Wasting in the Midst of Plenty
Starving in the Midst of Plenty (11/2020)
Medical Health Education Blog
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Samuel E. Sanchez, DO
So today is a special day. You turn 40 years of age. All your friends and family are preparing to give you a surprise birthday party, but you found out about it because your younger brother has never mastered the art of whispering. It is D-Day minus eleven hours till the party. You are feeling pretty good about yourself. You get to work about fifteen minutes early and drink your first cup of the day.
Now you are awake and ready to tackle the world, and in the field of law enforcement, you have to be ready for anything. You stroll up to the snack room and demolish your first glaze doughnut. You then reach over for a chocolate one, but you realize that your waist line is not what it used to be. You cut the doughnut in half, and remove yourself from the room before temptation gets the better of you. “Wow, what self-control I have,” you think to yourself.
After the morning meeting you and your partner get ready to cruise the miracle mile. Just before you enter the cruiser, you feel a sudden urge to relieve yourself. You tell your partner to wait, and you make a dodge to the closest bathroom.
At lunch, you both treat yourselves to the Mexican Plate Delight, this is one of your favorites, and by the way, did you remember that it was your birthday? “Just as you finish the last bite, a call goes out in the radio asking for assistance with some troubled youth. You and your partner, jump into the police cruiser, when, again, you have the need to relieve yourself. You sprint to the bathroom, take care of business, and jump back in to the car. Your partner asks you to navigate to the scene, but you noticed that you are having a hard time reading the street signs. Finally you make it, and you spring into action and grab a couple of the fleeing perps. As you are placing cuffs on the vandals, you start having a sense of fatigue. Your eyes are starting to feel a little heavy. You chug down the last half of the soda that you were drinking earlier, and instantly you perk up. “Thank goodness for caffeine” you say out loud.
As the day goes on, you have repeating episodes of fatigue and restoration. Finally, at the end of the day, the officer returns home. He is in a state of exhaustion, with little to no ability to function. As he opens the door, he enters the dark living room, “SURPRISE” is the scream for the sixty guests hidden in the room. The startled officer reaches for his gun, and collapses to the floor. Immediately, paramedics are summoned. They find the officer unresponsive, cold, with perspiration, heart racing, breath smelled like alcohol, and looking severely distressed. Spontaneously they call for transport to the local emergency room. While in route, the chief paramedic placed the officer on four liters of Oxygen, intravenous fluids, and place his head depressed below the body. The officers repeats the blood pressure had improved after the first liter of fluids. Then the paramedic decided to check the officers blood sugar, but unfortunately the machine was not functioning.
Upon arrival to the emergency room, the nurse was waiting with a glucose monitor, oxygen, normal saline, and regular insulin. The emergency room physician had already given orders upon arrival, and believed that he knew what was wrong with the officer. Quickly the nurse pricked the
officer’s finger, and within a moment, his blood sugar was found to nine hundred and fifty. Once the stat labs were ready, they were sent to the emergency room physician, where he confirmed what he had thought. The patient was in diabetic ketoacidosis coma. So what is “Ketoacidosis”? What is a “Diabetic coma”? What is Wasting in the midst of plenty?
We should start this discussion with a second question, just what is diabetes? Diabetes is a medical condition, where sugar control is affected, leading to abnormally elevated levels of sugar, known in medicine as Hyperglycemia.
How does diabetes differ from normal blood sugar regulation, and how does that occur? Blood sugar is monitored by the body thru a system of hormones excreted from the pancreas and liver. When an individual eats, the process of carbohydrate, or sugar metabolism is started by enzymes secreted by the Parotid Gland, known as Amylase. Amylase is responsible from breaking down the bonds between large chains of sugars, and creating smaller sugar units. Since now there are multiple units, where before there was only one, the surface area is also increased, and glucose can be more readily absorbed by the digestive track.
Once in the sugars reach the stomach, glucose catabolism, or break down stops. This is because amylase does not function in an acidic environment, and our stomach is the most acidic location in the body. Therefore, in the stomach, the process of carbohydrate break down, and digestion of glucose ceases.
When the carbohydrates are dispelled from the stomach, into the small intestines, the pancreas secretes pancreatic amylase to restart the process of breaking down carbohydrates. This can occur because the acidity within the small intestines is far less acidic than the stomach itself, in fact it usually ranges from a pH of 6.0 to 7.4, where as the stomach has a pH of one. Additionally, the intestines themselves, also secrete enzymes that assist in glucose break down, known as Disaccharidase (sucrase, maltase, lactase).
Once the sugars are small enough to be absorbed, the intestines cause the transport of sugars from the digestive track, into the circulatory system, or blood. This absorption is cause by multiple enzymes that bind with the sugars and help them cross the barrier, much like the good scout helps the old lady across the road. And hence answers the question, why did the old lady cross the road? So she can get to the other side.
Once the sugars are floating in the blood stream, they are measured and regulated by the pancreas. When the sugars enter the blood stream, the pancreas secretes an enzyme known as Insulin. Insulin secreting cells, known as Beta Islet Cells, then cause the muscles and liver, to intake the blood sugar and either use it for fuel, or store it for later use. This storage of sugar is a substance known as glycogen, or a type of fat. Therefore, the higher the sugar level, the greater amount of insulin will be released by the pancreas to combat the levels of sugar. So we should be able to realize, that our ability to help our body maintain blood sugar levels, can be done thru the things we choose to eat. Therefore, when the sugar in our blood stream is higher than normal, we call this condition Hyperglycemia, and insulin is used to combat or prevent these situations. Hyperglycemia is not a part of the normal process of glucose break down and absorption.
Well we know what happens when blood sugar enters the blood stream, but what happens when there is insufficient blood sugar? Lower than normal levels of blood sugar in the body is a condition known as Hypoglycemia. Hypoglycemia occurs when either there is too much insulin secretion, not enough glucose intake, or states where sugars are rapidly broken down. Too much insulin production can result
in a Hyper Insulin condition that is usually cause by an insulin secreting pancreatic tumor. In adequate intake of glucose can occur thru starvation, malnutrition, malabsorption, poor glucose break down, intestinal inflammation and the like. Medical condition where sugars are used to rapidly can be found in cancers, hyper functioning metabolism (hyperthyroid), wasting syndromes.
When a state of hypoglycemia (low blood sugar) occurs, the body has a means to improve the condition. This is done by the release of glucagon. Glucagon is another pancreatic enzyme. It cause glycogen (fat) formation to stop, reverses the process and makes the muscles and liver cells to break down glycogen into sugars, and releases them into the blood stream.
What a perfect instrument our Creator made for us. So the control of blood sugar is attained by two hormones, Insulin and Glucagon. The hormones production are controlled thru a negative feed back mechanism. In other words, when the sugars are high it causes an increased production of Insulin, and stops the production of Glucagon. When the blood sugars are low, the cells not only stop the production of Insulin, they cause the production of Glucagon, which stops the formation of glycogen. Therefore, some negative effect causes the production of one hormone, while blocking the production of another, a Negative Feed Back Mechanism.
So now we understand the mechanisms for normal blood sugar regulation, now we can address the second question, what is diabetes? Diabetes is a condition that occurs when the sugars of the body are higher than the normal values. There exists two types of diabetes, diabetes mellitus, and diabetes Insipidus.
Diabetes Insipidus is a disorder of abnormal water and salt metabolism in the body. Diabetes Insipidus is caused by the abnormal function in the enzyme Vasopressin, also known as Anti-diuretic Hormone. Vasopressin regulates the amount of water that your body maintains by controlling the amount of urine production by the body. In Diabetes Insipidus, Vasopressin does not adequately regulate the amount of water within your body. It allows too much production of urine, which results in excess water loss. For further study, you can search the types of Diabetes Insipidus, and the causes.
Diabetes Mellitus is a metabolic disease that results in abnormally high blood sugar in the blood, as opposed to the urine. Types of Diabetes Mellitus. The first form of diabetes mellitus is known as
pre-Diabetes.Pre-Diabetes is a medical condition where the sugar in the blood is higher than what is considered to be normal, but not to the level deemed necessary to be classified as diabetes. Therefore, pre-diabetes can be the result of blood sugar overloading, this is when the sugar intake, is greater than the pancreas’ insulin production capability, or when the insulin secreted by the pancreas is no longer functioning to push the sugar into the cells. Since blood sugar overloading is the cause for pre-diabetes, then dietary regulation of carbohydrates is the key to reversal, or stabilization of pre-diabetes. Imagine, you go to a certain fast food restaurant where they serve you a hamburger, french fries and a coke. You have probably eaten roughly one hundred and twenty grams of carbohydrates in a single meal, more than the body requires for the entire day. Since the pancreas would normally not be used to dealing with such an enormous concentration of blood sugar, it would not be
Diabetes as we previously have read, diabetes is a condition, where the serum blood sugar is elevated higher that the normal scientific range. Although the normal blood sugar ranges can vary from time to time, they do not vary significantly, and the average accepted range is 70 – 126 fasting. Anything, significantly higher than this range is considered to be diabetes. So far, we have dealt with Diabetes Insipidus, which we found was secondary to a lack of hormonal control by Anti-Duretic Hormone
(ADH) on the kidneys, and Pre-Diabetes, where insulin resistance begins, or a problem with sugar over loading.
Once pre-diabetes is initiated, if Glycemic (blood sugar) control is not established, the pancreas will be over used, due to attempts in combating elevated blood sugars (Hyperglycemia), and burn out can occur., leading to insufficient insulin production. If a person is predisposed to diabetes, over time the insulin produced by the Beta Islet Cells, could have malformations in its protein structure. This deviation in proteins no longer allows the proper recognition of insulin by the receptors in the cell. These receptors, which open the gates of the cell membrane, allow insulin infusion, into the cell for use or storage. Since the insulin receptor and insulin hormone specifically work in a Lock and Key Mechanism, and either the lock, or the key is altered, then there cannot be adequate recognition of insulin, to obtain Glycemic control. Then, there remains excess sugar in the blood serum. These high levels of sugars, when they reach the kidneys are removed from the blood, and secreted into the urinary system. Due to the principle of Osmosis, the water in the kidneys will flow from a region of higher concentration, to a region of lower concentration, and as the urine becomes concentrated with sugar, it cause the water to follow. In this process of Water Wasting, water is lost thru the urinary system.
Lastly, any thing affects the pancreas, it too can lead to either insufficient, or the absence of insulin production, causing diabetes. 1. Toxins – Alcohol, 2. Infections – viruses & bacteria – 3. Auto Immune Diseases 4. Other – blunt force trauma
Our last types terms for our diabetic vocabulary is used to distinguish between onset, and causes.
Type One Diabetes Mellitus also known as Juvenile onset Diabetes, is a medical condition, where the Beta Islet Cells of Pancreas no longer secretes any amount of insulin, or only scant amounts of insulin, which fall off to nothing in a short period of time. Juvenile onset Diabetes is believed to be caused earlier in life, since it is presumed that an auto immune response, caused by viral disease, is responsible for initiating the destruction of the Beta Islet Cells which secrete insulin.
Type Two Diabetes Mellitus also known as Adult Onset Diabetes, is a medical condition where the Beta Islet Cells of the Pancreas, no longer secretes sufficient amounts of Insulin. This can be caused by sugar overloading, damage to the Beta Islet Cells, Genetic Malformations of insulin, other forms of damage to the pancreas. Since in this type of diabetes, insulin is still being processed, alternatives to exogenous insulin, may be possible. This can be accomplished by using any mechanism that assists the lock and key structures of the insulin receptor-insulin hormone relationship. Therefore, medications that have a direct effect on either the receptor, or hormone recognition, will assist in the improvement of sugar infusion into the cells, by endogenous insulin.
Therefore, with diabetes, one can eat plentiful amounts of food, but do to inability to process and use the energy, the individual can perish, and waste away.
Note: Diabetes is one of the most preventable diseases. In Type Two, proper nutrition, exercise, maintaining weight, and other can prevent the formation of diabetes. May God bless and keep you healthy and happy. Amen!
By: Dr. Samuel E. Sanchez, DO
Doctor of Osteopathic Medicine
John 3:16 – For God so loved the world, that He gave His only begotten Son, that whosoever believeth in Him, should not perish, but have everlasting life. “Thank You Jesus Christ, come soon!”
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