Why is treating diabetes so important?

Many of you are probably well aware that diabetes is a medical condition that causes high blood sugar, but what does this mean, and why is it so important to treat? One of the reasons diabetes is so pervasive is that it can affect every organ system, and it does this in a couple of ways. Let’s first dive into how blood sugar travels in your body. When we eat a meal (composed of some ratio of carbohydrates, proteins and fats), our stomach breaks down our food into small molecules, one of those being glucose (or sugar.) Glucose is a very important nutrient for our organs, and they have special ways of absorbing it. While this can be very complex, the basic idea is that glucose travels through our blood in order to get to our organs, and it does so by hitching a ride on our red blood cells.  You may have heard of an A1c before - this refers to the “Hemoglobin A1c,” or a red blood cell with a protein that hooks onto the glucose to carry it along. When we measure someones’ A1c, we are measuring what percentage of our total red blood cells have a sugar attachment on it. A nondiabetic will have an A1c below 6% - above this, however, places someone in a pre-diabetic range, up to 6.5%, which is then considered diabetic. At that point, the red blood cells are oversaturated with sugar molecules and this can cause quite a few problems. 

One of the biggest problems with diabetes is that, over time, it causes cardiovascular disease. But how does it do this? Well, having high glucose (or sugar) levels in the blood can scratch the delicate inner lining of our blood vessels. Imagine scrubbing a spoonful of sugar between your hands. While it may not be too harmful for the first five minutes, if you continued to do this for a whole day…a whole week…or years…those little, seemingly inconspicuous granules would really wreak havoc on your skin. It would be red, raw, and start to callous and scab in attempts to heal itself. This is in essence what happens to the inside of your blood vessels when exposed to high blood sugar over time. They become raw, and in doing this, they are more susceptible to drawing proteins, cholesterol, and inflammatory molecules to try to “patch” those areas. But, these “patches” accumulate over time, and can narrow the inner blood vessel so much that it creates a blockage. A partial blockage can restrict blood flow to the organ, so that it is not receiving the nutrients it needs to function properly, and it may even result in a complete blockage of blood flow. In the heart, this kind of blockage is called a heart attack, and in the brain, it’s called a stroke. When blood flow is blocked from an organ, it is a race against time to open that blocked passage back up, otherwise, the tissue will quickly die and will not be able to recover. Simultaneously, and probably earlier in the course of diabetes, patients will often first have what’s called microvascular (or small blood vessel) damage, as these vessels have a smaller lumen and can thus develop blockages more quickly. Blockages in these small vessels, such as in the fingers/toes, the eyes, and the kidneys, can result in damage in eyesight, sensation, and urination. So while it may not seem obvious, diabetes very much so causes cardiovascular damage, just as high blood pressure or high cholesterol does. 

There are many lifestyle modifications and medications out there to try to lower blood sugar, and in turn minimize the damage that high blood sugar can cause on the blood vessels and multiple organ systems. The medications out there work in many different ways, and some are more effective than others. This would be a tailored discussion to have with your doctor so that you could find the right treatment plan for you (or your loved one) and for the betterment of their health.