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.