Prediabetes, Diabetes Type 1 and Diabetes Type 2 All Feature Progressive Glycation of Molecules

download (72)Glycation. Glycation is a random reaction between the ordinary glucose molecule and any tissue or any macromolecule in our bodies. Glycation is not enzyme-directed. It is not enzyme-facilitated. Glycation serves no positive purpose. Glycation is a chemical reaction between a substance – glucose – which has the property of sharing an electron with another molecule – and a receiving molecule, most usually a protein or lipoprotein. A glycation event is an irreversible union of glucose with a receptive molecule. Receptive molecules include hemoglobin, capillary endothelial cell membrane proteins, and structural membrane proteins of numerous organs, such as kidneys and nerves. Glycation reactions in our bodies occur when glucose molecules circulate too long in the blood stream – having not been transported into cells and tissues by insulin. How long is too long? Too long most certainly is greater than 3 hours. Even two hours can be too long. This random attachment of glucose changes the basic nature of the proteins and membranes. Glycation is undesirable, for it initiates and perpetuates disease on the organs affected.

Type 1 Diabetes Mellitus. Type 1 Diabetes Mellitus features relative insulin lack or insulin deficiency as its basic root cause. Insulin is present but in sub-normal concentrations. Insulin secretion in response to a glucose-containing meal is low, sluggish, and sub-normal, as well. The basic problem resides at the pancreas beta-cell, which are the cells where insulin is manufactured and secreted in response to glucose surges in our blood stream. Physicians can and do prescribe various insulin forms and dosages to repair and remedy the insulin deficiencies. But, a basic second problem can persist – glucose is not transported into target organ cells as promptly as would occur in the perfectly healthy state. Hence, blood glucose concentrations can be lowered with prescribed insulin preparations, but glucose absorbed from our meals still circulates too long and at higher than normal concentrations. Then, glycation events result. Tissue membranes are affected. Capillary wall membranes are affected. Organ disease results and progresses.

Type 2 Diabetes Mellitus. Type 2 Diabetes Mellitus features resistance to insulin action at the target tissue level. Insulin production and insulin secretion by the pancreas beta-cells is not below normal. In fact, insulin secretion is either normal or above normal. Most commonly, insulin secretion and presence rises in a biologic attempt to overcome the insulin resistance and to transport circulating glucose into the target tissues. Physicians will prescribe various pill forms of diabetes medications that aim to improve blood glucose and will even add various forms of insulin on top of the already present natural insulin. These interventions can help. Still, though, the blood stream glucose concentrations will linger in higher-than-normal ranges, perpetrating and perpetuating glycation events at various sites.

Prediabetes. Prediabetes is a recognizable condition where an individual experiences elevated blood glucose concentrations after a long fasting period, or will exhibit higher-than-physiologically normal glycated hemoglobin levels. Yes, elevated glycated hemoglobin events labels a person as being prediabetic. The elevated glycated hemoglobin concentration is not severe, but it is real. Hence, the person is diagnosed with prediabetes. Why call this prediabetes if glycation events are super-normal? What not call this condition Type 3 Diabetes? Well, prediabetes is a condition that does not mandate a diabetic pill or an insulin prescription. Prediabetes can be reversed and normalized with diet pattern alterations, with sustained weight loss, and with regular exercise. Nevertheless, prediabetes features glycation events, which are known to be harmful if left to progress and accumulate.

Actions. All three of these metabolic disorders are real. All three feature abnormalities of glucose metabolism. All three feature glycation events. The glycation events are the harmful and hurtful consequences of altered glucose metabolism. Action is essential. Action begins with awareness and with understanding. Action hinges on consuming small and smaller quantities of simple carbohydrates at any and every meal, of avoiding sugary snacks and drinks, and obtaining expert diagnosis, counsel and management of your particular condition. Know this and do this.

Rex Mahnensmith is a practicing Internal Medicine Physician who has special concern for persons with diabetes, prediabetes, glucose intolerance, and body weight concerns. He believes that prevention is key and awareness is essential.


Cell and Tissue Injury From Glucose Glycation Reactions Occurs in Both Prediabetes and Diabetes

download (71)Glucose absorbed from our food has a programmed journey. First, glucose enters our blood stream across our intestinal cells; then glucose travels to all tissues and cells, where it will cross cell membranes and enter the cell interior. Insulin is the essential hormone that facilitates the entry of glucose into our cells and tissues. Once in the cell interior, glucose enters the glycolysis pathway (lysis or breakdown of glucose), yielding carbon dioxide and water. Along this pathway, energy molecules form, which in turn, provide reaction energy for other essential cellular life processes.

Type 1 Diabetes. However, glucose will linger in the blood stream if cell uptake is sluggish. Sluggish cellular uptake of glucose happens when insulin secretion – and insulin presence at cell membranes – is inadequate. This is termed “insulin lack”. Though “insulin lack” is valid as an explanation, it is more appropriate to state that there is relative “insulin insufficiency” for the load of circulating glucose, for insulin is never at a “0” concentration – rather its concentration is lower than normal values and stimulation insulin secretion is abnormally low, too. This state exists in “Type 1 Diabetes Mellitus.” Or to say it another way, Type 1 Diabetes Mellitus” is the accurate diagnosis when glucose circulates at higher than normal blood concentrations, and insulin secretion is below normal. In this context, glucose will circulate longer and at higher than normal concentrations, and in essence, cells “starve” in the “midst of plenty.” Glucose is available but not moving into cell interiors where it is needed because of inadequate insulin presence.

Type 2 Diabetes. Glucose entry into cells can be slow and glucose concentrations in the blood remain higher than normal if tissue cells are “insulin resistant.” In this context, insulin is present but the cell is not responsive or is not fully responsive to the insulin. Then, again, glucose is available outside the tissue cells, but is not moving into the cell interiors, and again, the cell is “starving” in the “midst of plenty” of energy food. In Type 2 Diabetes Mellitus, glucose concentrations in the blood are higher than normal, and insulin concentrations are also higher than normal. Tissue cells are “insulin resistant,” and thus the pancreas secretes more and more insulin. Still, though, because of tissue cell “insulin resistance,” the super-normal concentrations of insulin are not sufficient to transport the glucose load from blood into tissue cells, and hyperglycemia persists.

Glycation Events. In both Type 1 Diabetes and Type 2 Diabetes, the presence of elevated glucose concentrations for prolonged periods of time leads to random “glycation events.” As explained in prior articles, glycation is a random reaction whereby a glucose molecule attaches without enzyme facilitation or mediation to a protein or lipoprotein molecule. Glycation is not governed. Glycation is not healthy. Glycation changes the nature of the affected protein or lipoprotein in a non-healthy way. Glycation is not desirable and is harmful. Glycation events that accumulate are irreversible and are the dreaded consequences of “insulin lack” and “insulin resistance.” Glycation events occur because of higher-than-normal blood glucose concentrations.

Prediabetes. Prediabetes is now recognized as a true metabolic disorder where glucose circulates transiently at higher than normal concentrations following a meal and random glycation events begin to accumulate. Prediabetes is diagnosed by higher than normal fasting glucose concentrations OR by the discovery of abnormal concentrations of “glycated hemoglobin” in the red blood cells that circulate. Glycated hemoglobin at barely higher-than-normal concentrations is the principal indicator of a prediabetic state. It is important to realize that the discovery of slightly elevated glycated hemoglobin concentrations in the blood stream not only reveals abnormal glucose management by our bodies – but this is revealing glycation events. And, glycation events are the dreaded consequence of elevated blood glucose concentrations – and the means of organ and vascular injury from diabetes. Thus, prediabetes not just heralds disease. Prediabetes, as indicated by slightly elevated glycated hemoglobin levels, is signaling disease and disorder that requires action. This same glycation event that is occurring on hemoglobin is occurring on proteins of vascular cell walls of every tissue in the prediabetic state. It is mild and minimal in the prediabetic state, but real and additive and progressive. Tissues are harmed and more harm will ensue unless the prediabetic state is remedied. Action is required.