So... What is Diabetes Anyways?
When I speak to people with diabetes about the idea of stopping dieting, a lot of the time people feel it isn't for them. People are terrified that if they stop restricting, their blood sugars will get 'out of control.' They think that because they have diabetes, their body is somehow broken. Your body isn't broken though, and you can learn to eat in a way that's sustainable and enjoyable!
First things first: What is Diabetes?
When I speak to people who have been diagnosed with diabetes, often no one has explained what it is or how it works. That's why I want to start here- there's so much misinformation out there! Usually people are just told to 'cut out sugar' or something along those lines and not only is that not the case (you can have sugar if you have diabetes) it is so much more complex than that!
When we eat food, it gets broken down into its smallest part and absorbed into our bloodstream. Sugars and starches (also known as carbohydrates) break down into glucose (sugar), which needs the help of a hormone called insulin to get into our cells, where it can get used for energy.
Think of your cells as being buildings where the doors are all locked- insulin is the key to open those doors and let the sugar in so it can be used for energy by your cells.
It might feel strange to think of sugar as being important for energy since it's so different than the way sugar is usually portrayed but the truth is, sugar is what allows our body to function!
Type 1 Diabetes
In type 1 diabetes, the body is no longer producing insulin because the immune system attacks the cells in the pancreas that produce insulin, called beta cells. That means the sugar can't get into the cells, which is why insulin needs to be injected (either using insulin pens or insulin pumps) as treatment to allow cells access to the energy they need. Before the discovery of insulin in the 1920s, people with type 1 diabetes rarely survived more than a year or two, which highlights how important it is to get that sugar into our cells!
We don't know exactly what causes someone to develop type 1 diabetes but we know there is a genetic component and people with a genetic predisposition to auto-immune diseases like Celiac Disease are at increased risk of developing type 1. It usually develops in childhood, although it can develop later in life.
Type 2 Diabetes
In type 2 diabetes, it starts with something called insulin resistance- basically, the insulin that opens the door to your cells doesn't work as well as it used to. One way to think of this is that some of the locks are a bit sticky and aren't working properly. Even with the same number of keys, since the locks aren't working properly the sugar has a harder time getting into the cell.
In an effort to get sugar out of the bloodstream and into the cells, the body starts producing more and more insulin in order to get cells the energy they need. Eventually some of the cells that produce insulin essentially get tired and stop producing insulin. That means that along with the insulin not working as well, there also isn't enough of it.
Not enough keys and the locks being sticky means blood sugar levels rise and not enough glucose gets into the cell to be used as energy. Once the blood sugar levels rise, this is when type 2 diabetes can occur.
A note on type 2 diabetes- often there can be a lot of shame around this diagnosis since so much of what the media talks about in terms of causes revolves around food and movement. I'm going to write about this more in depth but genetics plays a huge role in the development of type 2 diabetes along with many other factors and it isn't your fault that you developed diabetes. There are a lot of different factors at play, including genetics and your environment. You didn't do this to yourself.
There are other forms of diabetes, including Gestational Diabetes, which is where diabetes develops during pregnancy. This happens because people become more insulin resistant during pregnancy, so it often resolves after pregnancy. People who have a history of Gestational Diabetes are at an increased risk of Type 2 Diabetes, so screening after pregnancy is important!
Why do we care about high blood sugars?
So why can elevated blood sugars be an issue? Well first of all, your blood sugar levels are high because the sugar isn't getting into your cells where they need to go for energy! That can make you feel tired, drained, and hungry.
High levels of sugar in your blood in the short-term will do a few things- one is that it will make you pee more as your body tries to get rid of excess sugar (your kidneys can get rid of some of the sugar in your blood through your urine), and all that peeing will make you really thirsty.
In the long-term, sustained high levels of sugar in the blood can damage your blood vessels. That means that damage can occur to your eyes, nerves, kidneys, and your heart with sustained high blood sugars. In diabetes care, those are some of the the complications we're trying to prevent or delay.
That list of complications can feel really scary and I want to be really clear that not everyone with diabetes experiences complications. Just because you've been diagnosed with diabetes, that doesn't mean they are going to happen to you.
If that information was new to you, it might be helpful to take a moment to check in with yourself and see how you're feeling. That information can be scary. What thoughts are going through your head?
Often, I find clients have the thought that that's not going to happen to them because they're going to cut out sugar and things that make their blood sugar levels go up. Is that true for you?
If it is, again you're not alone. I want to acknowledge that those list of complications can be frightening and it makes sense for you to want to do what you can to prevent them. I also want to say that if you have diabetes, it does not mean you can't have sugar or carbs (foods that break down to sugar) in order to manage your blood sugars, even though that's the advice that often gets given.
There are so many options that can help you to manage your diabetes. Seeing your doctor to get blood work done is an important first step to see where things are at. If you have a history of disordered eating or are struggling with your relationship with food, medication might be more helpful than trying to manage your sugars through food and movement. Talk to your provider to see what's right for you.
If you want help improving your relationship with food and you have diabetes, you can contact me by clicking here.