Diabetes is a serious metabolic disease in which the body’s blood sugar levels are not correctly controlled. There are two types of this condition, Type 1 and Type 2. Type 1 is also known as juvenile diabetes. It typically appears in childhood, often well before the age of 10. It’s possible for adults to get Type 1 diabetes, too, but this is rather uncommon. Type 1 diabetes appears to have an autoimmune cause. This means that the body attacks and destroys its own cells. In the case of Type 1 diabetes, it’s the cells in the pancreas, in an area called the islets of Langerhans, that are attacked. Once this part of the pancreas is destroyed by the autoimmune attack, it can no longer produce insulin.
Insulin and Diabetes
Insulin is a hormone produced by the pancreas. This hormone acts like an escort for blood sugar, called glucose, to enter the body’s cells. The cells need glucose for energy. Without insulin, glucose cannot get into the cells. It builds up in the bloodstream to unhealthy and even dangerous levels. Insulin allows the glucose to penetrate the membranes of cells by a process called insulin sensitivity. Cells are normally very sensitive to the presence of insulin and allow the glucose easy entry. Once the glucose is in the cells, it’s available to them for energy, and then the glucose in the bloodstream drops and stays within normal limits.
Persistent, excessively high blood glucose levels can damage the heart, kidneys, blood vessels and eyes. Diabetes is a leading cause of heart failure, kidney failure and a type of blindness called diabetic retinopathy. Amputation of a limb is also a common consequence of uncontrolled diabetes.
Type 2 diabetes generally occurs in adulthood, often after the age of 50 to 60. It can run in families, but it can also appear in individuals with no family history of it. Type 2 diabetes also causes blood glucose levels to be too high, but many people with Type 2 diabetes still produce at least some insulin on their own. Type 2 diabetes is often complicated by problems with insulin sensitivity. This means that the body’s cells become more resistant and less sensitive to the presence of insulin. Even though the person’s pancreas may still produce some insulin, their cells don’t respond to it very well. Their blood glucose stays outside of the cells and in the bloodstream, where it can rise unchecked and cause serious problems. Type 2 diabetes is sometimes called sugar diabetes. There is also another condition, called prediabetes, where the body’s blood glucose levels are abnormal, but not yet into the diabetic range. Prediabetes often without symptoms and puts the individual at a high risk for developing full-blown diabetes in the future.
Diabetes is often difficult to treat. The oral and injectable medications used to control it often have unpleasant and sometimes dangerous side effects. There is insulin therapy, but it can be unpredictable. Insulin must be delicately balanced with diet and exercise. Insulin injections can’t do what the pancreas can, that is, release exact amounts of the hormone to keep the blood glucose levels precisely balanced throughout the day and night. Some basic symptoms of Type 2 diabetes include:
- Blurry vision
- Urinating way more often
- Being extremely thirsty all the time
- Frequently feeling famished
A New Diabetes Treatment: a Possible Cure?
Both Type 1 and Type 2 diabetes are treatable but not curable. A new procedure called duodenal mucosal resurfacing, or DMR, may change that. The duodenum is the initial part of the small intestine. It connects the stomach with the next part of the intestine, the jejunum. The duodenum mixes partially digested food from the stomach with bile from the liver and enzymes from the pancreas.
It has long been known that people with Type 2 diabetes who undergo gastric bypass surgery for obesity often show dramatic improvement in their blood glucose levels. After surgery, many patients need half the insulin they once required. Others may no longer need insulin at all. However, gastric bypass is a serious procedure. It’s reserved for people whose obesity is so bad it threatens their lives and who have failed repeatedly to lose weight with more conservative methods. Gastric bypass can result in grave nutritional deficiencies and other problems, such as gallstones, hernias and changes in stomach functions.
This link between the intestines and the improvement of Type 2 diabetes strongly suggests that the gut environment is heavily associated with this disease in some important way. One study reported remission of Type 2 diabetes in gastric bypass surgery patients to be as high as 70 percent during the first four years following the procedure.
Duodenal Mucosal Resurfacing: The Procedure
DMR endeavors to imitate some of the effects of bariatric surgery without involving the side effects and without inducing weight loss and nutritional deficiencies. It’s an outpatient procedure. The surgeon uses an endoscope, which is a tool that can see inside the body through a very small incision. The idea is to ablate, or destroy, the layer of cells underneath the top layer of the lining of the duodenum. Some of these cells are called intraepithelial lymphocyte T-cells. They are linked to the gut’s function of nutrient absorption and possibly to abnormal metabolism of dietary sugars and glucose. As part of this treatment, a natural intestinal hormone called liraglutide is given to promote further recovery from Type 2 diabetes. In one study, about 75 percent of the patients no longer required insulin and continued to have normal blood glucose levels over a following period of six months.
According to the CDC, complications from diabetes kills nearly 80,000 people every year. Countless others are blinded, maimed or required to endure regular kidney dialysis. DMR is a promising treatment for a dreaded disease that may improve quality of life for people today and for generations to come.