What is Diabetes?

Diabetes is a non-communicable disease (it cannot spread from one person to another) which develops over a number of years. Onset is typically over the age of 30. Diabetes is essentially a defect in the way that our bodies handle sugar. Carbohydrates�like bread and starch�and sugar, are a major source of energy for our bodies. When we eat, insulin is released from the pancreas. Insulin then turns on the cellular machinery that removes sugar from the bloodstream. Cells use the sugar for energy or store it in the form of fat. In diabetes there is a malfunction of this process. Diabetics have a genetic predisposition to gain weight and as they gain fat they become insensitive to insulin. As a result, diabetics cannot rid sugar from the bloodstream as effectively, and the increasing amount of sugar causes problems in many organ systems.

What's the Problem?

Diabetes Mellitus wasn't a problem 40 years ago, but it is a huge problem now in Micronesia. Diabetes is becoming the major public health problem facing the FSM and many other places in the Pacific (such as Nauru). It is now the main cause of death in Kosrae and in the Marshalls, the number two cause of death in Pohnpei and the number three cause of death in Chuuk. These numbers do not reflect the amount of pain, suffering and disability that this disease can cause. Diabetes is shortening our lives as well as reducing the quality of life. The incidence of diabetes among 45-54 year olds is 22% in Chuuk, 21% in Kosrae, and 19% in Pohnpei, compared to 8.5% in the US (where it is considered a major public health concern). The most frightening fact is that these already high numbers are on the rise.

How Does Diabetes Hurt Us?

Diabetes kills. The elevated sugar in the bloodstream damages small blood vessels in the body. This increases the possibility of:

• heart attack
• stroke
• blindness - diabetes is the leading cause of blindness in adults.
• kidney disease - diabetes is the number one cause of kidney disease in the world.
• amputation - because of diminished wound healing and loss of sensation.
• infections - The excess sugar in the bloodstream is a fertile environment for the growth of bacteria. Infections of the mouth, urinary tract and blood are common.

Why Are We Hearing About It So Much Now?

We are hearing about it now because it is a problem that is growing out of control. It is killing and maiming more and more people with each passing year. But why?

Current theory has focused on the so-called "thrifty genotype." In the distant past, Pacific peoples had to live through periods of relative starvation, whether this be because of an ocean voyage or a poor harvest. Those individuals who could store energy more efficiently when there was plenty had an advantage. This stored energy could then be used when food was scarce. The hormone that is responsible for the storage of energy is insulin. People who had this "thrifty" gene secreted an extra amount of insulin after eating. This allowed for the efficient storage of energy. Normally, when people gain weight their energy usage goes up, causing them to burn off some of the fat that they had just put on. This keeps our weight within a predetermined "normal" range. This thrifty genotype also slows down the body's metabolism and other energy-expending processes during weight gain, so that even more energy can be stored as fat.

While these adaptations may have helped us survive periods when food was scarce, they have become dangerous today in light of our relative plenty. Now we eat foods that are high in fat, sugar and starch but rarely, if ever, experience periods of starvation. We are also less active than we used to be, making it even easier to put on weight. In the face of this abundance of food we secrete lots of insulin because we have been programmed to store our energy when we can. However, we eventually develop diabetes because we become insensitive to the insulin that we secrete. Sugar builds up in our blood and causes all of the various complications.