Diabetes Mellitus: Causes and Treatments

Dr. Christopher McGowan
June 16, 2022

According to the CDC (Centers for Disease Control and Prevention), the prevalence of obesity in the United States has increased from 30.5% to 41.9% in the last 20 years. Moreover, the number of people classified as severely obese (BMI greater than 40) doubled during the same time period. Unfortunately this trend has also meant an increase in numerous medical conditions that have strong associations with obesity like cardiovascular disease and certain types of cancer. One of the most common of these conditions is diabetes. 

Facts About Metabolism   

One of the most important facts to understand about diabetes (technically diabetes mellitus) is that it is a chronic disease related to metabolism, the process by which the body converts food into energy. Every time you eat, food is gradually broken down by the gastrointestinal system into individual molecules that can be used by cells. One of the most important resources derived from food is glucose, a simple sugar molecule that is the main source of energy for cellular function.

Once digested food has reached the small intestine, glucose and other nutrients are absorbed into the bloodstream where they can be carried all around the body. When glucose is detected in the bloodstream, the pancreas is signaled to release the hormone called insulin. When insulin is in the bloodstream, it essentially unlocks the ability of cells to absorb some of the glucose for their energy needs. Once glucose levels return to their normal, pre-meal state, insulin stops being produced. 

What is Diabetes?  

When someone has diabetes, their body either doesn’t produce enough insulin or the insulin that is produced is no longer as effective. This means that glucose from food just stays in the bloodstream without being absorbed and used by cells. Over time, this excess glucose in the blood (also known as blood sugar) can begin to damage blood vessels and create a number of serious new health problems; indeed, diabetes has been linked to higher risk of heart disease, stroke, kidney disease, vision loss, and a variety of other negative health outcomes. 

In the United States, there are an estimated 96 million adults who are considered prediabetic; what’s more, most of them don’t even know it. Someone with prediabetes has elevated blood sugar (hyperglycemia) levels but insulin is still somewhat effective; however, it’s also usually an indicator that diabetes is on the horizon if no action is taken. If eventually diagnosed, it can be any of three possible types of diabetes: 

  • Type 1: Type 1 diabetes mellitus is somewhat rare and accounts for only around 5-10% of cases. This type is thought to be caused by a problem with the immune system and involves an autoimmune attack on insulin production in the pancreatic islets. Not much is currently known about how type 1 diabetes develops, but it may be largely passed on genetically. It is mostly diagnosed early in life among children and adolescents.  
  • Type 2: With around 95% of cases, type 2 diabetes mellitus is the most common. Type 2 diabetes develops over many years and is most closely associated with certain lifestyle and dietary choices. While there is no cure for this type, it can be prevented through lifestyle changes. 
  • Gestational: Gestational diabetes is fairly rare and only develops in pregnant women during their second or third trimester. For some women, insulin secretion and responsiveness decrease during this time and stay low until after birth. Even though it is temporary, it can still potentially cause damage to the blood vessels and even lead to type 2 diabetes in some cases.  

Because all types of diabetes involve high blood sugar levels, there is an ongoing increased risk of long-term damage to organs and blood vessels. The kidneys in particular are likely to experience dysfunction as they struggle to filter the glucose-rich blood. This can lead to chronic kidney disease (nephropathy) or kidney failure. Additional complications of diabetes can include diabetic retinopathy, diabetic ketoacidosis, or neuropathy. 

What Causes Diabetes?      

As noted above, the basic underlying cause of diabetes is a problem with insulin in the bloodstream. In type 1 and gestational diabetes, the problem arises for reasons that are typically out of the person’s control. While the precise cause of type 2 diabetes is not fully understood, decades of research has shown a strong correlation with a number of risk factors: 

  • already have prediabetes
  • overweight or obese (BMI greater than 30)
  • being 45 or older 
  • physically active fewer than three times per week 
  • previously had gestational diabetes
  • non-alcoholic fatty liver disease
  • have a family history of diabetes
  • high blood pressure (hypertension)
  • low HDL cholesterol 
  • high triglycerides 

The case for the connection between obesity and diabetes is particularly strong: around 80% of people with type 2 diabetes are also obese or overweight. The basic mechanism of this is thought to be insulin resistance, a condition where cells gradually stop responding to insulin. It is thought that one of the biggest risk factors for insulin resistance is a typical American diet that is high in simple carbohydrates (sugars, processed white grains). Because blood sugar levels stay so high over a long period of time, cells gradually grow immune to the effects of insulin.   

Diagnosis and Treatment

Diabetes often goes undiagnosed for a long time because so many people are unaware they have it. In fact, according to the American Diabetes Association, 8.5 million out of 37.3 million total adults have diabetes but are undiagnosed. It is usually only discovered after manifestation of symptoms like increased thirst, hunger, urination, fatigue, and blood glucose level. Doctors may use a glycated hemoglobin or oral glucose tolerance test to confirm a diagnosis of diabetes.

Since there is unfortunately no real cure, the treatment of diabetes mostly becomes the management of diabetes. This most commonly involves daily insulin injections as well as using a continuous glucose monitoring device. Doctors also often prescribe medication like metformin that lowers glucose production in the liver and increases insulin sensitivity. Living with diabetes also means embracing a low glycemic level diet and getting sufficient physical activity; body weight loss through a caloric deficit is also helpful.    

True You Weight Loss Solutions 

The unfortunate truth is that over 100 million Americans either already have diabetes or are prediabetic. Research has shown that genetics do play a role in whether or not you’re at a high risk for diabetes, but it can also be prevented in almost all cases by making some lifestyle changes. These same kinds of changes can also potentially lead to weight loss, but those traditional methods tend not to work for people over the long run. 

At True You Weight Loss, we understand the emotional, biological, and societal components of trying to lose weight. Diet and exercise are important for long-term health, but they aren’t a reliable means of reducing body weight enough to have a positive, lasting impact on health. At True You, we provide non-surgical weight loss procedures that are reliably successful at helping people lose weight and keep it off. If you’d like to learn more about endoscopic weight loss, please contact us to request a consultation

Dr. Christopher McGowan
Dr. Christopher McGowan

Dr. Christopher McGowan, MD, a leader in endobariatrics, specializes in non-surgical obesity treatments and is triple-board-certified in Internal Medicine, Gastroenterology, and Obesity Medicine. Renowned for pioneering endoscopic sleeve gastroplasty (ESG) with over 2,000 procedures, his global influence and research contributions define him as a top expert.

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