The Diabetes Puzzle

In people with type 2 diabetes, there are at least 8 core defects that can affect blood sugar levels. Doctors and scientists call these 8 core defects the “ominous octet.” (The word “ominous” suggests that something bad or unfortunate may happen in the future. And the word “octet” comes from the Latin word “octo,” meaning 8.)

The 8 core defects affecting blood sugar levels are like puzzle pieces. All of the different pieces fit together to keep your blood sugar under control. When one of the puzzle pieces is missing or does not work right, many of the other pieces can be affected.

Let’s take a closer look at each puzzle piece to better understand what is happening in the body of someone with type 2 diabetes.

Puzzle man

1. The gut

The gut is made up of such organs as your stomach and intestines. When you eat, a hormone called glucagon-like peptide-1 (GLP-1) is released to slow down the release of food from your stomach. This helps slow down the movement of sugar into your blood.

2. The pancreas 

The pancreas is where the hormone insulin is made. Insulin helps control blood sugar by moving sugar from the bloodstream into the body's cells for energy. When you have type 2 diabetes, the beta cells in the pancreas don't produce enough insulin. This can lead to too much sugar in the bloodstream, instead of in the muscles and other places in the body where the sugar needs to go.

The pancreas also makes the hormone glucagon. Glucagon tells the liver, which stores sugar, to release sugar into the blood to help balance blood sugar. With type 2 diabetes, alpha cells in the pancreas release too much glucagon, keeping blood sugar levels high after meals and overnight.

3. The muscles

Your muscles get their energy from sugar. But with type 2 diabetes, insulin has trouble moving sugar into muscle cells. This is called insulin resistance. Insulin resistance is one of the main reasons that people with type 2 diabetes can't get rid of extra sugar in the blood. Another reason is that the pancreas just doesn't make enough insulin to do the job.

4. The liver

If you have type 2 diabetes, your pancreas can release too much glucagon. This, in turn, causes the liver to release more sugar, leading to higher blood sugar levels. The liver can also be insulin resistant in people who have type 2 diabetes. This can cause even higher blood sugar levels.

5. The brain

The brain is also affected by GLP-1. GLP-1 signals your brain to help your body to understand when it's full and GLP-1 decreases appetite.

6. Fat

Fat cells, like muscle cells and liver cells, can be insulin resistant in people who are overweight or have type 2 diabetes. This can cause higher blood sugar levels indirectly and in several ways. Healthy eating, staying active, and maintaining a healthy weight can help get rid of fat cells and may benefit people with type 2 diabetes.

7. The kidneys

One job of the kidneys is to reabsorb blood sugar to help keep the energy stored in the sugar from being lost. But with type 2 diabetes, the kidneys reabsorb too much sugar back into the blood, rather than get rid of it.

NEXT: Separate myths from facts when it comes to diabetes.

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