June 30, 1999
Question from Columbus, Ohio, USA:
My 11 year old step-son was diagnosed with Type 1 diabetes at 18 months. I've been taught that high blood glucose levels can cause many health problems over time. What confuses me is whether the blood being high is the problem or not having enough insulin to feed the muscles and organs is the problem. I realize these two conditions go hand and hand but if he injects enough insulin to cover a 300 blood glucose level and then immediately eats enough carbs to raise his blood glucose levels to 400 still constitute dangerous conditions? He still has enough insulin to keep his muscles fed but his blood is still high. So is the "sweet blood" poisoning the body, or is it the fact the muscles are not receiving sugar the culprit?
Both the high glucose levels in the blood and extracellular water as well as the impairment of glucose entry into the cells are factors in the complications of diabetes. That is what leads to the concept of ‘control’ which is to have both in harmony as much as is possible. In general, the impact of high blood sugars is the ‘glycosylation’ of certain proteins: that is, the attachment of glucose to the protein molecule with some attendant change in function which can lead to small blood vessel complications and peripheral neuropathy. Chronic insulin insufficiency used to lead to a disorder called Mauriac’s Syndrome with growth failure, enlargement of the liver and infantilism. Acute insulin insufficiency leads, as you must know, to ketoacidosis. The two processes are in fact inextricably linked.