A bittersweet story about sugar, environment and lifestyle
The saga of type 2 diabetes is one of the great paradoxes of our time. At the beginning of the 20th century, type 2 diabetes was a rare disease. In addition, type 1 diabetes was extremely rare. Today type 2 diabetes is one of the most common common diseases in Sweden and the World Health Organization (WHO) classifies diabetes as a serious threat to human health.
Between 5% and 10% of Western population have type 2 diabetes. In Sweden, approximately 5% of the population has type 2 diabetes, which means that the incidence of type 2 diabetes is low in Sweden compared to other countries in Europe and North America. Approximately 90% of all diabetes in Sweden are type 2 diabetes and the majority of the others have type 1 diabetes.
Diabetes mellitus: an ancient invention
The term diabetes mellitus was coined by the Greek physician Aretaeus (80-138 BC) to describe a condition of sweet urine and need to urinate a lot. However, it was only in 1776 that Matthew Dobson was able to confirm that people with diabetes mellitus actually had a high concentration of sugar (glucose) in the urine. The high concentration of sugar in the urine is due to the fact that individuals with diabetes have high blood sugar (high concentration of sugar in the blood). Urine is formed in our kidneys when blood is filtered there; if blood sugar is high, urine sugar also becomes high. When urine sugar is high, more fluid is withdrawn in the urine and then you urinate both more and the urine becomes sweet. This explains why people with diabetes have high urine sugar and urinate a lot. The fact is that high blood sugar is one of the main explanations that diabetes is harmful.
Read more about Complications of Diabetes
After Dobson’s discovery, many groundbreaking discoveries were made that increased our understanding of diabetes. The researchers discovered how sugar (glucose) is absorbed in the intestines, that sugar can be made in the body (especially in the liver), sugar is stored in the muscles and the liver, and that the body can use the sugar that has been stored. Scientists realized that the body’s handling of sugar is very complicated. It may not be so surprising because sugar (glucose) is the most widely used source of energy on the planet. Most organisms use glucose as their primary source of energy.
In 1889, Oskar Minkowski and Joseph von Merring took out the pancreas (pancreas) on dogs, noting that this caused fatal diabetes. They suspected that the pancreas was crucial for the body’s handling of sugar (glucose). Fredrick Banting and Charles Best discovered insulin in 1921. They made several pioneering efforts. Among other things, they treated diabetic dogs with pancreatic tissue from healthy dogs. They noted that the diabetic dogs got better when they received injections with pancreatic tissue. Banting and Best additionally managed to extract insulin from pancreatic glands from cattle, thereby creating a life-saving treatment for people with type 1 diabetes. However, this discovery is also of enormous importance for people with type 2 diabetes because over the years they have a shortage of insulin and therefore need to inject insulin.
A few decades later, methods of industrial production of insulin were developed. This made it possible to make large amounts of insulin using bacteria. The above successes were made in a period when type 2 diabetes was not yet a folk disease. Little did the researchers know that diabetes would become one of our most common diseases, with enormous consequences for both society and the individual. People with diabetes have several times increased risk of cardiovascular disease (heart attack, stroke, heart failure), eye damage (retinopathy), kidney disease (nephropathy), nerve damage (neuropathy), etc. Fortunately, type 2 diabetes is a disease that can be effectively treated.
Why did type 2 diabetes become so common?
An explosion of overweight, obesity and diabetes
Today, about 400 million people live with diabetes and another 300 million have reduced glucose tolerance, which is a precursor to diabetes. Diabetes caused 5 million deaths in 2013 and this figure will increase by 50% over the coming decades. This negative development has not been stopped despite the fact that we know why you get type 2 diabetes and effective treatments are available. To understand this, we need to understand the stages that society has undergone during the 20th century and the beginning of the 21st century. In the last 100 years, societies have undergone certain characteristic stages. These stages can be seen as individual time periods with a typical lifestyle, environment and disease pattern.
From starvation to obesity and diabetes
Most of human time on earth has been marked by hunger and plague. Infections and malnutrition were the main causes of disease and death globally until the early 20th century. At the beginning of the 20th century, the agricultural community began to be gradually dismantled and instead industrialization began.
Industrialization brought many technological inventions and improvements that automated and streamlined human everyday life. Mmass production of cars began in 1910. Cars allowed long journeys, reduced the need to walk or ride a bicycle and made work and everyday life more passive. The inaction caused human energy consumption to decline at the beginning of the 20th century.
But it was not only transport that was streamlined. In the early 20th century, food habits and food availability changed. Food making became more efficient and, in addition, food could be distributed faster. This allowed more people to eat larger portions of food. In addition, it started with processed (processed) foods, soft drinks, trans fats and other unhealthy fats, as well as an abundance of fast carbohydrates.
Tobacco production (cigarettes) started in the 1920s when cigarette machines were invented. However, it took about 40 years to prove that cigarettes were harmful. Despite this, tobacco consumption increased over the next few decades. Tobacco also attracts other unhealthy habits such as abuse of alcohol, soft drinks and unhealthy food. Smoking itself is associated with insulin resistance and an increased risk of type 2 diabetes. In the first half of the 20th century, blood pressure was also increased in the population.
The beginning of the 20th century is therefore characterized by the following:
- Man is becoming less physically active; sedentary increases dramatically.
- More people eat large portions of food.
- The food contains several useless substances, such as trans fats and processed foods.
- Soft drinks and other sugar-containing beverages become very common everyday. common.
- High blood pressure became common.
However, during the 20th century drinking water became cleaner, incomes rose and public health measures were implemented in society. This led to fewer people suffering from infections and malnutrition, which meant that life expectancy increased. Then suddenly it was noted that a heart attack and other complications of atherosclerosis of the vessels of the body became more common. The fact is that the incidence of heart attacks increased very rapidly between the beginning of the 20th century and 1970. Diseases of the heart and vessels (cardiovascular disease) became the most common cause of death. Cardiovascular diseases caused 35% to 65% of all deaths in the period from 1960 to 1970.
Despite the fact that heart attacks and atherosclerosis became very common, life expectancy increased. At the same time, we became better at treating high blood pressure, gradually reduced smoking, we started treating high blood lipids and this prompted a decrease in the number of heart attacks. The fact is that the number of heart attacks has fallen by a whole 50% since 1980.
Inactivity, overweight, obesity, diabetes and dementia
Since the 1950s, dramatic urbanisation and automation have taken place. Cars, abundance of food and drink and sedentary have exploded globally. This led to an avalanche increase in the incidence of overweight and obesity. At the same time, living conditions improved, which meant that people became both heavier and older. Thus, diabetes and cancer became more common. In addition, dementia has also become a folk disease.
The most dramatic increase is undoubtedly the one observed for diabetes and obesity. Diabetes has become a global pandemic. Increase in overweight and obesity has affected all age groups in all communities. Today, almost 1.5 billion adults are overweight and, as mentioned above, about 400 million people have type 2 diabetes.
The irony in Cuba
Although we have made tremendous progress in understanding and treatment of type 2 diabetes, the situation is worse today than ever. It is unlikely that we will succeed in reversing this negative trend in the near future. Recall that the harmful effects of smoking have been known for almost 60 years and despite this, people continue to smoke. However, there is evidence that the pandemic can be stopped.
Shortly after the fall of the Soviet Union in 1989, Cuba suffered an economic crisis. Cubans could no longer enjoy the same level of amenities and food. There was a shortage of food, lack of public transport, financial difficulties, reduced consumption of food, tobacco and alcohol. People were forced to eat less and ride more. The proportion of physically active Cubans doubled during the first 5 years and BMI dropped 1.5 kg/m2. The incidence of diabetes, heart disease and stroke decreased by 51%, 35% and 20%, respectively.
In order to reverse the trend, dramatic changes in society are needed. Achieving such dramatic changes is unlikely without legislation. It is possible to make laws restricting the use of tobacco, soft drinks, alcohol, fast food, etc. Probably, such actions will be necessary to reverse the negative trend that is taking place today.
Type 2 diabetes was a rare disease that, due to lifestyle changes, became a very common disease. It is crucial, both for the individual and society, to implement lifestyle changes in the form of eating healthier and moving more to confront this disease.