One of the most common questions we receive from readers, listeners, and viewers is how to deal with diabetes (officially known as diabetes mellitis) in a grid-down scenario. This article is the first in a series all about this serious condition.
Diabetes is problematic for the survival medic. The medications used to treat the worst cases are unlikely 1) to be manufactured or 2) keep their potency in a long-term collapse scenario. I’m not just interested professionally. I’m also a father who had a severely diabetic son with kidney failure, partial blindness, and an amputated toe. He required a kidney and pancreas transplant to stay alive.
“Diabetes” comes from the Greek word for “to pass through” and mellitis comes from the Latin word for “honeyed” or “sweet”. These words refer to one of the most common characteristics of diabetes mellitis: Large amounts of sweet-smelling urine. Early physicians noticed that it even attracted ants. Diabetes is also characterized by high sugar (also called “glucose”) levels in the blood.
HOW DIABETES WORKS
I’m sure most people have heard of “carbs” and the importance to eat a balanced diet. Carbs (carbohydrates) come in many forms, and most foods have some carbohydrate content. All carbohydrates are broken down into simple glucose in your body, some faster and some slower. The resulting glucose ends up in the blood.
The pancreas is a large gland located behind your stomach and in front of your spin. Certain cells in it monitor the glucose in the blood and release a hormone known as “insulin.” Insulin is necessary to move the sugar from the blood into the body’s cells. Here, it can be converted to energy. If insulin is unable to control high glucose levels in the blood (also called “hyperglycemia”), damage occurs. The various organ systems involved include eyes, heart, kidneys, circulation and nerves.
HOW COMMON IS DIABETES?
The incidence of Diabetes has been increasing over time in developed countries. This may be due to some societies converting to “Western” diets or perhaps due to issues relating to rising obesity rates. According to the Centers for Disease Control and Prevention (CDC), in 2011, 25.8 million Americans had the disease. Ten years later, the number has risen to 37.3 million, or 11.5 percent of all U.S. adults. 96 million are thought by the CDC to be “pre-diabetic.”
The recent pandemic didn’t help the numbers. A large new study showed that people who were infected were 40 percent more likely to become newly diagnosed diabetics compared to the general population. The study identified the disease in many young adults who were otherwise healthy before being infected.
TYPES OF DIABETES
Diabetes is separated into various types, the most common of which are type 1 and type 2:
Known in the past as juvenile-onset or insulin-dependent diabetes, Type 1 diabetes results from the failure of cells (called “beta cells”) in the pancreas to produce insulin. Type 1 represents about 5-10 percent of all diabetics.
Failure or destruction of beta cells is thought to be caused by some type of autoimmune response. This means that the body’s own immune system attacks parts of itself: In this case, the pancreas. Type 1 diabetes is often first diagnosed in childhood, as it was in my son at age 8. Today, however, 60% of new cases are now found in those over the age of 40. These patients need insulin from an external source. As of yet, there is no way to regenerate the lost pancreatic cells.
Type 2 diabetes was known in the past as adult-onset or non-insulin dependent diabetes. In this disease, the pancreas produces insulin but your body is resistant to its effect. Type 2 diabetics may require some oral medications or even insulin to keep glucose under control. Lifestyle and dietary changes are often helpful in this form of diabetes and may even reverse the course or, at a minimum, prevent worsening. Most commonly diagnosed after age 40, the increased incidence of obesity these days is causing Type 2 diabetes even in children. Type 2 diabetes is, far and away, the most common type.
Pregnancy-Related (also called Gestational) Diabetes is a condition not uncommon even in normally non-diabetic women. In some cases, it can be serious enough to lead to organ damage, overly large babies, delivery complications, and worse. Most women with pregnancy-related diabetes go back to normal after the baby is born, but some studies show those women are prone to diabetes later in life.
Interestingly, A new study suggests it’s possible that the coronavirus may selectively target beta cells in the pancreas. It may even morph them into another type of cell that leads to a new version of diabetes that isn’t type 1 or type 2. The research is still in progress.
SYMPTOMS OF DIABETES
It’s important to recognize the signs and symptoms of hyperglycemia (elevated sugars). The three most classic symptoms of diabetes are:
1) Excessive thirst (also called “polydipsia”)
2) Excessive hunger (also called “polyphagia”)
3) Frequent urination (also called “polyuria”)
These are exactly the symptoms that my son began to manifest at age 8. As well, I noticed:
- He began to wet the bed.
- His urine smelled vaguely “sweet” (a sign mentioned earlier).
- He was losing weight.
- His breath had an unusual “fruity” odor.
Why do diabetics have fruity breath? When your body can’t access energy from glucose in cells (leading to very high levels in the blood), it burns fat instead. The fat-burning process creates a buildup of acids in your blood called ketones, which can lead to a life-threatening condition called diabetic ketoacidosis (discussed later). Fruity-smelling breath is a sign of high levels of ketones.
Other issues occur as well. Cuts and scrapes, especially in a diabetic’s lower extremities, are slow to heal. Over time, nerve damage occurs which causes numbness, pins and needles sensations and, in the worst cases, gangrene. Many uncontrolled diabetics require amputation of gangrenous extremities.
While many diabetic complications take time to develop, there are two common diabetic emergencies. These are related either to very low or very high glucose levels. If a diabetic, especially Type 1, fails to eat regularly or injects too much insulin, he or she may develop a “hypoglycemic” reaction (low blood sugar). Hypoglycemia can occur very rapidly; symptoms include sweating, loss of coordination, confusion, and even loss of consciousness.
On the other hand, very high glucose levels lead to a condition called “diabetic ketoacidosis” or DKA, something I mentioned earlier. This occurs as a result of missed insulin doses and/or chronically under-dosed insulin, leading to a combination of high glucose levels and high ketone levels. In addition to the symptoms of diabetes I previously mentioned, there will be nausea, vomiting, dehydration, hyperventilation, and abdominal pain as well. This is a major emergency which could lead to coma and even death. Once the patient is in full-blown ketoacidosis, the prognosis is grave without insulin and other interventions.
Now that you have a good overview of the disease, our next article in this series will concentrate on other aspects of diabetes. Ultimately, we’ll discuss both conventional and alternative strategies for each type. We’ll work on situations where you have limited supplies and no way to monitor glucose levels, a serious handicap for the medic in long-term survival settings.
Joe Alton MD
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