ASK THE DOCTOR

by Wesley W. Wilson, MD

NOTE: If you have any questions for "Ask the Doctor," please send them to the VOICE editorial office. The only questions Dr. Wilson will be able to answer are the ones used in this column.

Wesley W. Wilson, MD, has retired as an Internal Medicine practitioner at the Western Montana Clinic in Missoula, Montana. Dr. Wilson was diagnosed with type 1 diabetes in 1956, during his second year of medical school. He remains interested and involved in diabetes education for patients and professionals.

Q: I'm 42, and have just been told by my doctor that I have diabetes. Is it curable? What can I do to get better?

A: I can understand your confusion, since there are two types of diabetes, and many treatments. The answer to your first question is no, neither type of diabetes can be cured, though both can be effectively treated and controlled. Careful control of both types of diabetes is important, since with good control of the disease, life-threatening complications can be minimized.

The confusing part is that both type 1 and type 2 diabetes share the abnormality of higher-than-normal blood sugar, but otherwise they are clearly two different diseases. Test results suggest that the complications of both types are caused by the high blood sugar, and that if the blood sugar is maintained near normal (non-diabetic) levels, complications can be minimized or avoided. Such complications include eye, kidney, and nerve abnormalities, as well as an increased risk of cardiovascular disease.

Both types of diabetes can cause hyperglycemia, higher than normal blood glucose levels. Elevated blood glucose has harmful effects ("glucose toxicity"), and it is necessary for persons with either type of diabetes to measure their blood glucose and take appropriate action to keep blood glucose levels in a safe range.

Type 1 diabetes is also known as "insulin dependent," or "juvenile" diabetes. Persons with type 1 diabetes must inject insulin in order to survive. This form of diabetes seems to be caused by autoimmune destruction of the insulin-producing cells in the pancreas, resulting in an absolute lack of insulin in persons with type 1 diabetes. Along with the necessary insulin injections, a type 1 diabetic needs to follow proper diet, seek regular exercise, and follow a consistent and healthy lifestyle, so as to keep the blood sugar as near normal as possible.

Insulin acts to lower blood sugar, but it can bring the blood sugar down too far. This is called hypoglycemia or an "insulin reaction," and persons who take insulin injections face that risk. It is a balancing act, avoiding sugars that are too high or too low--and a regulated sugar level can be very hard for some type 1 diabetics to achieve.

Elevated blood sugar is also the principal symptom of type 2 diabetes (sometimes called non-insulin-dependent diabetes). Despite the higher-than-normal blood sugar levels, these individuals often have normal or above-normal amounts of insulin in the blood; but, for reasons still unclear, their insulin has less blood sugar lowering effect. This is termed insulin resistance.

Insulin resistance is not fixed, but varies with obesity, exercise level, presence of infection, and use of steroids, such as cortisone. Heredity also plays a role: Certain ethnic groups have a stronger tendency to develop type 2 diabetes, and the likelihood of developing it appears to be inherited.

Treatment of type 2 diabetes, like that of type 1, consists of getting the blood sugars down into the normal range. Where in type 1 this is done with insulin injections, in type 2 diabetes it is accomplished by lessening the insulin resistance: Proper diet, ideal weight, regular exercise, stress reduction, and oral medications or insulin as needed.

Your doctor will discuss with you the type of diabetes you have, and will explain what you need to do to control your blood glucose level. Many type 2 diabetics can keep their sugar "normal" with diet and exercise. Managing diabetes is hard work for both doctor and patient, but it is important to do so. Keep yourself informed; both VOICE OF THE DIABETIC and the publications of the American Diabetes Association can be helpful.