Jan 1st, 2020

The word Diabetes comes from a Greek word Diabeinein, which means to walk or stand with legs wide apart. Another literal meaning is passing through; it was originally so named in Greek because one of the symptoms of the disease is an excessive discharge of urine. The word Mellitus comes from the Latin Mellifluous, which means flow as sweet as honey.

Diabetes has been known to mankind since antiquity. Aretaeus the Cappadocian  (AD 170) described the mysterious affection ...being a melting down of flesh and limbs into urine.. life is short, disgusting and painful, thirst unquenchable, death inevitable.

A lot has changed since then.

The last two decades have seen the twin epidemics of obesity and diabetes, lead the way toward ill health in the United States.

The Belgium astronomer Quetelet observed in 1869 that among adults of normal body builds, weight was proportional to the square of height in meters. This useful index is called Quetelet`s index (QI), subsequently given the term body mass index or BMI.

A BMI above 25 is considered overweight and above 30 is considered obese. By these standards today, an estimated 60-70% of the US population is overweight, 30% is obese and 6% is morbidly obese or weighs at least 100 pounds above his or her ideal body weight.

An obese person has a larger energy store in the form of adipose tissue (fat) than a normal person. A person who is 15 kg overweight has 100,000 kcal more energy stored than a person of normal weight. An obese person with an extra 55 kg of adipose tissue has a half a million kcal in store. Fortunately, this person also has a higher daily basal energy requirement, approximately 12 kcal and 15 kcal more for a woman and a man respectively.

The predominant type of Diabetes today is due to obesity and insulin resistance. Insulin deficiency happens late, when the pancreas cannot keep up with insulin production. This together with increased hepatic glucose production causes diabetes. This type of Diabetes is commonly referred to as type 2, as opposed to type 1, in which the pancreas has lost all capacity to produce insulin.

Insulin insensitivity/resistance is also the key abnormality in Syndrome X described by Gerald M. Reaven in 1988, also known as Reaven`s syndrome or as referred to today as "the metabolic syndrome". The latter includes "abdominal obesity, hypertension, atherogenic dyslipidemia dysglycemia" and probably obesity-associated cancers.1,2

Another peculiar entity, associated with the metabolic syndrome and becoming more frequently recognized today is nonalcoholic fatty liver disease. This is now the most common cause of liver disease in the United States, and by some estimates affects 25% of the US population. The most severe form of this disease is called nonalcoholic steatohepatitis which has a prevalence of approximately 5-6%. Cirrhosis develops in 9-25% of patients with nonalcoholic steatohepatitis. Once it develops, 30-50% of these patients die from a liver-related cause during a 10 year period.  This mortality rate is similar to or worse than that for cirrhosis associated with hepatitis C.3

Coming back to diabetes, a common misconception is that all Diabetes is irreversible. In the case of type 1, this is certainly true, except for those rare instances of spontaneous remission or after pancreatic transplant. But type 2 diabetes, for the most part, is a lifestyle issue, albeit not without consequence. Remission is achieved in a significant number of those undergoing Bariatric surgery or those managing to lose weight through diet and exercise. Drugs are an important part of treatment, but lifestyle even more so!

For example, a weight loss of 5 kg halves the risk of developing type 2 diabetes. A weight loss of 5-10% in those with type 2 diabetes improves glycemic control, sometimes allowing reduction or withdrawal of medication.5

Today Diabetes is the leading cause of blindness in people 20-74 years of age in addition to being a leading cause of end-stage renal disease.

60% of diabetic patients are affected by neuropathies. Accelerated lower extremity arterial disease plus neuropathy makes diabetes account for 50% of all nontraumatic amputations in the United States. The risk of cardiovascular complications is 2-6 fold greater and the overall life expectancy is about 7-10 years shorter.6
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It is estimated that by the year 2050, as many as 1 in 3 American adults will have diabetes unless we take steps to prevent it.7

And as for liver disease; nonalcoholic steatohepatitis will most likely be the top reason for liver transplantation in the US by 2020.8

Living in Denial is therefore no longer a viable option!