Colonel Mustard and the Fundamental Difference Between Types I & II

 Comparison is often a dangerous thing.  On the one hand, it somehow makes us feel as though we are better than the subject.  On the other hand, we feel the urge to imitate the subject, or "keep up with the Jones", as the saying goes.

Diabetics do this all the time.  We see another diabetic eating cake and we cannot even begin to understand how they could do such a thing, especially after that huge meal!.....And then we secretly wish we would have saved room for cake as well.

Nine times out of ten, there are explanations for the way we behave.  And so it goes with treating diabetes.  So before we accuse Colonel Mustard of being in the kitchen with the knife, let's look at the fundamentals of diabetes.  This will help us to understand why us diabetics and our lifestyles consist of such a motley crew.   

The Pancreas - what is it, and what does it do?
Nestled behind the stomach, tucked under intestines, and just below the gallbladder lies a gland called the pancreas.  It's primary job is to secrete hormones that aid in digestion.  The mac-daddy of those hormones is insulin, which pushes glucose from the bloodstream into the body's cells for energy.

Diabetes Mellitus is hyperglycemia, or elevated blood glucose.  Essentially, there is some phenomenon that is causing the glucose in the bloodstream to remain there, and not be taken up by the body's cells.

Type I DM - immune dysfunction.
For a type I diabetic, the physiological function that has gone awry is the immune system.  It mistakenly identifies insulin-producing pancreatic tissue as alien, and then does what it's supposed to do.....attack the foreign bodies.  Quite rapidly, the pancreas goes from functioning perfectly, to never producing insulin again.  As you might imagine, the only treatment is subcutaneous insulin, which the patient must use to try to mimic the secretions of the once-robust-pancreas.     

Type II DM - metabolic dysfunction.
The pathophysiology of type II is generally more complicated.  Ultimately, there is a problem with the actual metabolism of glucose.  It typically boils down to the patient either being resistant to the action of insulin, or having decreased insulin output from the pancreas.  Because there is still likely substantial pancreatic function, subcutaneous insulin is merely one of several treatment options.  Depending on the circumstances, one may even treat type II with lifestyle changes only (no medications).  

I hope this quick overview sheds some light on this pandemic, yet grossly misunderstood, disease.  With this knowledge, let us not compare, and cast down; but share, and build up.  And then, let's be less than seven, greater than low!