According to the latest statistics from Health Canada, almost 3 million people in Canada are now living with diabetes.
Further, data obtained from blood samples and other clinical interventions would suggest that there are 600,000 or more Canadians living with the disease who remain undiagnosed.
And there are 200,000 newly diagnosed cases each year.
Not surprisingly, for many in the medical community, diabetes is a major concern.
It is also a concern for some parents on a very personal level. I was chatting with a friend this summer. While talking about her children, she told me that her sons had both been diagnosed with juvenile or Type I diabetes.
What was frustrating her was the attitude of other parents who said things such as "it's because you let them eat white bread" or "not surprising with everything kids are eating these days". One mother insisted that all my friend's boys needed is more exercise.
Most of these people have little understanding of Type I diabetes. Perhaps this is not surprising since most of the cases of diabetes in Canada - some 90% - are Type II (aka Adult onset diabetes) which may be a lifestyle disease.
Type I is definitely not. It is not something that you can catch and not caused by eating too much sugar or being overweight. It is not a consequence of a lack of exercise or too many video games. Type I diabetes is not a disease of our modern culture. It has been found in the historical records extending back thousands of years.
Unfortunately, when explaining Type I diabetes, almost the first words someone will say is "it's an autoimmune disease" which leads to further stigmatization because "autoimmune disease" immediately conjures images of AIDS.
Anyone suffering from an autoimmune disease, of which there are many including some forms of arthritis, knows that they are simply a disease where the body's own defenses destroy a particular set of cells. In the case of Type I diabetes, for reasons that no one is quite sure about, the body progressively destroys the beta cells of the pancreas.
Under normal circumstances, insulin is synthesized by the beta cells of the pancreas. A gene on Chromosome 11 codes for the synthesis of "preproinsulin". This is a long chain of amino acids with extra residues, which is typical of the syntheses of many proteins.
The preproinsulin is released right after synthesis into the rough endoplasmic reticulum where an enzyme cleaves a portion of the N-terminal resulting in proinsulin. This is then transported by vesicles to the Golgi apparatus.
The proinsulin is then converted by the cleavage of a 32 amino acid fragment (called the "C" chain) into insulin and it is stored in maturing granules until needed.
Insulin is released from the granules by the beta cells in response to various stimuli, including glucose, the amino acid arginine, and some sulphonylurea compounds. Bloodstream concentration of glucose is the major determinant with blood glucose levels above 90 mg per litre resulting in release.
But all of this is dependent upon the presence of beta cells in the pancreas. If these are destroyed, as in Type I diabetes, none of this chemistry can occur. The resulting lack of insulin results in dangerously high levels of glucose in the blood stream and the consequent associated problems. It is for this reason that Type I is also known as insulin dependent diabetes.
Glucose is essential for the body's metabolism. In simplistic terms, it is the starting point for the synthesis of ATP which is the body's energy molecule. As such, every cell in the body has a transport mechanism in its membrane that allows glucose to enter the cell and ultimately to find its way to the mitochondria. This pathway is essential for the proper function of the body's cells.
The glucose pathway is controlled by insulin. Insufficient insulin in the blood means that the cells do not pull enough glucose out of the bloodstream. The consequences are two-fold in that glucose levels in the blood increase while the cells are starved for energy.
It is this that makes Type I diabetes such a devastating disease. Indeed, Type I diabetes was a fatal condition prior to the discovery by Bantam, Best, MacLeod, and Collip of a method for extracting insulin in an active form.
All of this is different from Type II diabetes. In this case, the body's mechanism for producing insulin isn't destroyed. Rather, the signaling and uptake mechanism for the entry of glucose into the cells is impaired. Why this happens, no one is yet sure, but it is the subject of much research and it appears that to some extent Type II diabetes can be controlled through changes in lifestyle.
For the children that develop Type I diabetes, though, it is not that easy. Still, with modern medical aid, most diabetics live a long and healthy life.
