What causes diabetes?

By David Khorram, MD

Q: I understand that diabetes is a condition where glucose (or “sugar”) accumulates in the blood, and causes damage to blood vessels. But what causes the diabetes? Why do I have diabetes?

There is no easy answer to what causes diabetes, but we can explain some things. First of all, glucose goes into the blood from the food we eat. The glucose is the body’s fuel, but it cannot be used while it’s still in the blood. It has to get into the cells to be used as energy. Each cell has a wall around it, and the glucose has to get through this wall. There are lots of “doors” on the wall, and a special hormone that is made in your pancreas can open these doors to let the glucose into the cells. This special hormone is insulin. If glucose isn’t getting into the cells, it is because there is some problem involving insulin. And this is the condition we call diabetes.

Now, there are two types of diabetes. The first is what is called Type 1 diabetes. It is also called “juvenile onset” diabetes, because most people who got this type of diabetes get it while they are young. In this type of diabetes, the pancreas simply stops making insulin. If there is no insulin, the glucose cannot get into the cells and it builds up to very high levels. A person with Type 1 diabetes cannot live without insulin injections. If a Type 1 diabetic doesn’t get insulin, the glucose levels in the blood rise to such a high level that the person may go into a coma and die. There are very few cases of Type 1 diabetes in the CNMI, maybe less than 10.

Type 1 diabetes is caused by the body accidentally attacking the pancreas. It is thought that a person first gets a viral infection, and the body’s immune system sets out to attack the virus. In the process, it also attacks the pancreas and kills the cells that make insulin. It is what is called an “autoimmune” disease. That it, the body’s immune system attacks the body.

Most of the cases of diabetes in the world are Type 2 diabetes. It is also called “adult onset diabetes,” though more and more young people are getting it. Usually, there is enough insulin in the body, but the cells in the body just don’t respond to the insulin the way they should. The insulin that is produced can’t open the doors that let the glucose into the cells. The problem is “insulin resistance.” The cells of the body resist the action of the insulin. This type of diabetes affects over 3,000 people in the CNMI.

We don’t completely understand what causes this type of diabetes. But we do know some of the things that put you at risk for developing Type 2 diabetes. First of all, we do know that it runs in families. If one of your parents has diabetes, there is about a 10 percent chance that you will have it. If one of your brothers or sisters has diabetes, then there is about a 50 percent chance that you will have it. But having it in the family doesn’t cause you to also have it. It just increases your chances of developing diabetes. Although you cannot change the fact that diabetes may run in your family, there are some things that you can do to decrease your risk. If someone in your family has diabetes, it might make you more aware of doing these things that can help prevent you from developing diabetes.

There is a lot you can do to prevent this type of diabetes. Most of it has to do with diet and exercise.

In a future column we’ll discuss some things you can do to prevent development of full-blown diabetes.

(David Khorram, MD is a board certified ophthalmologist, the director of Marianas Eye Institute and a columnist for the Saipan Tribune. Questions and comments are welcome. Call 235-9090 or email davidkhorram@hotmail.com. Copyright © 2005 David Khorram.)