Once considered as divine nectar to all the mere humans, for sure its heavenly toothsome flavor makes you forget all the problems for a brief moment. Back then our kid selves always were on a sugar rush – mouths sticky from the constant consumption of treacly candies for hours on end. Little did we know about the devil behind its seductive mask. 

Given the innuendo, “psychopath of foods”, sugar and other sweetened food have got quite a name for causing diseases within people. Diabetes is one such infamous condition that is most abundant today, one of four priority non-communicable diseases. But does sugar trigger this problem as the popular belief, or is it just a typical myth? And what honestly is Diabetes? On this World Diabetes Day, we are on a mission to deep dive to explore some unpopular facts about the said sickness. 

What is Diabetes?

A grave chronic condition characterized by elevated blood sugar levels (BGL), diabetes has become a crucial public health problem in the world now. This is caused when the blood sugar is not regulated correctly by Insulin, one of the body’s main anabolic hormones. Insulin is secreted by the β cells of the pancreas to regulate the metabolism of glucose in our blood. Carbohydrates, specifically glucose are the key energy source in living organisms. When the pancreas does not produce sufficient insulin or when our body cells cannot utilize insulin effectively as needed this disease occurs. This interferes and alters the homeostasis in the body; causes homeostatic disruption.

Insulin-glucagon homeostatic mechanism under normal blood sugar levels.
Figure 01: Insulin-glucagon homeostatic mechanism under normal BG levels.

Now abbreviated only as ‘Diabetes’, since ancient times it was previously known as Diabetes Mellitus, the ‘pissing evil’ because of the sweetness of their urine. As of 2019, it is mentioned that an estimated populace of 463 million adults (20-79 years) was living with diabetes, and by 2045 it is approximated the numbers will rise to 700 million.

Types of Diabetes

There are three major types of this condition.

1. Type 1 Diabetes

In type 1 diabetic patients, insulin hormone production is insufficient. Although this type can occur at any age, generally its diagnosis of children and young adults is abundant. Hence, this was formerly also known as, insulin-dependent, juvenile, or childhood-onset diabetes.  People with type 1 diabetes, are required daily dosage of insulin to maintain BGL; if not they cannot survive. It is said that by an autoimmune reaction of our immune systems, the β cells in the pancreas have been destroyed. Thus insulin won’t be produced in adequate amounts. Unfortunately, this type is unpreventable.

2. Type 2 Diabetes

This is the most widespread type of diabetes found, around the world.  In type 2 diabetic patients even though insulin hormone is produced, as usual, it’s not capable of functioning properly and effectively, resulting in excessive levels of blood glucose. Insulin resistance is an important feature in type 2 diabetes. This condition is vastly detected among adults, but lately, it has caught on to children communities also. Therefore, this was earlier dubbed as non-insulin-dependent or adult-onset diabetes.

Over the few decades, type 2 diabetes has shown steady growth on a global scale. Though there is no permanent cure for this type, with necessary medications and proper lifestyle choices it can be managed. And also it could be largely preventable. Issues regarding intermediate conditions could lead to Impaired Fasting Glycaemia (IFG).

Insulin resistance against blood sugar in type 2 diabetes.
Figure 02: Insulin resistance in type 2 diabetes.

Both the above diabetic types demonstrate similar symptoms, but type 2 is prone to go unnoticed for several years, which may lead to severe complications later.

3. Gestational Diabetes (GDM)

This is a temporary condition that arises in some women during their pregnancy. Often after the delivery, this diabetic type fades away, but GDM sustains a long-term risk of type 2 diabetes; sometimes diabetes diagnosed during the pregnancy period is, in fact, the type 2 condition. This may increase the risk of complications during the labor which could endanger both the lives of mother and infant. 

Risk Factors and How Sugar Play a Role in Diabetes

Depending on each category of the disease, the risk factors and causes may vary. 

Type 1:

As said above, type 1 diabetes occurs when the function of immediate ruinous autoimmune reactions. For various reasons such as viral infections, vaccines, low levels of vitamins, and several genetic grounds the mentioned autoimmune reactions could be triggered; but the direct, exact reason is still unspecified.

Type 2:

Type 2 diabetes is caused by an extensive scale of risk factors; most of them are rooted in the coaction of myriads of genetic, metabolic, and biochemical reasons. Family heredity history of having diabetes, age, ethnic background, prior gestational diabetes records and obesity, unhealthy diet, lack of physical exercise, and smoking are the distinct risk factors that elevate the risk of diabetes.

It is such a wonder how with time conventional wisdom that ‘if you consume a lot of sugar, you will become a diabetic’. But does it? When food is plenty, do people become diabetic patients just by eating them? Considering all these hearsays, nowadays young mothers do not allow their kids to eat sugar or sweetened foods. 

Well, nothing to panic, it has been revealed by certain studies that consumption of sugar does not have vast and direct aftermath on diabetes. Nor the sweetened, honey tasted food. But that doesn’t specifically say sugar is completely guilt-free. Sugars are sucrose- disaccharides which when digested, will be converted into glucose and fructose. When our blood sugar levels are elevated, they are converted into excess fat and stored in our body alongside the preexisting stored fat storage.

Excess fat limits are the main reason for obesity and overweight conditions. To cause type 2, these two are considered as leading reasons. Especially, together with fats, a high intake of free sugars, sweetened food, and beverages increase the possibility of having diabetes in a later stage. Also, regardless of the amount of sugar people take, based on the unique nature and the insulin production of their bodies also the blood glucose levels change. So we cannot say sugar is the pivotal cause for diabetes as the common opinion in society; sugar is more like a sideline factor in this process.

Various symptoms of Diabetes (mostly type 1 and 2).
Figure 03: Various symptoms of Diabetes (mostly type 1 and 2).

However, too much of anything is not good. Quitting consuming tons of sugar concentrations has its benefits.

Gestational diabetes:

Pregnancy during old age, being overweight, gaining extra weight during the said period, and family history of having GDM cause this diabetic type. Generally, occurring diabetes during the pregnancy of a woman can cause, escalation of the possibility of the infant having type 2 diabetes.  

Complications and Impacts of Diabetes

Although it seldom seems lethal, actually, without proper medication and regulation, the condition may worsen and could threaten life. If complications are developed at a critical level, they may contribute to high mortality rates.  Also, it could lead to poor quality of life.

  • Exceptionally high blood glucose levels may bring on conditions like ketoacidosis in both types 1 and 2 and hyperosmolar coma in type 2 which are deadly.
  • Abnormally low blood glucose levels will arise due to dieting and starvation, over-exercising, or overdosages of prescriptions. These may result in seizures and sudden blackouts.

When GDM is kept unchecked in pregnant women, it can have a fatal effect on both the mother and the infant. Stillbirth, fetal loss, obstetric complications, perinatal death, and maternal morbidity and mortality are some of the potential aftermaths of the said diabetic condition. 

Over time, high blood glucose levels can damage various body organs, i.e. kidneys, hearts, eyes, nerves, and blood vessels, and also increase the risk of cardiac arrests. It is said that diabetes is the main cause of kidney failures in humans. Furthermore, such abrupt damages to organs may bring about reductions in blood flows in the system. Neuropathy is one such condition caused by diabetes; it heightens the risk of many infections and foot ulcers, and potential limb amputations even. Severe degrees of diabetes can lead to blindness as well. This is known as diabetic retinopathy and by prolonged damage to blood vessels in eye retinas, this adversity emerges.

Neuropathic leg of a diabetic patient.
Figure 04: Neuropathic leg of a diabetic patient.

With the prevailing Covid-19 virus, patients with diabetes are at higher risk.  Since this is a chronic disease, experts in the fields have stated that the risk of infection from COVID among those with diabetes is two to three folds higher regardless of other health problems.

According to the 2019 IDF global statistical report, 1 in 5 elder people who are above 65 have a diabetic diagnosis. Also, diabetes causes around 4 million deaths. Apart from that, this disease has affected the global economy as well. Soaring levels of diabetes across the world means, the burden it exerts on the economy is colossal.  This strain in the economy can cost people as direct medical expenses for medications and indirect costs surrounding the productivity loss. Particularly low and middle-income countries have faced drastic consequences on their economy rather than the highly developed nations. Besides all these things, diabetes plays an indispensable role in causing premature deaths and disabilities- which will alter the future generations of this world. 

Number of adult diabetic patients all over the world (2021).
Figure 05: Number of adult diabetic patients all over the world (2021).

World Diabetes Day

Throughout the years, countless actions have been taken and a number of suggestions have been presented by the World Health Organization and many untold corporations to halt and bring down this monster in disguise. Nonetheless of all these barren attempts, diabetes has shown progressive growth over the past few decades. World diabetes day is such a collaborative initiative taken by the World Health Organization (WHO) and International Diabetes Foundation (IDF) as a measure against the fleeting diabetic spread all over the globe. Found in 1991, this is mainly led by the IDF and as of now, this day is commemorated by more than 160 countries.

This day is the key global diabetes awareness campaign and every year on November 14th it’s celebrated. Each World Diabetes day is reserved for fixating on a different theme related to this disease. The theme for the World Diabetes Day 2021-22 is access to diabetes care. As this year marks the centenary milestone of the discovery of insulin, it is more than the responsibility of all the frontline workers of the health industry to find out a worthwhile way of treating the whole population of 463 million diabetic patients in the world.

World Diabetes day logo.
Figure 06: World Diabetes Day logo.

Food is something that we, the entire entity of living organisms depend on. Without a doubt, we all humans have a weak spot when it comes to sweets. No need for sugarcoating that fact. Surely sugar glucose, carbohydrates are our energy source. Therefore cutting off all the ways of sugar intake is not the ideal method. Believing fiction rather than facts will lead you down to unknown frail paths.

Sugar is vital for our survival and day-to-day tasking. Diabetes is a condition caused by countless rationalities. If you take high amounts of sugar, it doesn’t necessarily say that you will be diagnosed with diabetes later. But it may lead to various severe consequences depending on your body type. Too much of anything is bad. Nevertheless, sugars are vital for the body even in fewer amounts. It is in your hands, how you should manage your diet and prevent this incurable problem from happening to you.

Written By:

Nishakya Amandi Liyanarachchi,
2nd Year Undergraduate,
Biological Science Stream,
Faculty of Science,
University of Colombo.

References:
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