Patient's question:
My grandfather is 65 years old this year. He got diabetes when he was young and has never worked. He can't stand working at all. It's all taken care of by my grandmother. I don't know what factors or causes led to the diabetes?Doctor's answer:
1 Genetics: Diabetes has a familial genetic predisposition. However, this hereditary tendency requires the action of external factors, which mainly include obesity, reduced physical activity, an unreasonable dietary structure, viral infections, etc.2 Obesity: Obesity is a significant factor or cause of diabetes. It is particularly prone to triggering type 2 diabetes, especially in cases of abdominal obesity. The mechanism primarily lies in the fact that obese individuals exhibit (obvious hyperinsulinemia), which reduces the affinity of insulin for its receptors, leading to insulin resistance. This necessitates the pancreas β-cells to secrete and release more insulin, further exacerbating hyperinsulinemia. This creates a vicious cycle of glucose metabolism disorders and insufficient β-cell function, ultimately resulting in severe β-cell dysfunction and the onset of type 2 diabetes. Abdominal cells are inherently less sensitive to insulin compared to other tissues. In abdominal obesity, the increase in fat tissue is primarily due to cell volume expansion rather than an increase in the number of fat cells, leading to a relative reduction in receptor numbers on the cell membrane and causing insulin resistance. This significantly reduces glucose clearance, leading to hyperglycemia and diabetes.
3 Chemical Substances and Drugs: Several chemical substances have been identified as capable of causing diabetes. For example, alloxan (a rodenticide) can induce type 1 diabetes. Two clinical medications, framycetin (used to treat pneumonia) and L-asparaginase (an anticancer drug), can also cause diabetes.
4 Dietary Structure: Whether in China or the West, people's dietary structures are predominantly high in calories and fat. Excessive calorie intake beyond expenditure leads to fat accumulation and obesity. Additionally, a high-fat diet can suppress metabolic rate, contributing to weight gain and obesity. Obesity is a major risk factor for type 2 diabetes. Omnivores who consume meat regularly have a significantly higher incidence of diabetes compared to lifelong vegetarians, primarily due to the higher fat and protein content in meat. Therefore, a varied diet is essential to maintain nutritional balance and avoid excess.
5 Viral Infections: Some type 1 diabetes patients develop the condition after contracting viral infections such as the common cold or mumps. The mechanism involves viruses directly attacking pancreatic β-cells, causing extensive damage and inhibiting their growth, leading to insufficient insulin secretion and ultimately type 1 diabetes.
6 Psychological and Neurological Factors: The significant role of psychological and neurological factors in the development and progression of diabetes has been widely recognized by scholars worldwide. Stress, emotional excitement, and psychological pressure can trigger the excessive secretion of stress hormones, which are glucose-raising hormones and also antagonize insulin. The prolonged and excessive release of these hormones disrupts endocrine and metabolic regulation, causing hyperglycemia and diabetes.
7 Autoimmunity: Type 1 diabetes is an autoimmune disease, and multiple autoimmune antibodies can be detected in patient serum. The primary mechanism involves antigens such as viruses entering the body, disrupting the immune system and producing a series of antibodies targeting pancreatic β-cells. These antibodies can directly damage β-cells, leading to insufficient insulin secretion and diabetes.
8 Insufficient Physical Activity: Physical activity can enhance insulin sensitivity in tissues, reduce body weight, improve metabolism, alleviate insulin resistance, and mitigate hyperinsulinemia, thereby lowering cardiovascular complications. Therefore, reduced physical activity has become a significant factor in the development of type 2 diabetes.
9 Pregnancy: During pregnancy, the body produces large amounts of various hormones, which are crucial for fetal development but can also block insulin's effects, causing insulin resistance. Although the causes of diabetes are complex, the underlying reasons are ultimately (attributed to): ① absolute insulin deficiency, ② relative insulin deficiency, ③ insufficient insulin effect (i.e., insulin resistance: refers to the inadequacy of insulin performing its normal biological functions, characterized by impaired glucose utilization in peripheral tissues, especially muscle and fat).