The definition, types, causes, metabolic disorder, medical complications and the global burden of diabetes

Tigray Academy | August 23/2023

By Dr Gebrewahid Woldu

  1. Metabolic Syndrome/Insulin Resistance

The early sign of trouble is inevitable unless you are aware and willing to work on it.

What is metabolic syndrome. It is also called Insulin Resistance.

It is a group of five risk factors that when not addressed early will significantly increase the risk of heart disease, diabetes, and stroke.

The five criteria for Metabolic syndrome.

If you have three or more of the following:

1. Waist size (belly fat) is called “Apple-shaped” midsection.

Women – greater than 35 inches

Men – greater than 40 inches

(But any size more than ideal is a risk factor.

2. Triglyceride equal to or more than 150 mg/dl or using drugs for treatment.

3. Low HDL “good “cholesterol:

Women less than 50 mg /dl and Men less than 40 mg/dl.

4. High blood pressure.

Systolic (top) equal to or more than 130 mmHg and diastolic (bottom part) equal to or more than 85 mmHg or under treatment

5. High fasting blood sugar: more than 100 mg /dl or under treatment

Why are these criteria selected? What do these criteria indicate? These components are interrelated with each other. It is believed that the underlying problem is that insulin no longer works effectively (insulin resistance). It indicates that the body cannot effectively process the nutrient fat and sugars. It also indicates that a higher risk for HEART DISEASE, DIABETES, and STROKe will be doubled.

And the likelihood that you will be diagnosed with diabetes is five times higher.

To understand the relationship between the criteria, will briefly discuss how fat (belly fat) and insulin resistance are the main culprits.

BELLY FAT also called VISCERAL FAT: is the fat inside the abdomen surrounding the internal organs. These fat cells generate products called- FREE FATTY ACIDS and other substances, which are TOXIC ad cause inflammation, increasing the risk of heart disease and diabetes. These free fatty acids result in “lipotoxicity” and affect the pancreas making it difficult to produce insulin and interfering with insulin action, opening the door, for glucose to enter the body’s cells for energy use. The Lipotoxic( lipo means lipid(fat) causes insulin resistance, which means muscle and liver cells do not respond adequately to insulin.

Fat cells also release factors that can drive up blood pressure, reducing the blood vessel’s ability to relax.

Fat cells produce proteins that increase insulin resistance.

Insulin resistance is a risk for high Triglyceride levels. Blood sugar enters the body’s cells with the help of insulin. If someone has insulin resistance, excess blood sugar is stored as Triglyceride fat in the liver. A diet high in carbohydrates, especially refined sugar containing Fructose, can raise triglyceride levels in the blood.


Ideal Triglyceride is less than 100 mg/dl. Keeping triglyceride optimal means your body can efficiently process fat and indicates a low insulin resistance risk. Levels equal to or above 150 mg/dl increase your risk for heart disease.

150 to 199 is borderline high.

200 to 499 is high.

500 or more is very high.

The main culprit (sugar, fructose, High fructose corn syrup( in all processed food)

Whether you have metabolic syndrome/insulin resistance:

Serious lifestyle modifications are required to lose weight, especially belly fat and physical activity. (Please read my previous short notes on Diet and physical activity again).

Few additional points on bell fat and triglyceride.

Avoid food that quickly raises your blood sugar, because the body can’t use it all at once and is stored as fat.

The following types of food are examples:

1. Processed food with added sugar: cookies, cakes, pastries, ice cream, soft drinks, and canned juices (any juice)

2. White flour: pasta, pizza, bread, bagel

3. Starchy foods: white potatoes, rice, corn

Physical activity – exercise lowers triglycerides and bell fat. Exercise activates an enzyme called lipoprotein lipase which breaks down triglyceride.

Look at your blood work, or do new blood work and obtain your blood pressure.

The advantage of an aggressive lifestyle change and daily activity is that it can prevent developing heart disease, diabetes and is possible without medication.

The next topic is diabetes (unfortunately, the opportunity was missed), but you can stop developing the consequence of diabetes, which is possible.


Diabetes is one of the ancient diseases known to mankind.

History: (for your interest)

A polyuric state (frequent urination) was described in Egyptian papyrus writing, in about 1550 BC.

The sweetness of the urine of a diabetes person was first, recognized by Hindu physicians around the 5th century BC. The diagnosis of diabetes was made by testing the urine for sweetness or watching ants being attracted to the sweet urine.

The Greeks observed that the patient’s body “melted down” and expelled it in the urine.

DIABETES – a Greek word for “siphon” or “pass-through.” Sugar is an osmotic meaning it draws water and increases urination.

Mellitus (Latin)for “honey-sweet “describing, its sugary, taste.

Before the discovery of insulin in 1921 by Dr. Banting and its first use to treat diabetes in 1922, affected people lived a very short and dreadful life.

What is diabetes?

A chronic metabolic disorder and progressive disease characterized by high blood sugar(glucose) levels. Normally the body maintains blood sugar(glucose) at a narrow range (70 to 90mg/dl), because blood sugar above the normal range is “TOXIC “or “poison” and affects, many organs (head to toe).

Normal range blood sugar 70-90 m /dl (ideal

Prediabetic 100-125 (fasting)

Diabetics greater than 126 mg/dl (repeated to make sure no lab error)

95-100 mg /dl is not ideal, even at this range there is an increased risk for heart disease.

The metabolic disorder of diabetes is abnormal, insulin-secretion, action, or both.

What is Glucose?

Blood glucose is another name for sugar, and it’s the role of the pancreas, an organ behind the stomach, that processes glucose metabolism. (Definition of metabolism – a chemical reaction in the body’s cells that change food into energy).

Two types of cells are in the pancreas and are involved with the metabolism of food. One type is involved, producing enzymes that break down carbohydrates, proteins, and fats into smaller components that can be absorbed into the bloodstream and used for energy and building the body.

The second type of cell called Beta-cells produces a hormone called INSULIN. Insulin is the key that opens a door for glucose to enter. To keep blood glucose within the normal range, with the help of insulin glucose enters, cells for energy production, and the unused glucose is stored in the liver, muscle, and other cells, for use, when needed.

Normal glucose metabolism: Glucose is the primary energy source of food for the body’s cells. Carbohydrates are converted to simple sugars (Glucose) in the bloodstream and used for energy and building the body.

How diabetes develops:

Diabetes develops when the body’s normal sugar regulation becomes defective, resulting in high blood sugar.

The two major types of diabetes:

Both have similar symptoms due to high blood sugar(glucose) but different causes:

1. Type I – no insulin(autoimmune)

2. Type 2 -insulin resistance.

Type I.

The body’s immune system thinks the insulin-producing Beta cells are foreign and destroy them. This is called autoimmune. People with type 1 diabetes are diagnosed during early childhood or early teen years. In some, it may occur earlier but in others, it may occur over years. The result is the body being unable to produce insulin and the patient will use insulin injections for the rest of their life (tablets do not work for type 1).

TYPE 2 Diabetes( the “ Black Death” of the 21st century)

Some experts call type 2 diabetes the “BLACK DEATH” of the 21st century because of its rapid spread worldwide and its catastrophic health impacts. In the 13th to 14th centuries, the bubonic plague decimated Europe’s population. A bacteria transmitted by a flea from rodents killed around 20 to 25 million people (about 1/3 of Europe). It was called the “Black Death” because the dead people’s skin turned black.


Diabetes is the leading cause of death worldwide (over 5 million death yearly)

No country in the world is spared. Diabetes has the greatest impact on the world’s health and economy. According to THE LANCET, diabetes is one of the leading causes of death and disability worldwide. The Lancet systematic analysis of the Global Burden of Disease Study 2021 result

showed 529 million, people living with diabetes worldwide. According to the International Diabetes Federation (IDF), the global prevalence is projected to be over 783 million people with diabetes.

The increase in global health expenditure due to dates was us $966 billion in 2021 a 316% increase over 15 years (us $232 billion in 2007)

The IDF estimates diabetes health expenditure will reach US $103 trillion by 2030 and US $ 1.05 trillion by 2045. Three-quarters of those affected by diabetes live in low and middle-income countries.

IN AFRICA: there is a lack of awareness and access to healthcare.

Three out of five people with diabetes in Africa remain undiagnosed.

People are generally diagnosed after living with the disease on average for seven years which has already done much damage.


Type 2 diabetes is a complex, chronic, and progressive disease. Factors that cause diabetes are an interaction of genetics and environment.

The Following are contributing factors for type 2 diabetes.

1. Lifestyle: A. Dietary factors include Westernized life, excess animal fat intake, highly(ultra) processed, added sugar and salt, and sugar-sweetened beverages.

B. Sedentary lifestyle

2. Obesity (central obesity, belly fat) accounts for 80-85 percent of the risk of developing type 2 diabetes. The risk of type 2 diabetes increases as the body mass index (BMI) increases above 24 kg/m2.

3. Metabolic syndrome – discussed previously.

4. Family history of diabetes (especially mother’s side)

5. history of Gestational diabetes (diabetes during pregnancy)

6. PCOS (polycystic ovarian syndrome)

7. Dyslipidemia (a term for abnormal cholesterol): high Triglycerides and low HDL(“good”) cholesterol.

8. Age

9. Hypertension (high blood pressure)

10. Decrease sleep, some medication, and environmental toxins (air pollution of urbanization)

INSULIN RESISTANCE- the hallmark of type 2 diabetes:

Insulin resistance is accepted as the cause of metabolic syndrome, prediabetes, and type 2 diabetes.


BODY FAT: The fat we eat and the fat we carry. A comparing two groups: Those fed a fat-rich diet vs. carbohydrate-rich diet showed that insulin resistance was high in the fat-rich diet group. Fat in the muscle and liver interferes with the action of insulin. Insulin is the key that helps to unlock the door to cells, but saturated fat gums up the lock. The fat deposited inside the muscle cell is called intramyocellular lipid(fat). The fat inside the muscle cells makes toxic breakdown products that block the insulin signaling process. As I will further discuss the management of diabetes, decreasing fat intake and losing weight will lower insulin resistance (works efficiently).

The type of fat in animal fats (saturated fat) found in meat, dairy, and eggs is the primary cause of insulin resistance.

Saturated fat may also be toxic Beta cells (which produce insulin) of the pancreas. The pancreas contains about 1 billion beta cells. By age twenty the body stops making new beta cells. After that whatever is lost is lost forever. A reduction in Beta cell volume of up to 60% has been found in

prediabetic people and a further reduction in people diagnosed with diabetes.


It is the ugliest disease to get. It affects head to toe.

1, heart disease: diabetes is designated as a cardiovascular disease equivalent, which means a person with diabetes especially uncontrolled has an equal chance of heart attack as a person who already has heart disease (heart attack). Death from heart disease and risk for stroke is three times higher than no diabetes.

2. High blood pressure – about 75% of diabetes have high blood pressure.

3. Blindness – Diabetes is the number one cause of blindness.

4. Kidney failure- diabetes is the leading cause of kidney failure (one in three kidney dialysis patients due to diabetes).

5. Nervous system – loss of sensation in the feet, and impaired digestion.

6. Amputation – diabetes is the leading cause of limb amputation.

7. Cancer – increased risk of cancer, 30% increase in colorectal cancer

To be continued – management of diabetes

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