Usually due to smoking

This is Healthy Lung Month covering COPD.

What is Chronic Obstructive Pulmonary Disease (COPD)?

Chronic obstructive pulmonary disease (COPD) is a term that applies to patients with chronic bronchitis, bronchiectasis, emphysema and, to a certain extent, asthma. A brief review of normal functional anatomy will provide a background for the discussion of pathology.

The airway down to the bronchioles normally is lined with ciliated pseudo-stratified columnar cells and goblet cells. Mucus derives from mucus glands that are freely distributed in the walls of the trachea and bronchi. The cilia sweep mucus and minor debris toward the upper airway. Low humidity, anesthesia gases, cigarette smoking and other chemical irritants paralyze the action of these cilia. The mucociliary action starts again after a matter of time. This is why people awaken to “smokers cough.”

“Chronic obstructive pulmonary disease (COPD) is a term that applies to patients with chronic bronchitis, bronchiectasis, emphysema and, to a certain extent, asthma.”

Bronchi run in septal connective tissue, but bronchioles are suspended in lung parenchyma by alveolar elastic tissue. The elastic tissue extends throughout alveolar walls, air passages, and vessels, connecting them in a delicate web. Bronchiolar epithelium is ciliated, single-layered and columnar or cuboidal. Beyond the bronchioles the epithelium is flat and lined with a film of phospholipid (surfactant), which lowers surface tension and thereby helps to keep these air spaces from collapsing. Remember that the phospholipid develops during later gestation in utero. This is the reason why premature infant’s lungs cannot stay inflated without the addition of surfactant therapy. Macrophages are found in alveolar lining. Smooth muscles surround the walls of all bronchi, bronchioles, and alveolar ducts and when stimulated they shorten and narrow the passages. Cartilage lends rigidity and lies in regular horse-shaped rings in the tracheal wall. Cartilage is absent in bronchi less than 1 mm in diameter.

The terminal bronchiole is lined with columnar epithelium and is the last purely conducting airway. An acinus includes a terminal bronchiole and its distal structures. Five to ten acini together constitute a secondary lobule, which is generally 1 to 2 cm in diameter and is partly surrounded by grossly visible fibrous septa. Passages distal to the terminal bronchiole include an average of three but as many as nine generations of respiratory bronchioles lined with both columnar and alveolar epithelium. Each of the last respiratory bronchioles gives rise to about six alveolar ducts, each of these to one or two alveolar sacs, and finally each of the sacs to perhaps seventy-five alveoli. Alveolar pores (pores of Kohn) may connect alveoli in adjacent lobules.

Two different circulations supply the lungs. The pulmonary arteries and veins are involved in gas exchange. The pulmonary arteries branch with the bronchi, dividing into capillaries at the level of the respiratory bronchiole, and supplying these as well as the alveolar ducts and alveoli. In the periphery of the lung, the pulmonary veins lie in the interlobular septa rather than accompanying the arteries and airways. The bronchial arteries are small and arise mostly from the aorta. They accompany the bronchi to supply their walls. In some cases of COPD, like bronchiectasis, extensive anastomoses develop between the pulmonary and bronchial circulations. This can allow major shunting and recirculation of blood, therefore contributing to cardiac overload and failure. Lymphatics run chiefly in bronchial walls and as a fine network in the pleural membrane. The lumina of the capillaries in the alveolar walls are separated from the alveolar lining surfaces by the alveolar-capillary membrane, consisting of thin endothelial and epithelial cells and a minute but expansile interstitial space. This interface between air and blood, only 2 microns in thickness, is the only place where gases may be exchanged effectively.

Disease Specific Review

Chronic Bronchitis

Chronic bronchitis is a clinical disorder characterized by excessive mucus secretion in the bronchi. It was traditionally defined by chronic or recurrent productive cough lasting for a minimum of three months per year and for at least two consecutive years, in which all other causes for the cough have been eliminated. Today’s definition remains more simplistic to include a productive cough progressing over a period of time and lasting longer and longer. Sometimes, chronic bronchitis is broken down into three types: simple, mucopurulent or obstructive. The pathologic changes consist of inflammation, primarily mononuclear, infiltrate in the bronchial wall, hypertrophy and hyperplasia of the mucus-secreting bronchial glands and mucosal goblet cells, metaplasia of bronchial and bronchiolar epithelium, and loss of cilia. Eventually, there may be distortion and scarring of the bronchial wall.

Asthma

Asthma is a disease characterized by increased responsiveness of the trachea and bronchi to various stimuli (intrinsic or extrinsic), causing difficulty in breathing due to narrowing airways. The narrowing is dynamic and changes in degree. It occurs either spontaneously or because of therapy. The basic defect appears to be an altered state of the host, which periodically produces a hyperirritable contraction of smooth muscle and hypersecretion of bronchial mucus. This mucus is abnormally sticky and therefore obstructive. In some instances, the illness seems related to an altered immunologic state.

Histological changes of asthma include an increase in the size and number of the mucosal goblet cells and submucosal mucus glands. There is marked thickening of the bronchial basement membrane and hypertrophy of bronchial and bronchiolar smooth muscle tissue. A submucosal infiltration of mononuclear inflammatory cells, eosinophils and plugs of mucus blocks small airways. Patients who have had asthma for many years may develop cor pulmonale and emphysema.

Emphysema

Pulmonary emphysema is described in clinical, radiological and physiologic terms, but the condition is best defined morphologically. It is an enlargement of the air spaces distal to the terminal non-respiratory bronchiole, with destruction of alveolar walls.

Although the normal lung has about 35,000 terminal bronchioles and their total internal cross-sectional area is at least 40 times as great as that of the lobar bronchi, the bronchioles are more delicate and vulnerable. Bronchioles may be obstructed partially or completely, temporarily or permanently, by thickening of their walls, by collapse due to loss of elasticity of the surrounding parenchyma, or by influx of exudate. In advanced emphysema, the lungs are large, pale, and relatively bloodless. They do not readily collapse. They many contain many superficial blebs or bullae, which occasionally are huge. The right ventricle of the heart is often enlarged (cor pulmonale), reflecting pulmonary arterial hypertension. Right ventricular enlargement is found in about 40% of autopsies of patients with severe emphysema. The distal air spaces are distended and disrupted, thus excessively confluent and reduced in number. There may be marked decrease in the number and size of the smaller vascular channels. The decrease in alveolar-capillary membrane surface area may be critical. Death may result from infection that obliterates the small bronchi and bronchioles. There is often organized pneumonia or scarring of the lung parenchyma due to previous infections.

Classification of emphysema relies on descriptive morphology, requiring the study of inflated lungs. The two principal types are centrilobular and panlobular emphysema. The two types may coexist in the same lung or lobe.

Centrilobular emphysema (CLE) or centriacinar emphysema affects respiratory bronchioles selectively. Fenestrations develop in the walls, enlarge, become confluent, and tend to form a single space as the walls disintegrate. There is often bronchiolitis with narrowing of lumina. The more distal parenchyma (alveolar ducts and sacs and alveoli) is initially preserved, then similarly destroyed as fenestrations develop and progress.

The disease commonly affects the upper portions of the lung more severely, but it tends to be unevenly distributed. The walls of the emphysematous spaces may be deeply pigmented. This discoloration may represent failure of clearance mechanisms to remove dust particles, or perhaps the pigment plays an active role in lung destruction. CLE is much more prevalent in males than in females. It is usually associated with chronic bronchitis and is seldom found in nonsmokers.

Panlobular emphysema (PLE) or panacinar emphysema is a nearly uniform enlargement and destruction of the alveoli in the pulmonary acinus. As the disease progresses, there is gradual loss of all components of the acinus until only a few strands of tissue, which are usually blood vessels, remain. PLE is usually diffuse, but is more severe in the lower lung areas. It is often found to some degree in older people, who do not have chronic bronchitis or clinical impairment of lung function. The term senile emphysema was formerly applied to this condition. PLE occurs as commonly in women and men, but is less frequent than CLE. It is a characteristic finding in those with homozygous deficiency of serum alpha-1 antitrypsin. It has also been found that certain populations of IV Ritalin abusers show PLE.

Bullae are common in both CLE and PLE, but may exist in the absence of either. Air-filled spaces in the visceral pleura are commonly termed blebs, and those in the parenchyma greater than 1 cm in diameter are called bullae. A valve mechanism in the bronchial communication of a bulla permits air trapping and enlargement of the air space. This scenario may compress the surrounding normal lung. Blebs may rupture into the pleural cavity causing a pneumothorax, and through a valve mechanism in the bronchopleural fistula a tension pneumothorax may develop.

Paracicatricial emphysema occurring adjacent to pulmonary scars represents another type of localized emphysema. When the air spaces distal to terminal bronchioles are increased beyond the normal size but do not show destructive changes of the alveolar walls, the condition is called pulmonary overinflation. This condition may be obstructive, because of air trapping beyond an incomplete bronchial obstruction due to a foreign body or a neoplasm. Many lung lobules may be simultaneously affected as a result of many check-valve obstructions, as in bronchial asthma. Pulmonary overinflation may also be nonobstructive, less properly called “compensatory emphysema”, when associated with atelectasis or resection of other areas of the lung.

Bronchiectasis

Bronchiectasis means irreversible dilation and distortion of the bronchi and bronchioles. Saccular bronchiectasis is the classic advanced form characterized by irregular dilatations and narrowing. The term cystic is used when the dilatations are especially large and numerous. Cystic bronchiectasis can be further classified as fusiform or varicose.

Tubular bronchiectasis is simply the absence of normal bronchial tapering and is usually a manifestation of severe chronic bronchitis rather than of true bronchial wall destruction.

Repeated or prolonged episodes of pneumonitis, inhaled foreign objects or neoplasms have been known to cause bronchiectasis. When the bronchiectatic process involves most or all of the bronchial tree, whether in one or both lungs, it is believed to be genetic or developmental in origin.

Mucoviscidosis, Kartagener’s syndrome (bronchiectasis with dextrocardia and paranasal sinusitis), and agammaglobulinemia are all examples of inherited or developmental diseases associated with bronchiectasis. The term pseudobronchiectasis is applied to cylindrical bronchial widening, which may complicate a pneumonitis but which disappears after a few months. Bronchiectasis is true saccular bronchiectasis but without cough or expectoration. It is located especially in the upper lobes where good dependent drainage is available. A proximal form of bronchiectasis (with normal distal airways) complicates aspergillus mucus plugging.

Advanced bronchiectasis is often accompanied by anastomoses between the bronchial and pulmonary vessels. These cause right-to-left shunts, with resulting hypoxemia, pulmonary hypertension and cor pulmonale.

Keeping a healthy lung prevents emphysema.  So for starters don’t smoke and exercise; which includes don’t be exposed to smoke frequently!

Overall numbers the CDC reports in statistics up to 2021:

“OVERALL NUMBERS:

• Prevalence: In 2021, 38.4 million Americans, or 11.6% of the population, had diabetes.
  • 2 million Americans have type 1 diabetes, including about 304,000 children and adolescents
• Diagnosed and undiagnosed: Of the 38.4 million adults with diabetes, 29.7 million were diagnosed, and 8.7 million were undiagnosed.
• Prevalence in seniors: The percentage of Americans age 65 and older remains high, at 29.2%, or 16.5 million seniors (diagnosed and undiagnosed).
• New cases: 1.2 million Americans are diagnosed with diabetes every year.
• Prediabetes: In 2021, 97.6 million Americans age 18 and older had prediabetes.”

“Diabetes was the eighth leading cause of death in the United States in 2021 based on the 103,294 death certificates in which diabetes was listed as the underlying cause of death. In 2021, diabetes was mentioned as a cause of death in a total of 399,401 certificates.

Cost of diabetes

Updated November 2, 2023

$412.9 billion: Total cost of diagnosed diabetes in the United States in 2022

$306.6 billion was for direct medical costs

$106.3 billion was in indirect costs

After adjusting for population age and sex differences, average medical expenditures among people with diagnosed diabetes were 2.6 times higher than what expenditures would be in the absence of diabetes.”

American Diabetes Association (https://diabetes.org/about-diabetes/statistics/about-diabetes)

Diabetes is still common in the United States. From 1980 through 2011, the number of Americans with diagnosed diabetes has more than tripled as of 2011 (from 5.6 million to 20.9 million).

30.3 million – The number of people in the U.S. who had diabetes in 2022.  According to a the CDC’s most recent “National Diabetes Statistics Report” in 2023, an estimated 136 million adults in the United States are living with either diabetes or prediabetes.

Do you know how much it is costing in our country?  Its a combination of factors that has caused such and increase in the disease of Diabetes in the U.S.

Factors:

-Look how much our population has increased with fast food companies pushing the  unhealthy foods the sell in restaurants or food stores.

-Also people from other countries who permanently came into America becoming a citizen from 1980 to now and came in to the U.S. already eating poor OR picked up the bad habits of eating poor foods that the U.S. media pushes that is acceptable to enough by U.S. society (that just continues).  This factor is adding to the diabetic population whether they came in the U.S. with it or got it when coming to live in America.

-Than people born in the U.S. with family having a history of diabetes or worse parents who did not watch good eating habits when raising their children who got obese putting them at high risk for diabetes.

–Ending line, these factors massively increased making the number of Diabetic Americans 3x higher since 1980.

-Than another factor is the illegals with diabetes also adds to the number of diabetic people in America; for they are not left out and are treated in hospitals with citizens of the U.S.  If they come to an ER in the U.S. we treat them.  Think of what the count is now with all these illegal people coming in the U.S. since the past 4 years with Former President Bidon and Harris in the office.

These factors all IMPACT an increase in the number of Diabetics in America!

Wake up America!  We need to get this disease under better control!  Diabetes increasing in the U.S. will not help disease overall in America!

Statistics:

That’s right. The metabolic condition is about as American as you can get, according to a the CDC’s most recent “National Diabetes Statistics Report” in 2023, an estimated 136 million adults in the United States are living with either diabetes or prediabetes, with the highest prevalence of diagnosed diabetes among American Indian/Alaskan Native adults, followed by non-Hispanic Black adults, Hispanic adults, non-Hispanic Asian adults, and then non-Hispanic White adults; the report also highlights disparities in diabetes prevalence based on socioeconomic factors like income and education level.

The report shows that nearly half of Americans have diabetes or prediabetes, which puts them at high risk for the condition. A good number of these folks haven’t been diagnosed and don’t even realize their predicament.

People with diabetes have too much sugar in their blood. If the disease isn’t controlled, they can wind up with heart disease, nerve damage, kidney problems, eye damage and other serious health problems.

Type 1 diabetes was previously called insulin-dependent mellitus (IDDM) or juvenile-onset diabetes. This type of diabetes happens when the immune system ends up destroying beta cells in the body that come from our pancreas and they are the only cells in the human body that make the hormone INSULIN the regulates your glucose. Insulin allows glucose to transfer into the cells and tissues of our body to give them their energy to do their job in the body and nutrition to work properly=sugar-glucose. To live with this diabetes the person must have their insulin delivered by injection or a pump. This form of diabetes usually occurs in children or young adults but can occur at any age.

Type 2 diabetes was called non-insulin dependent diabetes mellitus (NIDDM) or adult-onset diabetes. In adults, type 2 diabetes accounts for about 90-95% of all diagnosed cases of diabetes. It usually begins as insulin resistance, a disease in which the cells do not use insulin properly due to the pancreas not making enough or the pancreas not secreting the correct form o of insulin to do its function. Ending line the insulin isn’t working properly. As the need for insulin rises, the pancreas gradually loses its ability to produce it.

Type 2 diabetes is associated with older age, OBESITY, family history of diabetes, history of gestational diabetes, impaired glucose metabolism, physical inactivity and race/ethnicity.

Gestational diabetes is a form of glucose intolerance diagnosed during pregnancy. Gestational diabetes occurs more frequently among African Americans, Hispanic/Latino Americans, and American Indians. It is also more common among obese women and women with a family history of diabetes. During pregnancy, gestational diabetes requires treatment to optimize maternal blood glucose levels to lessen the risk of complications in the infant.

Other types of diabetes result from; specific genetic conditions (such as maturity-onset diabetes of youth), surgery, medications, infections, pancreatic disease, and other illnesses. Such types of diabetes account for 1% to 5% of all diagnosed cases.

Treatment for Diabetes:

Diet, insulin, and oral medication to lower blood glucose levels are the foundation of diabetes treatment and management. Patient education and self-care practices are also important aspects of disease management that help people with diabetes lead normal lives or as normal as possible.

To survive, people with type 1 diabetes must have insulin delivered by injection or a pump.

Many people with type 2 diabetes can control their blood glucose by following a healthy meal plan and exercise program, losing excess weight, and taking oral medication.

Medications for each individual with diabetes will often change during the course of the disease. Some people with type 2 diabetes may also need insulin to control their blood glucose.

Self-management education or training is a key step in improving health outcomes and quality of life. It focuses on self-care behaviors, such as healthy eating, being active, and monitoring blood sugar.

The medications used for diabetes would be that your endocrinologist doctor would decide:

-Insulins-commonly in Type I DM but can be used if needed in Type II DM which the MD decides:

If you have type 1 diabetes, your body can’t make its own insulin. The goal of treatment is to replace the insulin that your pancreas can’t make.

Insulin is the most common type of medication used in type 1 diabetes treatment. There are more than 20 types sold in the United States.

It’s given as an infusion under the skin (with the help of an insulin pump) or as an injection.

There are multiple types of insulin. They vary based on how quickly they start working, how long they work, and whether they have a peak level of action.

The type of insulin you need depends on your body’s sensitivity to insulin and the severity of your insulin deficiency.

There are short acting, rapid acting, intermediate acting  long acting, and combination insulins.

Also there is amylinomimetic. It’s an injectable medication that’s used before meals.  It works by delaying the time your stomach takes to empty itself. It also reduces the secretion of the hormone glucagon after meals. These actions lower your blood sugar.  Specifics are another topic in itself.

-Oral medications commonly used in type II diabetics; again specifics are another topic in itself.

If not doing treatment the diabetic will end up with severe complications to possibly death sooner in life than a compliant diabetic.

Pretty simple isn’t it but you have to  the make a move quick if you haven’t yet!  Take action and make changes if you need to!

How the cost of diabetes impacts America:

Diabetes is not only common and serious; it is also VERY COSTLY!  This impacts medical insurance being so high since our population is so high in America. Let us take a look how:

The cost of treating diabetes is staggering. According to the American Diabetes Association, the annual cost of diabetes in medical expenses and lost productivity rose for $98 billion in 1997 to $132 billion in $2002 to $174 billion in 2007.

Two years ago in this post it stated one out of every 5 U.S. federal health care dollars is spent treating people with diabetes. The average yearly health care costs for a person without diabetes is 2,560 dollars; for a person with diabetes that figure soars to $11,744. Much of the human and financial costs can be avoided with proven diabetes prevention and management steps.

Now in 2022 the American Diabetes Association states “People with diagnosed diabetes incur average medical expenditures of $16,752 per year, of which about $9,601 is attributed to diabetes. On average, people with diagnosed diabetes have medical expenditures approximately 2.3 times higher than what expenditures would be in the absence of diabetes.”   https://diabetes.org/about-us/statistics/cost-diabetes

Diabetes.org states now that “The estimated total economic cost of diagnosed diabetes in 2017 is $327 billion, a 26% increase from our previous estimate of $245 billion (in 2012 dollars).

The CDC states the following:

“Natural insulin (i.e. insulin released from your pancreas) keeps your blood sugar in a very narrow range. Overnight and between meals, the normal, non-diabetic blood sugar ranges between 60-100mg/dl and 140 mg/dl or less after meals and snacks.  To keep the blood sugar controlled overnight, fasting and between meals, your body releases a low, background level of insulin. When you eat, there is a large burst of insulin. This surge of insulin is needed to dispose of all the carbohydrate or sugar that is getting absorbed from your meal. All of this happens automatically!  Insulin is continuously released from the pancreas into the blood stream. Although the insulin is quickly destroyed (5-6 minutes) the effect on cells may last 1-1/2 hours. When your body needs more insulin, the blood levels quickly rise, and, the converse – when you need less, the blood levels rapidly fall —The situation is different when you have diabetes and are getting insulin replacement therapy. Once you have injected a dose of insulin, it is going to get absorbed into your bloodstream whether you need it or not.

Insulin pump therapy is increasingly popular. Because insulin pumps more closely mimic what your body does naturally, you can improve your blood sugar control. With that control comes a more flexible lifestyle. Remember, though, that the pumps still require a lot of input from users.

Type 1 diabetes is caused by a loss or malfunction of the insulin producing cells, called pancreatic beta cells. Damage to beta cells results in an absence or insufficient production of insulin produced by the body.

You have Type 2 diabetes if your tissues are resistant to insulin, and if you lack enough insulin to overcome this resistance. Type 2 diabetes is the most common form of diabetes of diabetes worldwide and accounts for 90-95% of cases.”

University of California (https://dtc.ucsf.edu)

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Insulin is a hormone made by the pancreas that allows your body to use sugar (glucose) from carbohydrates in the food that you eat for energy or to store glucose for future use. Insulin helps keeps your blood sugar level from getting too high (hyperglycemia) or too low (hypoglycemia).  How it works; when the glucose gets in your body after digestion starting from eating or even if your not eating by mouth but through IV with Dextrose in it (a form of sugar) or just on a feeding tube via a nasogastric tube or gastric tube (PEG) with Dextrose or some form of sugar in it will put glucose in your blood.  When you eat or drink, much of your food is broken down into a simple sugar called “glucose.”   All 3 routes of getting nutrition can cause your glucose count in the bloodstream to go up, if some form of sugar is in the nutrition supply you get in your body for the cells in our bloodstream.  Now glucose is food to our cells but the food has to get into the cells.  For glucose to pass into our cells it needs a hormone to allow the glucose to pass in the cell to be the food for the cell.  This is where Insulin comes into play!  Insulin is released by the pancrease and put in our bloodstream to do one of its MAIN functions to allow glucose in the cell.  For without insulin what happens is the glucose just will pile up outside of the blood cells and in time cause what we call Diabetes.  Without glucose going into our cells through insulin allowing it to pass in the cells we would not have energy that helps us in doing our activities of daily living.

So in review, the amount of glucose in your bloodstream is tightly regulated by the hormone insulin. Insulin is always being released in small amounts by the pancreas but especially after eating and when digestion takes place releasing the broken down sugar to “glucose” being released into our blood. When the amount of glucose in your blood rises to a certain level, the pancreas will release more insulin to push more glucose into the cells.

Diabetes mellitus (sometimes called “sugar diabetes“) is a condition that occurs when the body can’t use glucose (a type of sugar) normally. Glucose is the main source of energy for the body’s cells. The levels of glucose in the blood are controlled by a hormone called insulin, which is made by the pancreas that it releases into the blood- stream when glucose level goes up allowing for it to be utilized by our body in allowing the glucose to transfer over the cell membranes into the cells as the main source of energy-a major form of nutrition for out cells to do its functions especially transfer oxygen throughout the body to keep our tissues healthy and alive.  Without oxygen we would have tissue and cell starvation.  Think in a diabetic when blood flow gets thick due to high glucose levels in the bloodstream making it difficult for the blood to move throughout our body to oxygenate our tissues the first place the body compensates to allow oxygenated blood by our cells to get to our vital organs like heart, lungs, brain and not areas far away from the body like feet.  That is why you commonly hear of amputations of lower legs with uncontrolled or badly controlled diabetics (arms amputated is very, very rare due to diabetes, more its due to trauma.

People with diabetes either don’t make insulin or their body’s cells are resistant to insulin, leading to high levels of sugar circulating in the blood, called simply high blood sugar. By definition, diabetes is having a blood glucose level of 126 milligrams per deciliter (mg/dL) or more after an overnight fast (not eating anything).

So ending line without Insulin no glucose, a energy nutrition for our cells. we would not get glucose inside the cells. This as a ending result would cause cellular starvation of energy resulting into death in time (much sooner than other people without this problem) unless they take their insulin!

Another function of insulin is after our body uses all the glucose it needs at that time it needs to be stored somewhere.  Insulin helps control blood glucose levels by signaling the liver and muscle and fat cells to take in glucose from the blood.  To get the glucose level in therapeutic range for the body in time.

The 2 major groups of Diabetes occurs if someone has a problem with this role function of insulin resulting in one of the following:

Type 1 Diabetes occurs because the insulin-producing cells of the pancreas (called beta cells) are destroyed by the immune system. People with type 1 diabetes produce no insulin and must use insulin injections to control their blood sugar.  This is most commonly seen in people under age 20 but may occur at any age.

Type 2 Diabetes is the most common form of diabetes, affecting almost 18 million Americans. While most of these cases can be prevented, it remains for adults the leading cause of diabetes-related complications such as blindness, non-traumatic amputations, and chronic kidney failure requiring dialysis. Type 2 diabetes usually occurs in people over age 40 who are overweight, but can occur in people who are not overweight as well.Sometimes referred to as “adult-onset diabetes,” type 2 diabetes has started to appear more often in children because of the rise in obesity in young people.

Sometimes referred to as “adult-onset diabetes,” type 2 diabetes has started to appear more often in children because of the rise in obesity in young people.

Some people can manage their type 2 diabetes by controlling their weight, watching their diet, and exercising regularly. Others may also need to take a pill that helps their body use insulin better, or take insulin injections.

Often, doctors are able to detect the likelihood of type 2 diabetes before the condition actually occurs. Commonly referred to as pre-diabetes, this condition occurs when a person’s blood sugar levels are higher than normal, but not high enough for a diagnosis of type 2 diabetes.

Know this diabetes can be hereditary as well.

Maybe you might want to get your glucose checked by your M.D. and make sure your insulin is functioning well for the side effects of uncontrolled diabetes are detrimental and could shorten your life!

“Research shows that type 2 diabetes increases a person’s risk of developing dementia. Dementia risk also increases with the length of time someone has diabetes and how severe it is. However, it is important to note that diabetes is only a risk factor and does not mean that a person with diabetes will go on to develop dementia.

In people with type 1 diabetes. severe blood sugar highs and lows are also associated with increased risk of developing dementia.As you get older, you are more likely to develop certain health conditions, including diabetes.

To manage this, speak to your GP about going for a health check.

Eating a healthy, balanced diet may reduce your risk of type 2 diabetes. No single ingredient, nutrient or food can improve health by itself. Instead, eating a range of different foods in the right proportions is what makes a difference. This is known as a ‘balanced’ diet.

By eating a balanced diet you are more likely to get all the nutrients you need to stay healthy.”

Alzheimer’s Society (https://www.alzheimers.org.uk/about-dementia/managing-the-risk-of-dementia/reduce-your-risk-of-dementia/diabetes)

It’s Alzheimer’s Disease and Dementia Care Education Month.

At one time Alzheimer’s disease was a disease considered with unknown etiology (or cause).  Today it is considered different in the eyes of many in the medical profession.  By a Dr. Mercola a physician who founded Mercola.com (Mercola.com is now the world’s top natural health resource site, with over 1.5 million subscribers.) feels this about Alzheimer’s disease:    “The cause of the debilitating, and fatal, brain disease Alzheimer’s is conventionally said to be a mystery.”

While we know that certain diseases, like type 2 diabetes, are definitively connected to the foods you eat, Alzheimer’s is generally thought to strike without warning or reason.

That is, until recently.

Now, a growing body of research suggests there may be a powerful connection between the foods you eat and your risk of Alzheimer’s disease and dementia, via similar pathways that cause type 2 diabetes.  Some have even re-named Alzheimer’s as “type 3 diabetes.””

Can You Eat Your Way to Alzheimer’s?

In a recent animal study, researchers from Brown University in Providence, Rhode Island were able to induce many of the characteristic brain changes seen with Alzheimer’s disease (disorientation, confusion, inability to learn and remember) by interfering with insulin signaling in their brains.

Know that faulty insulin (and leptin, another hormone) signaling is an underlying cause for insulin resistance, which, of course, typically leads to type 2 diabetes. However, while insulin is usually associated with its role in keeping your blood sugar levels in a healthy range, it also plays a role in brain signaling. When researchers disrupted the proper signaling of insulin in the brain, it resulted in dementia.

What does this have to do with your diet?  Let us go back to one of my articles on diabetes this week and how it impacts your diet.  It states “The foods we eat that contain starches, carbohydrates, calories are made up of sugar.  When food reaches our stomach in time digestion starts to take place where these foods are broken down in the stomach into individual or complex sugar molecules ( glucose being one of the most common and important ones).  The glucose then passes from our stomach into our bloodstream when it reaches the liver 60 to 80 % of the glucose gets stored in that organ turning glucose into inactive glucose that’s converted to glycogen.  The purpose for glycogen is when our glucose is low and our body needing energy we have this extra stored sugar, glycogen,  to rely on.  This is done by the liver which allows the sugar to be stored and released back into the bloodstream if we need it=energy,  since nothing is in our stomach at that time, in that case scenario).  When glucose=an active sugar, it is our energy for our cells and tissues and is a sugar ready to be utilized by the body where it is needed,  by many organs.  Think of a car for one moment, and what makes it run?  That would be gas/fuel for it to function.  The same principle with glucose in your bloodstream=fuel for the human body so we can function, for without it we wouldn’t survive.  That is the problem with a person that has diabetes.  They eat, they break the food down, the glucose gets in the blood but the glucose fuel can’t be used due to lack of or NO insulin at all.  Insulin allows glucose to pass into our cells and tissues to be used as energy/fuel for the body parts to work.  Glucose is used as the principle source of energy (It is used by the brain for energy, the muscles for both energy and some storage, liver for more glucose storage=that is where glucose is converted to glycogen, and even stored in fat tissue using it for triglyceride production).  Glucose does get sent to other organs for more storage, as well.  Insulin plays that vital role in allowing glucose to be distributed throughout the body.  Without insulin the glucose has nowhere to go.”

So how does this impact your brain thinking?

“This new focus on the Alzheimer’s/Diabetes/Insulin connection follows a growing recognition of insulin’s role in the brain. Until recently, the hormone was typecast as a regulator of blood sugar, giving the cue for muscles, liver and fat cells to extract sugar from the blood and either use it for energy or store it as fat. We now know that it is also a master multitasker: it helps neurons, particularly in the hippocampus and frontal lobe, take up glucose for energy, and it also regulates neurotransmitters, like acetylcholine, which are crucial for memory and learning.”  What is effected with Alzheimer’s disease? Your memory and learning,  So your diet plays a big role in Alzheimer’s disease.”                                                                                        

Over-consumption of sugars and grains is what ultimately causes your body to be incapable of “hearing” the proper signals from insulin and leptin, leaving you insulin resistant in both body and brain.  Alzheimer’s disease was tentatively dubbed “type 3 diabetes” in early 2005 when researchers learned that the pancreas is not the only organ that produces insulin. Your brain also produces insulin, and this brain insulin is necessary for the survival of your brain cells.

If You Have Diabetes, Your Risk of Alzheimer’s Increases Dramatically

Diabetes is linked to a 65 percent increased risk of developing Alzheimer’s, which may be due, in part, because insulin resistance and/or diabetes appear to accelerate the development of plaque in your brain, which is a hallmark of Alzheimer’s. Separate research has found that impaired insulin response was associated with a 30 percent higher risk of Alzheimer’s disease, and overall dementia and cognitive risks were associated with high fasting serum insulin, insulin resistance, impaired insulin secretion and glucose intolerance.

A drop in insulin production in your brain may contribute to the degeneration of your brain cells, mainly by depriving them of glucose, and studies have found that people with lower levels of insulin and insulin receptors in their brain often have Alzheimer’s disease (people with type 2 diabetes often wind up with low levels of insulin in their brains as well). As explained in New Scientist, which highlighted this latest research:

What’s more, it encourages the process through which neurons change shape, make new connections and strengthen others. And it is important for the function and growth of blood vessels, which supply the brain with oxygen and glucose.

As a result, reducing the level of insulin in the brain can immediately impair cognition. Spatial memory, in particular, seems to suffer when you block insulin uptake in the hippocampus… Conversely, a boost of insulin seems to improve its functioning.

When people frequently gorge on fatty, sugary food, their insulin spikes repeatedly until it sticks at a high level. Muscle, liver and fat cells then stop responding to the hormone, meaning they don’t mop up glucose and fat in the blood. As a result, the pancreas desperately works overtime to make more insulin to control the glucose – and levels of the two molecules skyrocket.

The pancreas can’t keep up with the demand indefinitely, however, and as time passes people with type 2 diabetes often end up with abnormally low levels of insulin.”

“Diabetes is a condition that happens when your blood sugar (glucose) is too high. It develops when your pancreas doesn’t make enough insulin or any at all, or when your body isn’t responding to the effects of insulin properly. Diabetes affects people of all ages. Most forms of diabetes are chronic (lifelong), and all forms are manageable with medications and/or lifestyle changes.”

Cleveland Clinic (https://my.clevelandclinic.org/health/diseases/7104-diabetes)

Diabetes is becoming more common in the United States.  From 1980 through 2011, the number of Americans with diagnosed diabetes has than tripled (from 5.6 million to 20.9 million).

DIABETES: The Signs & Symptom and How to control the them:

The signs and symptoms of Diabetes 1 or 2 with hyperglycemia (HIGH GLUCOSE LEVELS):

THINK OF THE 3 P’s=

1.)Polyuria-When all of sudden you are voiding urine.  Poly ,meaning alot, uria, meaning urine,; so a lot of urinating due to your body trying to void out of the body excess glucose in your urine can be a symptom of diabetes. This is a common symptom that causes the next symptoms due to your voiding a lot of urine which causes your body to lose fluid, being water with alot of glucose in the urine, and in return you become very thirsty with hungry. This gives you:

2.)Polydipsia= very thirsty

3.)Polyphagia=very hungry

This should be a red light for a diabetic with these one or all 3 symptoms to finger stick or glucose test themselves.   See where your glucose level is at and if over 200 this is why you have one or all of the “P” symptoms (listed above).

Other s/s of Diabetes consist of:

– Tingling / Numbness in the hands and feet (diabetic neuropathy)

-Very tired and fatigued

-Weight Loss (more common to see in Diabetes 1; most of the time Type II DM is due to obesity and noncompliance of a diabetic )

-Blurred Vision.

-Sores or diabetic ulcers especially in the lower extremities that do not heal; and if not healed, this can cause in time a severe condition.

Complications that can come about due to DIABETES:

Dental Disease – Diabetes can lead to problems with teeth and gums, called gingivitis and periodontitis.

Heart Disease – People with diabetes have a higher risk for HTN, heart attack and stroke.

Eye Complications – People with diabetes have a higher risk of blindness and other vision problems.

Kidney Disease – Diabetes can damage the kidneys and may lead all the way up to kidney failure.

Nerve Damage (neuropathy) – Diabetes can cause damage to the nerves that run through the body.  Particularly neuropathy can occur leading to no feeling to other complications occuring (Example diabetic with neuropathy keeps stepping on sharp items not feeling them making a wound develop causing a sore not to heal that leads into a diabetic ulcer that doesn’t heel leading to a foot amputation or worse below or above knee amputation it leads to in time).

Foot Problems – Nerve damage, infections of the feet, and problems with blood flow to the feet can be caused by diabetes.

Skin Complications – Diabetes can cause skin problems, such as infections, sores, and itching. Skin problems are sometimes a first sign that someone has diabetes. Sores that cannot heal due to constant high glucose in the body can lead into a severe condition=AMPUTATION of the foot or leg.

**. (At least 15 % of all people with diabetes eventually have a foot ulcer, and 6 out of every 1000 people with Diabetes have an AMPUTATION. Possibly first surgery with bypassing the blood can resolve the problem 100% or like many only temporary. It is based on your other medical history with how brittle the diabetes and how compliant you are in taking care of yourself with diabetes.   This is why you see with some diabetics amputations of the lower extremities, hardly ever a upper amputation which is usually due to trauma or smoking.***

All these complications are effected by hyperglycemia and in playing a part in the blood circulation of our body. Ending line the person is getting bad oxygenated blood supply sent to the lower extremities when the glucose is poorly controlled over a long time. Based on the principle of gravity; what happens here is the heart pumps our blood throughout our body and when it gets difficult for the organ to do its job due to thick high glucose blood than it has to compensate at some point. Simply a narrowing to a blockage is occurring in that lower extremity and the reason for this is it’s the furthest area from the heart=FEET/LEGS.

This can be caused by just thick high glucose blood flowing throughout the body making it difficult for the heart to pump as effectively as opposed to someone that doesn’t have hyperglycemia which over time leads to further complications (listed above).

Diabetes with constant high glucose blood levels can leaded into poor circulation causes the feet and lower leg to first become cool to cold to changing colors of pale to cyanotic (purple) which takes over weeks to months to years, depending on the patient. Then the tissue gets necrotic (black=dead tissue) and an amputation has to be done to save the person or else this will get infected locally, at first, going into a systemic infection causing the person to go into septicemia and expire.

REFERENCES for Part 1, Part 2 & 3:

1.)  Center for Disease (CDC) – “National Diabetes Fact Sheet”

2.)  NYS Dept. of Health –Diabetes

3.)  Diabetic Neuropathy.org “All about diabetic neuropathy and nerve damage caused by Diabetes.”

4.)  NIDDK “National Institute of Diabetes and Digestive and Kidney Diseases.

5.)  National Diabetes Information Clearinghouse (NIDC) – U.S. Department of Health and Human Services.       “Preventing Diabetes Problems: What you need to know”

“Among the U.S. population overall, crude estimates for 2021 were:

• 38.4 million people of all ages—or 11.6% of the U.S. population—had diabetes.
• 38.1 million adults aged 18 years or older—or 14.7% of all U.S. adults—had diabetes (Table 1a; Table 1b).
• 8.7 million adults aged 18 years or older who met laboratory criteria for diabetes were not aware of or did not report having diabetes (undiagnosed diabetes, Table 1b). This number represents 3.4% of all U.S. adults (Table 1a) and 22.8% of all U.S. adults with diabetes.
• The percentage of adults with diabetes increased with age, reaching 29.2% among those aged 65 years or older (Table 1a).”

Center for Disease Control and Prevention – CDC (https://www.cdc.gov/diabetes/php/data-research/index.html)