How Much Sugar Do You Take?

What is diabetes?

Diabetes is a serious, lifelong illness that affects how the body uses food.  The food we eat is broken down into sugar, also known as glucose, which is our body’s main source of energy.  The body normally breaks down carbohydrates from foods such as fruit, pasta, bread, and rice, into glucose.  The body then uses this sugar as energy.  A hormone called insulin acts as a key, moving sugar from the blood stream into the body’s cells where the sugar helps the cells function.  Insulin is made in the beta cells of the pancreas, which is an organ found behind the stomach.  When you eat, the body senses that sugar has entered the blood stream and signals the pancreas to send out more insulin to move the sugar into the cells.  However, in diabetes, there is a problem with the insulin.  The key doesn't work for some reason.  And just like a car, your body won't run well without a key to open the cells to let in glucose for energy.

In type 1 diabetes, the beta cells are destroyed by antibodies and can no longer make insulin, resulting in a shortage of insulin.  In type 2 diabetes, the body becomes resistant to the effects of insulin, so the insulin does not work right.  Because of this resistance, the beta cells in the pancreas have to work harder to make more insulin.  The beta cells eventually get worn out and stop making insulin altogether.  Both of these defects in insulin production and/or use cause sugar to build up in the blood stream, which starves the body's cells of energy.  The cells begin to break down body fat for energy, causing weight loss.  When fat is broken down, acids called ketones are made.  These acids build up in the body and lead to ketoacidosis, which can make you feel sick to your stomach and even throw up.  The ketones can give your breath a “fruity” smell.  With so much sugar in the blood stream, some of it spills into the urine and pulls extra water from the body’s cells with it.  This leads to dehydration, and the common signs of diabetes:  increased thirst and urination.

How did I get diabetes?

Nobody knows for sure what causes type 1 diabetes, although there are some theories that may give us an idea.  Genes (not the kind you wear!) play some role in diabetes, but diabetes does not always run in families.  For some unknown reason, the body sees its cells as foreign and starts makeing antibodies against those cells, just like it would a virus.  In diabetes, these antibodies attack and destroy the beta cells, or insulin-making cells, in the pancreas so they are not able to make insulin anymore.  A virus or other environmental factors may cause this to happen.  Nothing you or your parents did caused the diabetes!  The destruction of the beta cells is not reversible, which means the body will need another source of insulin to get energy from food.

Type 2 diabetes is more likely to happen when someone is overweight.  There tends to be a family history of type 2 diabetes.  Being overweight causes the body to be insulin resistant, so it can’t use insulin appropriately.  Starting a healthy lifestyle of diet and exercise is the first treatment for type 2 diabetes.  Weight loss reduces the insulin resistance so the body can use the insulin better.

What is the treatment for diabetes?

Treating diabetes is a balancing act to find the right amount of carbohydrates, exercise and medicine to keep blood sugars at a healthy range.  Healthy eating and exercise are very important in treating both type 1 and type 2 diabetes.  You and the registered dietitian will work together to make a meal plan that fits your life. 

Because the body is not able to make insulin in type 1 diabetes, the treatment is to replace the insulin.  This is done using a variety of insulins, given by injection into the fatty tissue under the skin.  There is usually a long-acting insulin that acts as background insulin to keep blood sugars at a healthy level during the day (see Insulin Action Chart).  In addition to the background, or basal, insulin, there is also a need to give a short or rapid-acting insulin when foods containing carbohydrates are eaten.  We call this a bolus.  Sometimes extra insulin is given when the blood sugar is too high.  There are several insulin regimens and your provider will work with you to decide which plan works best for you and your child.

In type 2 diabetes, there is insulin resistance and sometimes a shortage of insulin.  There are different types of medicine that address both of these problems.  Some children with type 2 diabetes take medicine by mouth to help their body be less insulin resistant, or to help the pancreas work better to make insulin at the right times.  Sometimes, though, it is necessary for type 2 diabetics to be on insulin injections. 



, Paul Smart,