I know that diabetes is partly genetic and that the environment affects it or brings about its outcome, but what is the actual process of how diabetes affects the cell — the genetics behind the disease? My second mom has the disease. I am African-American and I know that it affects our race tremendously. I’m also really interested in medical type things and this is why I want to know the actual process. I hope to apply what I’ve learned in my biology classes and see if I can understand the process.

It would require quite a large book to give you all the answers, well beyond the scope of an e-mail anyway. To start with however, there are two broad types of diabetes, each with several distinct subdivisions. Type�1 is for the most part a disorder of the immune system in which some of the white blood cells mistakenly see the insulin producing (beta) cells in the pancreatic islets as foreign bodies and start to destroy them over a period of years. It occurs primarily in young people and usually requires insulin for life. It is actually rather less common in African American than in Caucasian people. The genetics has been well defined, but this is not the case with the environmental triggers although early consumption of cows’ milk and some viral infections are fashionable ideas.

I suspect that your second mom has type�2 diabetes in which the genetics are much less clearly defined and the main predisposing factors are a tendency to be overweight and not to get enough exercise. These people can manage without insulin for a long time and control their blood sugars with diet, exercise and sometimes oral medication. African American men seem especially vulnerable to this form. Fundamentally the problem is with the insulin receptor on the cell surface which requires proportionately more insulin molecules to make it function properly. Ultimately the beta cells get worn out and extra insulin has to be given.

You might try to contact the local office of the American Diabetes Association for suggestions or go to their website and look under ‘Educational Providers’ for suggestions. You might also do some exploring under PubMed.

These are very complex issues, but, one day, you may have a PhD in immunology and be a graduate student in a research center and you will find plenty more problems.

DOB