If you go back 50 years, diabetes was a rare phenomenon! Most of the diabetes cases were represented by type 1 diabetes vis-a-vis type 2 diabetes. If you would observe 9.3% of India population & 6.8% of global population (462 million individuals) is suffering from type2 diabetes.
In the 1950-60’s not many people knew about type 2 diabetes. Historically, it was known as sugar disease, consistent across different regions of the world. It was named after high levels of sugar in a person’s urine & hence the name diabetes mellitus. For most people, diabetes was death in the making. Earlier treatments consisted of starving or feeding solutions. It was in late 1800’s, that doctors found out the role of Pancreas in onset & progression of diabetes.
How does sugar find its way in someone’s urine? It has a lot to do with our Pancreas. When we consume food, it goes through our digestive tract to be converted into simple forms of sugar, fats & protein. Once complete, our body pumps these nutrients through our bloodstream to reach various tissues for energy production. The carbohydrates we consume make up most of the glucose circulating through our bloodstream. So once that bread is completely digested and floods your system to pump out energy, it is the responsibility of your pancreas to secrete insulin, a special hormone whose role is to communicate to your cells it’s time to let the glucose in.
Pancreas have more functions. Most of us think of Pancreatic Juices- an important step to break down nutrients during the digestion process. But Pancreas have a very important role- it controls two opposing functions to bring glucose homeostasis. This section consist of different cells including alpha & beta cells.
Beta cells of Pancreas secretes insulin to tell you cells that it is time to absorb energy. On the other hand, alpha cells release glucagon, a hormone used to tell your liver to release stored glucose into the blood because your body needs it (in specific cases of fasting). These two hormones work together to stabilize & regulate our blood sugar level.
For individuals suffering from type 1 diabetes, their Pancreas do not have beta cells to secrete insulin. This can occur due to numerous factors including health of pregnant mother (in case child has type-1 diabetes) & leaky gut which makes microbes move from gut to Pancreas & kill beta cells). Without Beta cells, there is communication with cells & glucose does not get absorbed. This makes glucose circulate in the blood for a longer period of time causing hyperglycemia, which can have some pretty severe consequences like weight loss, heightened risk of infection & excessive thirst. Eventually, it’s left to the kidneys to remove excess glucose molecules from our blood to be excreted with our urine.
Without access to all this energy, our cells start starving & resort to other nutrients for energy. In today’s world, we manage this through high fatty & high protein diet.
People suffering from type 1 diabetes typically report to external administration of insulin to meet their insulin needs. Around 95% of people suffer from type 2 diabetes due to insulin resistance. Their pancreas most likely contains healthy beta cells properly secreting insulin, but for some odd reason, the message seems to get lost in translation (we will discuss this in the following paragraphs). The surrounding cells don’t connect well with the messenger-hormone insulin, resulting in similarly high levels of blood glucose. Those people who experience metabolic disorders such as obesity have issues such as chronic inflammation( due to gut dysbiosis) & high circulatory level of triglycerides( high fat foods) which impacts cell-insulin communication.
Scientists have discovered a close knit relationship between obesity & gut microbiome since our gut microbiome drives our digestive functions & regulates most of the hormones.
Changes in gut microbiome composition can have cascading impact throughout our bodies. Studies have shown that our gut microbiome can drive our metabolism, impact our hormone levels, interact with our brain & immune system & can directly drive inflammation. These microbes living in our gut perform various activities that impact our mood & immune system & help us fight illness. Recent studies & clinical trials have unmasked the relationship between imbalance in gut microbiome (gut dysbiosis) & type 2 diabetes. There are certain bacteria populations that can regulate our blood glucose & influence our glycemic response to different foods. When gut dysbiosis negatively impacts these microbial populations, it can disrupt normal signals & lead to insulin resistance.
This gut dysbiosis also results in leaky gut which makes your gut lining compromised & creates pores in your gut lining. These microbes then pass through these pores into the bloodstream, thereby causing pro-inflammatory reactions. When the gut microbiome is balanced & these microbes are contained in the gut, they help in digesting the food & strengthens the gut lining. However, when the gut lining is compromised, even beneficial microbial population can rent out real estate where they do not belong- Pancreas & kill beta cells, thereby causing type 1 diabetes.
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