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October 9, 2015 / 26 Tishri, 5776
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Diabetes – The Silent Killer

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Metabolic syndrome is the name for an increasingly common cluster of symptoms exhibited together in the same patient which are likely due to common factors. People with metabolic syndrome are at increased risk for coronary artery disease, stroke, and type 2 diabetes. The greatest risk factor for metabolic syndrome is obesity in which most of the extra weight, in the form of fat, is found in the chest and abdomen, giving the body an “apple” shape. It is also commonly associated with the phenomenon of insulin resistance, in which the body is unable to use insulin properly to control blood sugar and fat levels, leading to pre-diabetes. Other risk factors for metabolic syndrome include age, lack of exercise, and genetic factors.

While not yet proven, scientists have a theory about how excess fat, especially in the abdomen, leads to Type 2 diabetes. Dr. Naveed Sattar, professor of metabolic medicine at the University of Glasgow, in Scotland, believes that if too much fat is stored in the abdomen, it can interfere with the way the pancreas produces insulin, and the way that the liver uses it to control blood sugar and fat levels in the body.

Glucose is one of the main fuels for the cells of the body. It is released into the bloodstream by the digestion of the carbohydrates in our food. Insulin is used by the body to help maintain a constant level of glucose in the bloodstream by stimulating the liver and muscle cells to store excess glucose in the form of glycogen. When there is too much glycogen to be conveniently stored, the body turns it into fat which is stored in fat cells.

According to Dr. Sattar, Type 2 diabetes may be the result of the body being unable “to make and store fat safely. Some people can store fat subcutaneously (under the skin). With others, it goes straight to the liver and pancreas. That’s the classic big waist, pot belly shape; the fat isn’t distributed around the body.” According to the theory, at some point that excess fat interferes with the proper functioning of the liver and pancreas.

The classic symptoms of uncontrolled diabetes include increased frequency of urination accompanied by increased thirst, and increased hunger. The symptoms develop more rapidly (over a few weeks or months) in type 1 diabetes while in type 2 diabetes they usually develop much more gradually and may therefore be more difficult to notice.

Another symptom of uncontrolled diabetes is blurred vision, because of changes caused by high blood glucose levels in the shape of the lens of the eye.

Many of the long term complications from diabetes are the result of its accumulated damage to blood vessels throughout the body, including the coronary arteries, the veins in the legs, and the tiny blood vessels found in the retina of the eye and in the kidneys.

How does one get diabetes? Scientists are not sure, but for Type 1, heredity plays only a minor role. Less than 10% of people with Type 1 have a family history of the condition. Scientists believe that even those with a genetic predisposition still must be exposed to an unknown triggering mechanism for the autoimmune reaction which destroys the body’s ability to produce insulin.

Type 2 has a much stronger hereditary component, particularly when both parents have the condition. But even those who have those genetic factors can lower their risk by maintaining a proper weight and exercising regularly.

While there is no cure for Type 1 diabetes, there has been encouraging progress in its treatment. A new generation of miniaturized insulin infusion pumps is being developed which includes a continuous blood glucose monitoring system. Once perfected, the system would be implanted under the skin to function like an artificial pancreas.

There are also ongoing experiments with transplants of pancreatic cells or stem cells to start producing insulin in the body again. But for now, most people with the condition still must rely on daily insulin injections.

However, for people with Type 2 diabetes, there are viable alternatives to lifelong dependence on medications. In a recent study, more than 70% of subjects with Type 2 who underwent bariatric (gastric bypass or lap band) surgery, and who lost more than 30 pounds of body weight, appeared to be free of the condition. Similar benefits can be obtained by following a very low-carbohydrate diet, combined with regular exercise, which is intended not only to eliminate body weight, but also to slash the amount of fat around the liver and pancreas.

According to Dr. Joel Goodman, the head of the Department of Endocrinology and Metabolism at Brookdale University Hospital and Medical Center, in Brooklyn, NY, a low-carb diet is most appropriate for people treating their Type 2 diabetes.

Jews appreciate good food, and perversely, diabetes actually increases the body’s cravings for food, making it more difficult to curb one’s appetite. Yet today, religious Jews with diabetes can, within certain limitations, eat the traditional foods they love on Shabbos, Yom Tov and even Passover without endangering their health. Readily available resources provide diabetes-safe recipes for Jewish delicacies, halachic guidance, support and counseling.

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