Diabetes is an umbrella term to describe the phenomenon in which the body is unable to utilize glucose from carb sources, mostly related to the absence or resistance of insulin.
Insulin is produced from cells in the pancreas. It can be thought of as a key holder to the cells, allowing glucose to exit the bloodstream and enter into cells for energy use.
Without insulin or the "key," glucose (the body's primary source of energy) starts to build up in the blood. This is why diabetes is connected to having "high blood glucose" or "high blood sugar."
While diabetes is mostly attributed to an unhealthy weight and lifestyle choices, it may also be related to autoimmune reactions.
But is diabetes an autoimmune disorder? The answer is mostly related to the type, though understanding their upbringing is imperative for safe, effective diabetes management.
Types of Diabetes
There are three common types of diabetes, including type 1 diabetes, type 2 diabetes, and gestational diabetes:
• Type 1 Diabetes: Previously more known as a juvenile-onset diabetes, type 1 diabetes is when the body’s own immune system destroys the cells responsible for producing insulin, the hormone required to assist glucose from the blood into the cell.
• Type 2 Diabetes: Type 2 diabetes results to elevated blood sugars mostly related to insulin resistance, a condition in which cells do not respond well to insulin and cannot sufficiently easily take up glucose the blood.
• Gestational Diabetes: Gestational diabetes is the development of diabetes during pregnancy. Though it often disappears after pregnancy, women and their children are at increased risk of developing type 2 diabetes later on.
While not as common and often misdiagnosed, another form of diabetes includes latent autoimmune diabetes:
• Latent Autoimmune Diabetes: Latent autoimmune diabetes, also known as latent autoimmune diabetes in adults (LADA), is a subgroup of type 1 diabetes and is often misdiagnosed. LADA occurs due to the pancreas stopping insulin production slowly.
Is Diabetes an Autoimmune Disease?
As mentioned, type 1 diabetes and LADA are autoimmune diseases, conditions in which the body's own immune system destroys normally healthy cells.
So in the case of both diabetes cases, cells responsible for producing insulin (also known as beta cells from the pancreas) are destroyed, subsequently negotiating the ability for the cells to utilize glucose.
Due to the complete loss of insulin produced from beta cells, insulin therapy via injection or infusion pumps are required along with careful, close attention and monitoring. In fact, without insulin administration, ketoacidosis and death are at high risk, particularly with type 1 diabetes.
However, there is newer evidence questioning whether or not type 2 diabetes is an autoimmune disease.
What Makes Type 2 Diabetes an Autoimmune Disease?
Again, type 2 diabetes is related to insulin resistance, a condition in which cells do not use insulin effectively which causes blood sugars to rise.
Type 2 diabetes is mostly developed in individuals who are overweight or obese, likely due to lifestyle choices such as poor diet and inactivity. And unlike type 1 diabetes, most individuals do not rely on insulin and the condition may even be reversible, particularly when weight is lost and maintained in a healthy range.
But while weight was mostly a predicter of diabetes, obesity-related insulin resistance and type 2 diabetes may be autoimmune diseases.
The autoimmune component may be related to two metabolic pathways: Changes in metabolic tissues following fat accumulation and the alteration of gut microbiota and mucosal immunity, potentially triggering inflammatory responses in the body and initiating an autoimmune response.
"Fat is inflammatory," says Dr. Caroline Cederquist, founding physician of bistroMD. "Fat cells and tissues release chemicals called adipocytokines, which cause swelling and inflammation in the body tissues. Chronic inflammation is definitely linked to autoimmune disease development, though the pathology of this is unclear."
Clinical Presentation and Diabetes Management
Though type 1 diabetes can occur at any point of the lifespan, most cases are diagnosed in ages 30 or younger and mostly between 10 to 15 years of age. Individuals are often underweight.
Type 1 diabetes accounts for 5 to 10 percent of all diagnosed cases of diabetes, with type 2 engulfing the largest portion of diabetes at 90 to 95 percent. Carrying excess weight is a risk factor for type 2 diabetes.
Individuals with latent autoimmune diabetes present clinically with characteristics of both types 1 and type 2 diabetes, including the combination of a lower BMI as in type 1 and longer onset and insulin resistance as observed in type 2 diabetes.
Common signs and symptoms of diabetes include hyperglycemia, fatigue, excess thirst, and frequent urination. And unlike overweight and obesity being a strong risk factor for type 2 diabetes, type 1 may present itself with unintentional and significant weight loss, along with electrolyte imbalances.
If experiencing any of the signs and symptoms, considered overweight, or diabetes runs in the family, careful screening can further detect risk of presence of diabetes.
Diabetes management is mostly dependent on the type, as type 1 diabetes relies on insulin whereas type 2 mostly does not. Those with LADA may require insulin months or even years following diagnosis.
Additional management considerations include ongoing self-management and scheduling and attending regular doctor checkups. Careful supervision can ultimately lessen the risk of further complications, including heart disease, kidney disease, retinopathy, and neuropathy just to name a few.
Ultimately, those living with diabetes can benefit from a healthy diet and exercise with a common goal primarily including keeping blood sugar levels within an appropriate range, along with managing blood pressures and lipids.
How to Reduce Your Risk of Diabetes
While type 1 diabetes cannot be prevented, there are lifestyle changes one can make to lower the risk of development of type 2 diabetes, including weight management, regular exercise, and a balanced diet.
"To help prevent the development of diabetes, making sure that your body's immune system is strong by giving it a variety of balanced foods will go a long way," says Dr. Cederquist.
"Balanced foods will benefit your health in many other areas too. You can empower your immune system greatly by losing weight, eating a variety of colorful fruits and vegetables, as well as making sure you get plenty of sleep and regular exercise."
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