Two hundred years ago, a myriad of diseases were known by a single term: fever. We still use the word as a part of some disease names today – yellow fever, scarlet fever – but more often today the word “fever” is used to describe a symptom: body temperature above the narrow range that is normal for a human being. We have inoculations and other measures to prevent or cure many of the diseases once grouped as “fever,” and if those diseases had not been separated, this could never have happened.
Diabetes melltus, as defined today, is an elevation of blood sugar – more accurately, of blood glucose. Like body temperature, the human body needs a particular amount of sugar in the blood. Too much, and there are all kinds of long-term consequences to blood vessels and all that depend on them – kidneys, wound healing, eyes, the nervous system …. Too little and the brain, which more than any other organ requires glucose as a fuel, shuts down. (I’ve used this as a basis for esper shock in Homecoming and Tourist Trap.)
The body of a healthy person has a number of feedback mechanisms to keep both body temperature and blood glucose within the ranges necessary for life. Blood glucose feeds the cells of the body, but the use of blood glucose by the cells requires a hormone, insulin. If the blood glucose goes too high, the islets of Langerhans in the pancreas pump out more insulin. This allows the cells either to use the glucose for themselves, to store it short-term in muscles and liver, or to store it long-term as fat. If the blood glucose goes too low, glucose is released from the liver or used as fuel by the muscles which have stored it.
When these mechanisms go awry, the result is diabetes. But there are many ways they can go awry. You can treat a fever with aspirin, cold cloths, or ice, but to prevent or cure the fever, you need to know what is causing it. And there are many ways the regulation of blood sugar can go awry.
When I was first diagnosed with diabetes, 42 years ago, there were assumed to be two types of diabetes: juvenile and adult. On age, I fell in the crack. Juvenile diabetes required insulin, which must be injected into the body, and one simply does not get over this type of diabetes. Adult diabetes could often be treated with oral medications or even with diet. Since I did not respond to medication, I was assumed to have juvenile diabetes.
Today we have type 1 (defined as autoimmune destruction of the ability to produce insulin) type 2 (often considered due to overweight and lack of exercise, but there is evidence that fairly thin people can present with type 2) LADA, gestational diabetes (which may disappear immediately after the baby is born but may go on to develop into type 1 or type 2) and even a type that looks like type 1 but clears itself up. Not to mention the fact that the islets of Langerhans can be destroyed or damaged by things other than autoimmunity, such as chemicals or actual removal of or injury to the pancreas.
Why can’t we accept that diabetes is not in itself a disease, any more than fever is, but a symptom of a large number of diseases?
It is true that there are two major intermediate causes of diabetes, which may occur together or separately.
The more common cause, often associated with a modern sedentary lifestyle, is insulin resistance. There is plenty of insulin available, but the cells seem unable to use it to metabolize sugar. In fact, the body may overproduce insulin in an effort to make up for the insulin resistance, ultimately leading to the death of the insulin-producing cells and the need for insulin therapy. But this is an intermediate cause. The chances are that there are several underlying disease states that produce insulin resistance, some of which may be hereditary, dietary, lifestyle or chemicals. But we’re not likely to find them unless we quit lumping all insulin resistance as type 2 diabetes.
The rarer intermediate cause is an inability to produce insulin. If this inability is due to an autoimmune attack on the islets of Langerhans, the result is type 1 diabetes. That of course leaves the cases of insulin-dependent diabetes due to actual injury or destruction of the pancreas by other than autoimmunity, or the inability of the islets to produce insulin for reasons other than their destruction, out of the definition, though as far as treatment goes, they are type 1. Even the autoimmune destruction may have many triggers. Things as far apart as viruses and cows’ milk have been suggested.
Treatment is insulin – first obtained from beef and/or pork pancreases, but now biologically (bacterially) produced using the chemical structure of human insulin. Some insulins further modify this structure to give faster or slower action. Because insulin is a protein which would be destroyed by the digestive system, it must be given under the skin using a hypodermic, an insulin pen or an insulin pump. Without insulin, death can occur within days.
I’ll probably visit this subject again – it’s a favorite rant of mine. Meanwhile, the symptom of diabetes is increasing in frequency worldwide. Why? And which underlying diseases are actually increasing?
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Hi Sue Ann,
Nice blog on disease vs. symptom.
I fully agree that diabetes describes a common set of symptoms rather than a specific disease. For this reason I always say that we will not enter the “Pearly Gates” of the so called cure together. There will never be a headline that honestly can say “Diabetes Cured”! An honest headline would only be able to say that a form of diabetes has been cured, and currently even that is a pipe dream.
The comparison of diabetes to fever was a good one. Over the last 6 months, another one that I am currently personally fighting is what is called GERD. Conventional medicine would have you believe that this also is a disease. Functional medicine says that it is actually a symptom. Classifying GERD as a disease as opposed to a symptom has elevated drugs like Nexium and Prilosec to best selling status and billion dollar markets.
While some of us like to beat up on Big Pharma, the problem also lies with a gullible public which is all too willing to accept symptom relief via pill as miraculous, even though it is still far from a cure. Another way to put it is many of us have bought into the conventional medicine argument that degenerative disease is a natural part of the aging process, so symptom relief is the best a person can hope for. Epidemiological studies show that some ailments are far more common in industrialized nations (diseases of civilization) and almost non-existent in simpler cultures, despite these cultures violating many of the principles of “good health” as dictated by our health care system.
One of the criticisms of our health care system is that it is composed of a bunch of specialists with blinders on, but the public also has to bear some culpability. It is just as narrow minded when a person contests a post such as one on digestion, as being inappropriate on a diabetes or insulin pumping site. It is easier for many people to understand that the blue smoke coming out of the tail pipe of their car is not an exhaust problem, but an engine problem. It is also easier to understand that the reason a person can not print a page at home may be because of a software driver on their computer, not the printer. However, many struggle to understand how topics like digestion and GERD affect diabetic control and only seek symptom relief. Cars and home computers are integrated networks, but healthcare is viewed differently.
Functional medicine takes the approach that many symptoms and actual disease, begin in the digestive tract. Just as car will eventually break down if you do not change the oil and give it the gas and other fluids it needs to run, the body will present various symptoms and actual disease if it is not properly nourished (not to say that all disease can be conquered with nutrition). If you look at the list of best selling and prescribed drugs (http://www.webmd.com/news/20110420/the-10-most-prescribed-drugs), most are only treating symptoms and most patients are resigned to the fact of taking them for the rest of their lives. Some of the conditions on the list can be addressed functionally, but in our healthcare system, it is easier for conventional medicine to classify the condition as a disease, but only address the symptoms pharmaceutically. Billion dollar markets are created because the public loves a pill that can clear symptoms in a week or two, though the actual ailment persists.
With my GERD, I have chosen to treat it as a symptom and not a disease. I believe the doctors that say that there is nothing wrong with the stomach producing acid, as it is supposed to do. The problem is that some of the acid is getting into the esophagus, creating heartburn. Conventional medicine says that the “excess” acid must be neutralized or inhibited from forming via antacids or PPIs, which gives short term symptom relief, but also blunts the digestion process. As mentioned before, we know that interfering with the digestive process is not a good thing for the long term health of the individual. I have read of patients who say they start off with OTC antacids, but because the treatment is in conflict with how their body wants to work and the problem only gets worse, they eventually have to move up to prescription strength medications. Some continue to suffer some degree of heartburn, despite the prescriptions. In severe cases of GERD, the surgical intervention is called Nissen fundoplication, where they tie the upper part of your stomach around your esophagus, which sounds barbaric to me.
Functional medicine tries to find the root cause of the acid causing the heartburn, shut it down and hopefully affect a true cure that does not require a lifetime of treatment. Hiatal hernia and H.Pylori infection are 2 possible root causes of GERD. I am treating the symptoms with probiotics and digestive enzymes. I chew the probiotics to coat the esophagus and swallow the enzymes before most major meals. The probiotics “remodel” the gut flora and the enzymes allow the digestive system to not work as hard during digestion. I am also using mastic gum, ACV and New Chapter Broccolive to treat any H.Pylori I may have. I have been on the treatment for almost 3 weeks, Results thus far are that I can now eat what I like, without suffering any heartburn. I continue to suffer exercise induced heart burn, although it is much milder than before I started the treatment. Non-pharmaceutical treatments work much slower than pharmaceuticals, so I have been encouraged by others to not give up too soon. I have also noticed an approximate 10 unit drop in my insulin TDD, which I attribute to an improvement in my digestion (for those who ask what does digestion have to do with diabetic control). I also had a visceral manipulation session, which gave me partial temporary relief if the root cause is due to a hiatal hernia.
I am hoping to work with my body, instead of being in conflict with it. To get there, I had to consider what is a true disease and what is merely a symptom.
I agree totally. There are three ways to approach a health problem: prevent it (generally vaccines, public health, lifestyle) cure it, or treat the symptoms. Of the three, treating the symptoms is the most profitable (the sufferer is hooked for life), so given our privatization of research, that’s what gets most of the money and attention.