skinny. don’t promote the idea that only fat people need to worry about it! it will lead people to believe they’re okay when they’re in danger!
• BEING DIABETIC IS A LIFELONG DIAGNOSIS. there is no cure. once someone is a diabetic, they don’t get to ‘un-become’ a diabetic. they will need to manage it for all of their lives.
• THERE ARE MANY WAYS TO MANAGE DIABETES EFFECTIVELY. all of them are valid. just because someone is able to not use insulin does not mean that everyone can skip out on insulin; just because someone uses insulin doesn’t mean everybody’s gotta use insulin, either. the end goal is managing your diabetes effectively. nobody is more ‘morally pure’ or ‘better’ because they use one strategy or another, and what may work for one person may not be enough – or too much! – for another.
• HIGH BLOOD SUGARS ARE DANGEROUS. they can cause substantial damage, especially long-term. this is why diabetes involves so many other doctors sometimes, like podiatrists (checking for diabetic neuropathy in the feet) and optometrists (checking for diabetic damage to the eyes).
• LOW BLOOD SUGARS ARE DANGEROUS AND AN IMMEDIATE PROBLEM. if your diabetic friend is acting confused, shaking, dizzy, saying their heart is racing, or having a headache, or any other combination of the above and more, get them to test their blood sugar right away! and if your friend passes out, CALL FOR HELP AND TELL THE PARAMEDICS THAT YOUR FRIEND IS A DIABETIC. a very low blood sugar is immediately life threatening.
• DIABETICS CAN EAT SUGAR. they just have to compensate for it. tell your diabetic friends if something has sugar so they know how to balance for it. try to make sure there are options with fats and proteins to go along with sugary things if you can (like eating your dessert at the end of the rest of your meal, instead of a couple of hours later all alone).
• DIABETES ISN’T A DEATH SENTENCE. it’s just a thing. most diabetics live long and happy lives, and there is a lot of support for people who are diabetic. if you are diagnosed as diabetic, don’t despair! it’s not the end of the world. you can even still have sweets!

there are ways to be healthy and happy and diabetic, and they’re pretty easy to find with help of your doctor – but first you must understand what diabetes actually is.

again, this is a quick overview. this is not comprehensive and should not be substituted for medical treatment. but hopefully it clears up some of the longstanding myths and misconceptions. further sources to justify every point can be given upon request.

I don’t have diabetes but this is very informative you’re always told that if you eat a lot of sugar you’ll get diabetes which isn’t true.

i’m glad i could help out!

honestly there is just a ton of misinformation out there. and that misinformation leads to a lot of harm, too. even if it’s people who are well-meaning, they’ll still end up hurting people, and this is serious enough to not play with.

and hey, i think it’s really important that non-diabetics know this stuff. that way they can go, “oh, my friend is diabetic. if i see them getting really out of sorts, maybe i can suggest they check their blood sugar.” which, as a diabetic, is actually really useful lol. going low messes with your head haaaaaaard, and sometimes it’s really difficult to think straight. having somebody to go “hey dude, you might be going low, you wanna check?” is SUPER helpful.