Despite how it seems, diabetes used to be a very rare condition. It also represented primarily incidences of type 1 diabetes, over the more common type 2. But rates are climbing with 30 million Americans currently diagnosed with diabetes, and another 84 million right on the cusp of developing it(1). Between the two, that accounts for more than a third of the American population. It might be near impossible to encounter an adult who hasn’t heard of diabetes.
It wasn’t always like that, though. In fact, 30-40 years ago type 2 diabetes was barely recognizable to what you see today. Historically, it was known as the sugar disease, consistent across various regions of the world. It was a rare genetic disorder with no “apparent” cause that seemed to disrupt a person’s ability to regulate their weight. It was named after the high level of sugar in a patient’s urine, hence the name “diabetes mellitus” which is a mixture of Greek and Latin origin meaning “to pass through” and “honeyed or sweet(2).” For most, diabetes was usually a death sentence. Early treatments consisted of starvation or feeding therapies, typically ill-coordinated and not particularly effective. It wasn’t until the very late 1800’s that doctors discovered the role of the pancreas and its impact on the disease.
The Insulin Machine
You might be wondering how exactly does sugar end up in someone’s urine, at least to the level that is depicted for early diabetes patients – which is a great question. It all has to do with a handy little organ called the pancreas(3).
When we consume food, it goes through our digestive system to be broken down into very simple forms of sugars, fats, and protein. Once the job is complete, our body pumps these nutrients through our bloodstream to reach various tissues in our body for energy production. When it comes to that pasta you ate earlier, your digestive system takes those tasty carbs and converts them to glucose – a simple sugar our body loves for energy. The carbohydrates we consume make up most of the glucose circulating through our bloodstream. So once that spaghetti is completely digested and floods your system to pump out energy for your afternoon jog – it’s up to your pancreas to secrete insulin, a special hormone whose role is to communicate to your cells it’s time to let the glucose in(3).
The pancreas has more than one role. Most people think of pancreatic juices – a necessary step to help break down nutrients during digestion. But the pancreas also controls two opposing functions for glucose homeostasis. The distinct section that controls this process is called the Islets of Langerhans - but we’ll just refer to it at the pancreatic islet – which contains several types of cells including alpha and beta cells(3).
The beta cells of the pancreas secrete insulin to tell your cells it’s time to absorb glucose for energy, but conversely, the alpha cells secrete glucagon, a hormone used to tell your liver to release stored glucose into your blood because you need it for energy (especially in cases of fasting)(3). Together, these two hormones help us stabilize our blood sugar really well all day long.
However, for individuals suffering from type 1 diabetes, their pancreas no longer has healthy beta cells secreting insulin. This can occur from a variety of factors and honestly, scientists are still a little stumped. Without insulin, there is no communication to the cells and the glucose never gets absorbed. That glucose can stay circulating in the blood for a long time causing hyperglycemia, which can have some pretty severe consequences like weight loss, heightened risk of infection, excessive thirst, and even coma(2). Eventually, it’s left to the kidneys to remove excess glucose molecules from our blood to be excreted with our urine, hence the name.
Without access to all that convenient energy, your cells become starved and resort to using other nutrients for energy. In today’s society, that can be managed by eating fatty and high protein foods – but back in the 1600s, 1700s, and 1800’s most people’s source of food was usually bread related. This typically resulted in many diabetic patients wasting away.
Type 2 Diabetes and Insulin Resistance
Individuals with type 1 diabetes are typically required to have regular injections of insulin to help regulate their blood glucose, but even now, only about 5% of cases of diabetes are type 1. Instead, nearly 95% of cases of diabetes today are type 2 – a disorder defined by insulin resistance(1). Their pancreas most likely contains healthy beta cells properly secreting insulin in response to mealtimes, but for some odd reason, the message seems to get lost in translation. The surrounding cells don’t connect well with the messenger-hormone insulin, resulting in similarly high levels of blood glucose.
You see, type 2 diabetes is closely correlated with a higher BMI. Those who are experiencing metabolic disorders like obesity often have issues with chronic inflammation and high circulating levels of triglycerides (the fat source of energy) which can often jumble up communications with insulin.
Although the pathology of obesity is complex, its impact on our cells and our organs can be quite damaging. Currently, scientists are exploring the relationship of many metabolic disorders with our gut microbiome because of their close relationship to our digestive system and hormone regulation.
Dysbiosis and Diabetes
Changes in our gut ecosystem can have profound ripple effects throughout our bodies. Studies have shown our gut microbiome can interact with our brain, with our hormones, change our metabolism, and contribute to inflammation. These microorganisms can carry out different activities that shift our moods and impact our immune system, including helping us fight off illness. The importance of having a healthy gut microbiome is gaining foot and the science behind it is fascinating – especially if you’re a bit of a science buff like we are at Viome.
Some scientists have even unmasked certain relationships between gut dysbiosis – or microbiome imbalance – and Type 2 diabetes. Some studies have found several bacterial populations can influence our glycemic control and regulate our blood glucose(4). When dysbiosis negatively impacts these colonies, it can disrupt normal signals and contribute to insulin resistance.
Gut dysbiosis can also lead to leaky gut syndrome, allowing the intestinal lining of your gut to become compromised. Microbes can then pass into our bloodstream and cause inflammatory reactions. When contained in the gut, many of these microbes secrete compounds that help digest or promote a healthy gut lining, but even when helpful microbes in the gut get into crevices they don’t belong – like our pancreas – they can harm our cells and cause pancreatic beta-cell death, contributing to incidences of type 1 diabetes(5).
Although type 1 diabetes has no cure just yet, for many facing type 2 diabetes, hope remains. Symptoms can often be resolved through improving their diet and activity. Part of this is by managing their weight loss journey and their dietary practices. As we continue to examine the links between gut dysbiosis and diabetes, we might find even more data supporting the role of gut dysbiosis in glucose balance – and don’t be surprised if some of that research comes straight from the many scientists working right here at Viome.
We believe learning from our gut can change the way we view chronic disease, and each day we’re even more confident about a better future: for diabetes patients, and for many others as well.
*The information on the Viome website is provided for informational purposes only and with the understanding that Viome is not engaged in rendering medical advice or recommendations. Viome is providing this educational information to share the exciting developments being reported in the scientific literature about the human microbiome and your health. Viome products are not intended to diagnose, treat, or prevent any disease.
1. Bullard KM, Cowie CC, Lessem SE, et al. Prevalence of Diagnosed Diabetes in Adults by Diabetes Type - United States, 2016. MMWR Morb Mortal Wkly Rep. 2018;67:359-361.
2. Lakhtakia R. The history of diabetes mellitus. Sultan Qaboos Univ Med J. 2013;13:368-370.
3. Roder PV, Wu B, Liu Y, Han W. Pancreatic regulation of glucose homeostasis. Exp Mol Med. 2016;48:e219.
4. Aw W, Fukuda S. Understanding the role of the gut ecosystem in diabetes mellitus. J Diabetes Investig. 2018;9:5-12.
5. Everard A, Belzer C, Geurts L, et al. Cross-talk between Akkermansia muciniphila and intestinal epithelium controls diet-induced obesity. Proc Natl Acad Sci U S A. 2013;110:9066-9071.