How Diabetes Works

I'm Josh Clark, There's Charles w Chuck Brie, there's Jerry over there, and here we are doing maybe what's gonna be the best episode of Stuff you Should Know We've ever released? Jerry's back. Yeah, welcome back Jerry from hospice. You said she just through her her can of carbonated water down and belched. Is gonna name check it, But I'm glad you didn't. Man, we do enough buzz marketing as it is. Seriously, we can never do enough of that. I agree. Um, So, how are you feeling? Okay? Yeah?

I feel like this article has ticked me off, though it is it's not that that Freud and Rick who is that? Yeah, the only PhD how Stuff Works. Ever, it's it wasn't he didn't do anything wrong. Like the logic behind the copy layout is what does it? It is almost like designed to keep from sticking in your mind to information you're reading. It's like, it's like if a person who in a grocery store put the milk together with like the canned spinach in an aisle and

expected people to be able to find it. All right, all right, it's got worse than that. The cheese puffs and the game, the cheese puffs and the cash shots. Actually the little I can do this. Maybe by the end of the episode, I'll have it. But the point is, how about the oatmeal with a pickled herring? Okay, it's funny that you, like, we're picking things are still in the same unit. My imagination died at age ten. I

just thought I turned into a robot about that. I thought it was a pretty dry article though, that was like none of the character of How Stuff Works articles that it read like a medical journal from the nineteen fifties, a diabetes how to article. Yeah, I was like, boy, how are we gonna make this fun? Well, that's our job. I know. So let's get started making this fun. Huh. Yeah, how about some stats, yeah, because these are pretty outdated. Uh,

it's gotten way worse since this article. It has, and we're talking about in the United States, but in the last twenty years, type two diabetes has tripled. Eight four million Americans now have pre diabetes and don't know. Yeah, that's startling. Yeah, we'll we'll get into pre diabetes in a minute. And about thirty million people currently have diabetes in America type two or total I think total at a total cost of um, including lost wages, about three

hundred and twenty seven billion dollars a year a year. Yeah, in the United States alone. I saw worldwide something like four hundred million people have diabetes and America makes up how many of those? Uh? Yeah, okay, which is surprising because it didn't used to be that way. It used to be like a wealthy Western disease, and all of a sudden it's starting to spread throughout the world, which is really kind of shocking and jarring. Like this is

a huge increase in this disease. It's become a really big problem for not just like healthcare networks, but you know, the people with diabetes too. They're dying from it something like a million and a half deaths a year in the world. Yeah, it's it's a seventh leading cause of death in the the United States right now. And it's here's the thing. It's the type two diabetes is, from what we understand, utterly preventable. It looks like it is utterly

preventable from what from what I've seen. Not one single person who has type two diabetes has to have it like they were genetically destined to have it, although there is some other evidence that we'll talk about that suggests otherwise. But I don't want to give anything up. Yeah, but I mean we can pretty much say now that it is let's just go ahead and say largely caused by being out of shape and being overweight and eating like

terrible stuff all the time. Yeah. I love this article, Chuck, because it's one of those ones where it's like, oh, all of this makes total sense. Like I love the body just like I love Earth sciences. It's just we can kind of it forms a system that we can understand, and like when you understand this one part, you're like, oh, this other part that happens makes total sense. That's diabetes. Yeah, I hate the buddy in our sciences, I like um mysticism and cosmology and dreadlocks. Oh boy, why do we

do that show on that? I was thinking of one the other day that we did Jackammers. No, it's even even worse than that. Oh I can't remember, but I was like, why did we even attend that one? Occasionally I'll look through the old list when we're picking out selects and I should go, what to myself? It's weird? All right? So we need to break down did mean that pun? A lot of breaking down in this in this show, you know what I mean? That was sort of a deep that was a foreshadowing punt, how it was.

But we do need to break down the whole spiel with glucose and insulin, because the root of at all it's a disorder of glucose disorder. Yeah, it's a disorder of both will yeah, either be fair either high or low or none? Yeah. So okay, Well let's talk about glucose first, all right, Well, before we even talk about glucose, we need to define what a simple sugar is, or a simple carbohydrate it can be called. These are carbs

that are absorbed very quickly for energy. And they're called simple because they only have one or two units of sugar as opposed to like a complex carbohydrate. And glucose is a simple sugar, right, And since it's a simple sugar, I think that means it can be broken down from different types of complex sugars, So not just like sugar, but carbs like you said, right, yeah, And this is the sugar that gives all the cells in your body energy to do sell selly things. Enters the bloodstream through

the intestine. All the cells are like, give me some sugar, baby, yeah. And this comes from the foot food food that you eat. It really does. Right. So you eat some food, particularly say a carbohydrate rich food, and your guts start to break it down and it breaks down ultimately to that glucose, the simplest form of sugar that the body can use for energy without being stripped down further, and it shoots out through the blood stream and it's just a free

for all. Right. Cells, like you said, use this stuff, and some cells in particular use nothing but glucoset, some use glucost and like other stuff like a TP, which of those red blood cells. Brain cells quite importantly use nothing but glucose for energy, So glucose is extraordinarily important. Yeah, and what your body wants to do. We always talk about that homeostasis. There's another example that your body wants to keep a constant glucose supply for your cells. We

don't want it to be super high or too low. Uh. And it does this in a pretty interesting way. Otherwise, when we like right after we eat, we'd be great. And then if we didn't eat for a while or went to sleep at night, potentially our organs shut if we slip along. And because again this is the stuff that fuels your cells. Your cells need fuel twenty four hours a day. It doesn't care whether you're sleeping or not. Right, that would solve everything. If your cells went to sleep,

it would when you slept, they just stop yapping for once. No, they're always talk talk talk, which actually I guess it is good because again, if your cell stopped working, then you die. Right, Okay, So that's glucose energy That power sells some cells exclusively, and your body wants to keep an eye constant level. Yeah, and you get it through food,

which could conceivably spike your glucose. So when you eat something and all of a sudden, you have a surplus of glucose rather than that even keel homeostasis glucose in your bloodstream. Uh. Your body has a way of dealing with this, and it's called insulin. And insulin is one of two chemicals that are made by the pancreatic islets. I s l et islets, right, I don't know, did you look it up. I think it's islets, like islands, like it means like tiny islands. That's probably it. And

they're they're they're called tiny islands. That's what we're gonna call them from now on because I don't want to get it wrong for the rest of the episode. But they're they're called tiny islands because they're indeed little endocrine cells inside your pancreas, so they're they're embedded like a journalist with a troop detachment. Basically. Yeah, so you're pancreas in uh In in this case is producing to insulin and glcagon I'm sorry, glucagon. Glucagon glucagon or alpha cells

produced by alpha cells and secreted by alpha cells. Insulin are the beta cells. All of its produced in the pancreas. Like you said, with those little islands. But so let's focus. And here's a better one than than a military um uh analogy a post office in an airport. It's like here, we're gonna serve you, our customers. We're just gonna go to you. Do they have those? Yes? Some do? Man. I think there's one of the Toronto Airport. Yeah, there is, y y z so um who thought that was gonna

come up? Huh. So you've got these little cells that are specialized to create insulin, to release insulin from the liver um, you know, from the pancrease, I'm sorry. In response to glucost becoming abundant in your gut, as you're digesting it, your gut sends out signals saying, hey, I got a bunch of gluecoats here. You guys want to do something, and the beta cells say we're on it

and start releasing insulin. So insulin enters the blood stream, and its whole jam is to take the glucoast that enters the blood stream and give it two cells and it doesn't just push it down the cells throats. Apparently the cells have some sort of say in whether they accept gluecoast or not. But the only The only person they're going to accept glucose from is insulin, So insulin

will take this gluecoast too. Different types of cells and with different cells, Um, different things happened to it, right, Yeah, Like it depends on what part of your body. If you're the liver or muscle cells is going to store that glucose and something called glycogen. Yeah, it's like just chains of glucose, right. Yeah, it's gonna stimulate fat cells to form fats from fatty acids and glycerol. Uh. Then the liver and muscle cells is gonna make those make

proteins from amino acids. Yeah. And these are like the three base proteins or based nutrients that you get from eating food, right, amino acids, fats, fatty acids, and glucose. Correct. And then your body makes use of those because insulin deliverism two cells around the body. Yeah, then it's gonna inhibit the liver and kidney cells from making glucose. Uh. And this is something called gluco neo genesis, which is

confuse me just a little bit. Why, Yeah, because it just I don't know something about the metabolic pathway, Like I don't know I didn't fully grasp it. I think what it is is that maybe my answer is just I'm not smart enough to get I don't think that's it at all. If if anything, yeah, that's your problem. Um. If anything, it was the article Chuck not you. Well, now this article is pretty stinky, but also went to

kids health sites like I always do. But it makes sense, and that like if you will die, if you don't have the source of of energy, you're gonna have some backup plan. And the backup plan is, well, we probably have some constituent parts that we can put together to make our own glue cose. So that's like Plan B is make your own glue cose. And that's Gluco Neo Genesis. Okay, that's what I think. I mean, that's my interpretation. And I play a doctor on TV. Dr Drake Remore. What's

U from those Friends? You probably didn't watch Friends? Did you? I saw an episode or two. I love that. Were you into Friends? Oh yeah I still am? Yeah, I'll watch those reruns. Oh really? Yeah, it's funny. It's very dated show now. Oh man, the clothes, the hairs, the white people. Yeah, I mean everything about it that they hung out at a coffee shop when that was new, because if you cast that show today, it would look

like a Bennetton Colors ad. And rightly so, probably so. Alright, So at the end of the day, though, insulin is gonna store nutrients right after you eat that meal, but by reducing these concentrations of glucose and like you said, the fatty acids and amino acids, those three main components, right, which is pretty interesting because you really only hear of insulin dealing with blood sugar, but it deals with the main three nutrients. I didn't know that before, did you.

I don't think I did. It's a it's a pretty handy little hormone to have, and by the way, it's a protein hormone. Glucos gets all the headlines it does because it's the troublemaker. And we'll see what happens when insulin can't do its job. What you get his diabetes and the symptoms of diabetes. We'll talk about that later, but first let's talk about glucagon. I thought you said for a second, the Simpsons of diabetes. The symptoms, Yeah, I know the Simpsons. No, the who would have diabetes

on the Simpsons? Oh? Probably Homer and Wigham, yeah, I guess and Barney yeah, and well that will become clear as we explain diabetes more. Right, But let's talk about glucagon real quick, because you've got insulin doing its thing, and it's pretty clear now what insulin does, but there's another hormone that does the exact opposite that comes from those pancreatic tiny islands too. Yeah, this I thought was pretty neat as far as that homeostasis, that the body

has like two methods to deal with this, you know. Yep. So like you said, if you go without eating or you um sleep, if your cells don't get that glucose that they need, they starve and die. So while you're sleeping and not eating, your your cells are still powering. They still need that energy. So your body has a way to deal with this, and it is by producing glucag glucogen, right, Yes, And it's a little confusing because it's glucagon and glucogen. Oh yeah, I'm talking about both

with the G. Glucagon is what I'm talking about. That's how your body deals with a lack of a flood of new glucost being introduced from food, that's right, And that comes from the alpha cells of the pancreatic islets, right yeah, and it it acts on those same cells, but it just has the opposite effect, which is pretty cool.

Like in the end, it's gonna like when you're sleeping and when you're not eating, it's gonna mobilize glucose and where it's stored up your body and say, hey, we need this stuff now, right, So it goes to the liver cell and the muscles and the muscles and says, hey, you remember the the glucogen. Isn't that what the chain

of it's called, Yes, glycogen. So the the glucagon goes to the liver cells and the muscle cells, right, and it says, hey, you remember the chain of glucose that you made the glycogen the other day, Well, we need it, and so break it up and spit it out to me and I'll just get it into the blood stream. And it does that to the liver and muscle cells. Um. It also tells the kidneys and liver It says, by the way, liver, while I'm here, why don't you kick

off some gluco neo genesis to make some glucose. And so all of a sudden, the low blood sugar in your blood stream comes up to normal, and your cells all say hooray, we're saved, and insulin gets a lifted up on everybody's shoulders and all the cells carried around for triumphant fist shaking um parade. Yeah, and it's pretty great because this is all happening when you're sleeping. This is right. So all this, this is how your your body keeps homeostasis for your blood sugar in your blood stream,

your cells powered, if you're healthy. If this goes wrong, well you'll find out all about that right after these messages. So I don't think we mentioned that there is an ideal level here, and that's about ninety milligrams per one milds of blood for your blood glucose concentration or five millimolar. Yeah, and they, uh, you know that you can get this tested. They have little strips where you can poke yourself in

the finger and bleed on the strip. Yeah. So this is apparently the most complex thing I've since the breathalyzer. You glucose call tolerance test um with a I'm sorry, I guess that's not it. It's a gluck glucose meter. You prick yourself and bleed onto that little strip of paper, like you were saying that the blood react with a

chemical or with an enzyme I'm sorry. On the strip it's called glucose oxidase, and so that creates an entirely new compound, gluconate, which combines with another chemical, and that turns the strip blue. Right, And so you would think, okay, well, if it's blue, it's um it's it's I'm diabetic or I'm in trouble. If it's not blue, I'm fine. No, what the what the diabetes testing apparatus, I think that's what they're called. Does it analyzes the shade of blue

that that turned? That's that's complicated. That's that's maybe the best blue. Really, sure, it's a good second. That's the only two blues, right, But I thought that'd be pretty cool if that's how I did do it. I I was like, oh, this is Robin's like, that's navy, this is cerulean, cerulian, you're in trouble. Well, that's not how they used to

test it though. In fact, the full name for diabetes is diabetes, and militis M E L L I T U S, and that literally means sweet urine, because in ancient times the test involved the physician drinking your urine and going taste sweet. You're in trouble. You're in trouble. You're in trouble. So if you say that you have that sweet diabetes militis, you're saying you've got that sweet

sweet urine. You know. I wrote a back in the day when I was writing spec scripts when I lived in l A. I wrote a seventies show script and uh it was a Halloween episode where Eric pete his pants at a haunted house and the title of the episode was urine for a Treat. Oh that's great, man. I thought that was enough. It was like, man, they're going to see that. That's it. You gotta publish those. I'm gonna be I should take that up, surely. I

mean I don't have like a digital copy. I'd have to literally find the paper, take a how many pages do you think? I think it was like twenty four to thirty perfect, take a photo of each page. Why they didn't like it? Posted on Instagram a page day for a month. People will go crazy for it. They would love that. That's probably one of the better things I ever wrote. Oh, good out there like it was a legit sevenies show episode. I'll ever tell you about

the Simpsons script I wrote not enough about. So remember the one where it turns out that Principal Skinners actually arm In Tanzarian. That's one of the great episodes. This one is if you If you remember, you know that's Matt Greening's most hated episode. I think he hated that episode, that one. I didn't know that at the time because I wrote this on spec to hoping that they'd notice it um although I never sent it in UM. But the at the end of that episode, they the judge

says that it's you. They're You're never allowed to speak of this, punishable by death or something like that. So my episode starts with one of Armor tans Arian's old friends coming to Springfield to start his life, anew Ida, and he sees Principal Skinner and says, hey, arm in Armor Tansarian, And all of a sudden the police surround him and he's taken away to jail and held UM and it gets out he escapes, I think, gets out, and then Clinton was president when I wrote this, Um,

he gets out. Somehow it gets to like Clinton that this town is like holding people hostage basically unconstitutionally, and so Springfield gets invaded and yours was eighty pages long. Uh no, I think it was like appropriately Yeah, I think so. Actually, I imagine a different life where uh I wrote for the seventy show, that seventy show, when you wrote for the Simpsons and we like eight lunch together on the Fox slot. Can I that'd be pretty cool?

You know? Can I tell you something though, I would I prefer this. Oh yeah, yes, I prefer what we do. As someone who's never written for The Simpsons, I prefer this. Hey man, I've been to the writer's room before. I know what it looks like to chain him to the desk. I like it. We get to we don't have to live in l A. Yeah, I like l A. I've noticed a lot of our friends from New York are starting to move to l A. Have you noticed that it's like a hemorrhaging? Al Right, should we get back

to diabetes, we should probably just edit all that out. No, I think that's a nice tangent. Al Right, So in the case of diabetes, like we said, um it is, uh, well, we already said what it was, but there are three types, type one, type two, and gestational diabetes. Type one is by far the in the minority. It's um. It says here five to timber cent. But I saw like kind of a straight up five number for the number of diabetes cases overall. Okay, um, But they say five to

tim percent in this article. Or it's called juvenile diabetes or insulin dependent diabetes. Uh. And this is caused by a lack of insulin, either not much insulin or sometimes no insulin at all in their blood. And this is this is clearly genetic, right, it says an also could be environmental, but yeah, they think it's possible, possible that it's caused by a virus. Exposure to a virus earlier

in childhood. Interesting that sets off an autoimmune reaction, and so your immune system attacks your beta cells that produce insulin and just destroys them, and so you don't produce insulin. And it happens in your your younger years, maybe adolescence, which is why it's called juvenile diabetes. And you when you have type one or juvenile diabetes, you are you're dealing with it for life. And we'll talk about, you know, managing and treating diabetes. Um, but there's no cure for diabetes.

But the idea that it's possible that this is the result of a virus has made some people call for research into a type one diabetes vaccine. Interesting, which would just change everything for some people. Yeah, because I mean, like, I don't like it's certainly not like you get what you deserve kind of thing with type two diabetes. But type one diabetes. Man, you've got zero saying that's whatsoever. Yeah, so type two is the one that's most prevalent between

adult onset diabetes. That is, when uh, you are usually over forty um, usually between fifty and sixty. Even I'm so nervous you were usually overweight. Why are you nervous. I'm just nervous. I'man end up with type two diabetes. By I thought you meant you were going to say something wrong. No, I'm nervous. You're nervous about diabetes too. Yeah, it sounds like it's virtually predestined that we're going to

get it. I don't think it's in my family. But I'm overweight and forty seven years old, and like, you need to get my act together, Like now, yes, you know it's not like, yeah, I'll wait another five or six years and then tackle it. And there's no reason for us to like just put it off until the end. We can say, like you can you can reverse pre diabetes through diet and exercise. You don't. Even if you have pre diabetes. You can, which is you have higher

than normal blood sugars. We'll see, but you don't have full blown diabetes yet. You can actually reverse course, like it's not too late doing something like what you're talking about, and it's great. This is a wake up called like your body literally can inch up to that line and if you do the right thing, it can go whoa, All right, yeah, I'll back off then. I like, I like the way you're going here, Like what I'm saying, give me some more less celery, baby, get on that peloton.

Chuck that that was a buzz market right there. Well they're an advertiser with us, are they still? Well? They were, and I still have that thing. I love it. It's nice. I just need to love it every day, not like I love it every couple of weeks. That hill, you know, anyway, Type two, like I said, is about and this is when you have higher insulin in your blood not lower like in the case of type one, right, because you

have a lot of insulin. It's just not working, which is why type two diabetes is also called insulin resistant diabetes. Is that right on? Insulent dependent or insulent resistant? Yeah? Okay, yeah, so that means that your body is producing insulin just fine, but for some reason or another, and this seems to be the mystery at the heart of diabetes. Your cells don't respond to insulin anymore. They won't say, oh, it's insulin, sure, bring me some glucosset, I'll turn it into a chain

of of glucose. They don't know exactly why, right, I mean, that's what I'm saying. That's that's why it's the mystery at the heart of diabetes. They don't know what the problem is with insulin. If they could figure that out, I think that they could actually cure diabetes. Instead, what they've learned to to cure is some of the problems associated with it, which is but they do definitely know it's for sure linked to obesity, Yes they do. So that's type two. We'll talk a little more about how

that actually works. As far as you know the the effects that it has on your body. But one of the some other research I found was that there's some evidence that it's possible that type two diabetes, the actual mechanism of it, is the result of folded, misfolded proteins. So the same type of thing is like mad cow disease or guru that you get from eating like brains

with some sort of sponge ofform disease. Right, remember that we talked about that vaguely, So, um, they think that it's possible that type two diabetes is the same thing misfolded protein. And the third one it kind of relates to type two diabetes. That seems as well, just stational diabetes. Yeah, this is Uh. If you're a pregnant woman, you can have or acquire I guess gestational diabetes. Um. The good

news that usually will go away after your baby is delivered. Um, but it can put you at risk for type two later on. You're more at risk if you're over twenty five having a baby, if you have a baby over or have had a baby over nine pounds. Oh yeah, uh yeah, if you are overweight, if you have a family history of it, or if you are African American, Hispanic Latina, or Native American Native American Pacific islander, and I believe that's it, okay, so um, which is interesting,

it really is. And I I didn't see anywhere why they thought that, I think, really different different ethnicities, Yeah, why they would be at a higher risk than I don't know. So um, I think that I get the impression, Chuck, that there's been like the American Diabetes Association has been around for a while and all that stuff, and they've

been trying to do what they can. But then this this enormous spike in diabetes cases in the West and now the world has really kind of drawn attention and funding to it, and we're now really diving in to figure out what's going on. But we haven't figured it out yet, which is where we are right now. I'm sorry. One more thing, um, gestational diabetes they think can actually be passed down as type two diabetes. These to the offspring's interesting, that's yeah. Wow. Yeah, So we're just learning

about all this stuff now. Alright. So symptom wise for all three versions and types of diabetes. Uh, Polly, Well, why should I say that when I can just say you're very thirsty, Polly dips you. You means you're very thirsty, you urinate a lot, uh if you're always hungry. Uh if, but you are also losing weight and you can't explain that. Yeah, I didn't know that part about diabetes. But now that I understand diabetes, that makes sense. Yeah, um, glucose in

the urine. That's sweet, sweet taste of urine. Uh. Fatigued a lot, tired, blurred vision specifically like changes in your vision, um, numb hands and feet, fingertips, slow healing wounds, and then uh abnormally high frequency of infection. Right. So that's all the Those are the symptoms, and they'll make sense once

we explain what's going on behind them, right. Yeah, but in some of these symptoms though, in fact, a lot of these symptoms can be other things too, which is why it's sort of distressing to be doing research on this and be like, well, wait a minute, my I need glasses to read now. But that also and so for forty, I'm tired a lot. That also happens when you have a three year old. Um, I have a lot of slow healing sores. No, I'm just kidding. My

phote was just amptutating because I had no sensation. I do I get numbness in my hands and feet sometimes when I sleep, but that's been happening since my early thirties here and there, and that just could be because you're you know, I sleep with my arm up and stuff like that. So you know, I'm reading this stuff and I'm freaking out. Go to the doctor. No I do. And last time I went there, my blood sugar was fine. I go every March. Oh, you're good, except I didn't

go this March. I didn't either. I've been going every year and then skip this year, and now, um, we're about to I think we just found a new doctor who specializes in diabetes. I'm so nervous. I'm like, is she is she one of those doctors who like is like a hammer, so everything looks like a nail. Just gonna be like, you have diabetes. I'm gonna trick myself

into actually thinking it. Yeah. I did the dumb thing this year, which was, oh geez, I gain weight last year, Like I'm gonna take your off and get back in shape like that. I can't this, which is the opposite of what you should do. But I was like, I can't face my doctor because when I go in there, he's like what are you doing, dude. He's very just a matter of fact about everything. It's like, what are you doing? You want to be one of those old

guys with diabetes R laying around. He'll say that stuff to me. I know. He's like, good, well, you know it's up to you. It's good to hear that. Yeah, I mean, you need that kind of straight talk from a doctor. You know, they say or I've read that. Um. Weighing yourself every week if you're if you're trying to lose weight, it's bad, No, it's good, or I should say I've seen some you shouldn't it's too much. Yes. Because your weight fluctual so randomly throughout the week, you

can get demoralized. You want to do it once a week at the same time, usually right after you get up the same morning every week, and then you will see whether you're going up or down. You'll really be able to see four times a week, you're just like all over the place. It doesn't make any sense. You can't make heads or tails of it. Once a week at the same time that makes sense, and it has the psychological effect of being like, well, I don't want to I don't want to see it go up. So

I'm gonna, I'm gonna, I'm not gonna. I'm not gonna eat that chocolate cigar. Now you have to step on the scale. Oh yeah, yeah, Like I said, I weigh myself too much, but I'll kick it down to once a week. All right, let me know you, thank you, thanks for doing that. Oh should we take a break? Is it is this episode still going on? All right? Then? Yes,

all right, we'll be right back. All right, chuck. Yeah, Now we get to the point of the article that's called let's try and confuse people as much as possible. This is where the grocery store starts putting weird stuff next to other stuff and expect you to just pretend like everything's normal. I tried to just mark the relevant parts to make it all makes sense and streamline it, and it still was confusing. Great, everybody, I just cracked my knuckles. That means it's you just turned to chare

around backwards. Prepare, Prepare for the monotony. Ready the monotonous droning. Right, which is basically, how does this out as a lack of insulin affect your body? By Josh Clark. Yes, so, well, let's take different ones. Right, you've got um blood. Well, see here's here's a good example. You've got glucose appearing in your urine above urinating frequently, but logically glucose appearing in your urine should follow after it and be in

the same thing. So we're gonna start with your urinate frequently. Poly dipsy I think is what, or no, poly syria is what. It's called polyuria. So that just means you pee a lot, way more than you normally would if you didn't have diabetes. And this is actually easily explained. Right, You've got a lot of glucose in your kidneys because it's in your bloodstream and your kidneys are you're the filter,

one of the main filters for your body. Um, and so when you have liquid waste, it goes to the kidneys, and in that liquid waste is a lot more glucose than your kiddies are used to processing, and so they become overloaded. There's like a backup of glucos right, pretty simple, easy peasy, um. So since there's a backup of this stuff, um, the actual the actual thing that shoots urine off to your your ethra, right, the tubule illumin it becomes backed

up with glucost as well. Yeah, because glucose retains water, right, which means the tubule alumin says, well, I should probably get rid of some of this and I'm gonna start peeing. So you start peeing more and more, right, Okay, that's one effect of it, and that will also help make you thirsty, which is another symptom. That's another. It's like a vicious cycle. Right. So you start drinking more, and that is another symptom. So you're drinking more, but you're

just peeing more because there's so much glucose in your blood. Now, because there's more glucost in your blood and you're peeing out more water from your blood stream than usual, your blood actually becomes a little thicker, yes, and you're also losing sodium. Okay, right, so you're peeing a lot more. You're drinking a lot more, but you're just peeing it right out. Your blood is becoming thicker, So your body says, whoa, whoa, something's a little off. I need some water and becoming dehydrated,

sending out this thirst signal isn't working. I'm gonna steal some water from the organs, right, do they actually become a little dehydrated. But the them as it doesn't solve the problem because there's still all that glucose overloading your kidneys. You just pee that water out, so again you're constantly thirsty. There's a glucose that appears in your PA, which is how ancient doctors um said, Yeah, you've got the diabetes and you um, your your organs already hydrated, which is

a bad jam. Yeah, and I think they liken the thick and blood to like a molasses consistency, right, not good. This article isn't touch on it, but that leads to another thing that's usually or often comorbid with diabetes is hypertension high blood pressure because you're your your heart is requiring more energy to pump this blood because it's thicker, and it's actually really hard on your blood cells as well, and that can lead to all sorts of things from

cardiac arrest a stroke. So you can get all those in addition to diabetes just from having thick sweet blood. Molasses blood dick and sweet is usually good, but not in this case. Maybe if it's in the syrup that you're eating that will eventually give you diabetes, it's good h All right, now where does that put us? We're going back up to the top. Yeah, we should, we

should participate in confusing people along with this article. Right. So, the whole reason you have high blood glucose levels UM is because your body is not responding to insulin, right, right, So because the insulin is running around going guys, guys, what what I do? What's the problem? Take this glucose and the cells just turned their back on the insulin,

and the insulince is sad. You'll have a lot of insulin in your blood stream, it's not doing anything, and so there's some other secondary alarms that your body sets off saying we've got a lot of we got a lot of insulin in the blood stream, but our cells aren't getting any energy. They're starving, so we need to start producing our own glucose. Right, And that's where the glucagon. The alpha cell secrete that glucagon and those levels rise

in your blood stream. That acts on your liver and muscles like we talked about, to break down that glycogen uh and releases well too much glucose into the blood in that case, right, which is one reason why you suddenly lose weight inexplicably despite eating all the time or being hungry all the time, because as far as your body is concerned, it's it's all it's pretend like your body can't tell that there's a problem with the insulin.

All it knows is that the cells are starving. It's it's like it's lacks some sort of uma to show how much um, how much blood sugar there actually is in the blood stream, or how much insulin there is, and that there's something wrong. It just knows the cells are starving, so it kicks off this thing where it makes its own glucose, which just raises the levels even

further and exacerbates the problem. Right, Okay, so you're constantly hungry because your body thinks your cells are starving, but you start to lose weight despite eating, because it's also attacking those stores of um glycogen, those glucose chains, and you're just you start losing weight despite eating a lot. Yeah, you're tired. That was another one of the symptoms because you're not absorbing that glucose, so it's not doesn't have

anything to burn for energy. Your hands and feet, remember I talked about them feeling numb or cold, that's because it increases osmotic pressure of your blood, draws the water from your tissues. That means your cells becomes everything becomes dehydrated. And again that goes back to the kidneys. Uh, the water in the blood is lost as urine because you're being so much, you're literally pissing it away. Yeah, seriously, And that basically that's what makes that blood thicker, which

leads to poor circulation. It's all. It sounds confusing, but it all kind of makes sense in a cyclical way. And so the poor circulation leads to its own cascade of problems. Right, poor circulation means that you have less feeling and sensation in your extremities, which means that if you stub your toe or cut it open or something like that, you might not even notice. So you have a wound that's left of fester because you're not treating it.

And then and then on top of that, because of the poor circulation, your immune system can't go to the site and help it as easily, and you're more prone to infections, which can lead to gang green, which can actually lead to amputation. All because your blood is too thick to circulate properly. Right, and that poor circulation is also what's going to lead to your changes in vision

as well. Right, So there's one other thing that happens to there's something called keto acidosis, which is where your your metabolism basically goes into the fatty acids or the fat cells and crack them open and starts burning whatever glucose it can. Um. There's there's this thing called ketosis where if you're on like a right where you it's actually as far as that cans people are concerned, that's like where you want to be because you're just burning

fat cell and you're at this buzzing level. Um, and you're you're losing weight, you're not gaining anything you can. Your skull is very prominent, it's a beautiful thing. Right. Your breath is kind of stinky. Yeah, it'll seem a little sweet. Keto Acidosis is not keytosis. Keyto acidosis is um. It's it's the same thing but to the nth degree. And it can lead to all sorts of big problems because the the the acidic keytones build up in your liver.

I think that can cause stinky breath too, right, it can acetone breath, Yeah, and it's that can lead to central nervous system problems, heart trouble, and even it can lead to coma, yeah, and hard irregularities too. It can mess your body at pretty bad. And this can be an extreme result of diabetes, which is one of the reasons it's life threatening. Man, it's a big deal. It

is so as far as monitoring this stuff. Back in the day, you just had to monitor it every day, and some people still do that with the little pin prick and uh, they're glucose monitors. But now you can add have them, Uh, you can have them built into your body. Right. Oh, that's actually that's been around a little while. So if you're type one, you have to you don't make insulin, so you have to inject it

artificially from externally. And there's like pumps that you can carry around your ware that are connected into your body that you just press a button and it um it delivers insuline. But you have to test to see how much you need at any given time, right, and if you if you put in too much insulin, it's gonna sweep up too much blood sugar. Because there's it's not like there's anything wrong with the communication between your insulin and your cells. With type one diabetes, it's just that

you don't have insuline. So when you put insulin in your body, it does, it goes to work like it's supposed to. So you have to really walk that fine line well and you probably are going to be administering it a few times a day to right, and so you've ausually around your meals and you want to make sure that you don't again put in too much or else you're gonna get lightheaded because your brain cells use glucoast and if you have too much insulin stopping up

too much glucose, your brain starves and you pass out. Yeah, it's called hypoglycemia. Uh, like you said, lightheaded, shaky um. I think most people have experienced that feeling, even if you don't have like pre diabetes or diabetes. Just that. I mean, people just call it low blood sugar, right, but it's actually probably and yeah, I guess it would be low blood sugar from an over abundance of insulin. Yeah.

The only time I've noticed that is when I eat uh something super carbi like, and I don't really do that for I don't need a lot of breakfast anyway. But if I eat just like like a big fat bagel for breakfast and then don't eat again till dinner, I'll get like a little shaky, yeah, the shakes. Yeah, but it almost feels good in a weird way, you know what talking about? Not to me, No, it's never felt like kind of high, like you're a little high.

Every once in a while, not every time, but every once a while will strike me where I'm like shaky, But right here in my chest, in my solar plexus, I can kind of feel it glowing a little bit, and it's almost it's almost like a weird high. Interesting. Yeah, and I is that that's not a normal thing. I mean, I can only speak for myself. I do know that though, if you are feeling lightheaded or shaky like that, because this is because your brain is not getting enough glucose.

And we talked about the brain was one of the specific organs that really needs it. Um. This is when you might see someone drink juice or eat a candy bar or something sweet just to get that like quick spike. But if it goes really really low, you can go into what's called uh insulin shock, where you lapse into a coma and that's serious business. Oh yeah, a diabetic coma is pretty bad because all sorts of bad stuff can happen to your brain at that time. So that's, um,

that's mostly type one. Type two is managed differently, although similarly you have to keep up with your blood sugar not nearly as frequently as you do with type one, but diet and exercise or like they just say right away, like if even if you well, let's talk a little bit about reversibility, because I saw a new study. Okay, well, let's hear it. Here's a new study that's called very low calory diet in six months of wait stability and Type two diabetes. And this was on the American Diabetes

Association homepage. Uh, and they did a study basically because it's long been thought that even though they say, like you know, if you really lose weight and exercise, it will really really help you manage your diabetes. But it's not reversible, like you've got it for life. You have to if you stopped exercising and dieting, you would exactly develop the symptoms again, right exactly. But they now say, um that it is possible with at least for the

results of the study. And here's the deal. It wasn't a very robust study. It was only thirty people with type two diabetes. UM, I think it was they didn't have a good enough sample of ethnicities. But some of the subject had diabetes less than four years, some had longer than eight years. Uh. And they found that and this is usually after a very bariatric surgery. But they did find the same results of people who just and this is dramatic calorie reduction, not just like, well, I'm

gonna eat a little better like bariatric surgery level calorie reduction. Uh. They found that immediately after an eight week low calorie, very low calorie diet, twelve of the thirty participants had fasting blood glucose levels normal fasting blood glucose levels. And then and this is the big finding, after six months of maintenance, thirteen out of the thirty, we're able to keep that glucose level below that threshold. That means that

we're seemingly reversible. But they're not making the claim like for sure, but thirty people that yeah, I mean that's promising that the people that really really lost a lot of weight and ate a lot less. An exercise were able to seemingly reverse or at least get it down to normal. But like you said, if they stopped then it it might just come right back. And that fasting

glucose level is is significant. I don't think we really said, but the fast One of the ways that they test for for diabetes is, Yeah, you fast overnight, go to your doctor and they give you a thing of sugar water and you drink it, and then they start testing your blood sugar for several hours afterward. And if you don't have diabetes, your blood sugar comparatively speaking, doesn't spike all that much because your insolence working and doing the

right thing. So if you have full blown type two diabetes and you're in the study and you go take a diabetes test and you have regular fasting level diabetes blood sugar, yeah, that's pretty significant for sure. Yeah. I hope it extract plates onto everybody else. Well, we'll see. Um, it's normally controlled through medication oral medication for type two. It's not like you're having to give yourself a shot every few hours or anything. Um. Yeah, that's that's big.

There's and there's different ways to to do it. Yeah, one one medication and I guess they just tailor it to what your specific case might they think it might warrantably. But one stimulates the pain crease to release more insulin. That's kind of a no brainer. One interferes with the absorption of glucose by the intestine. One interferes with the absorption of glucose by the intestine. Ones improves insulin sensitivity.

One reduces glucose production by the liver, stops gluco neogenesis. Yeah, one helps a breakdown um of glucose, and the other one some literally supplement insulin, which makes me curious, like, does that mean that if you if you inject more insulin and type two diabetes, you overwhelm the insulin resistance

or something like that. I don't either, but if you so, management is the right word for diabetes, Like you have to pay attention to your diet, your exercise, You have to test your blood sugar levels depending on what kind you have day to day. But there are like a lot of apps out there um to help you do that. And since we're buzz marketing, you me works with a guy or worked with a guy who's the CEO of company called Gluco g l O g L O O K O, and um, they're one of many. I mean,

there's a bunch of them. But if you have diabetes, this is probably the most convenient time for you to keep track of your diabetes because apparently it's a pain too to keep up with the tests and all of the stuff, the data and so chuck. There's like we said, right now, there's apparently it's possible maybe to reverse it. But for type one diabetes in particular, because remember you're just not producing insulin. They've actually come up with a

procedure and experimental procedure called pancreatic islet transplantation. Yeah. I saw that this has been around since like the sixties, but um, like it's not new, but I couldn't really find out if it's like the affectiveness of it now and like if it's working, Um, is it working? That's not good. If there was nothing, if you there was

no follow ups on it, that's I don't know. It says that showed promise, but the big problem was tissue rejection where it's so basically they go into a deceased donor and they remove their pancreatic islets because remember that's where the insulin and the UH glucagon is produced. Yeah,

that's like the root of the problem. And you put it into a like a syringe in a catheter and injected into the person with type one diabetes pancreas, and supposedly they'll they'll eventually attached to a blood vessel and start producing insulin. But if it that's if your your the body doesn't reject the door tissue. Yeah, I'm gonna follow up on that because I couldn't find a whole

lot about it and time ran short on me. But I do know that that's I mean, it's been around legitimately for at least three decades, and then before that with like experimentation, so I don't know. It seems like they would have had a firmer grasp on the results by that, That's what I'm saying it. It's a little like, uh, yeah, you know, we'll find out. Gluco. Have you got anything else? Gluco the app? Yeah, yeah, go get it. It's pretty cool. I checked it out. What did it say? It said

check me out? No, It's like, I don't have diabetes, so a lot of it doesn't make sense to me. But from the demonstration video, it seemed pretty robust. Yes, and then some Um. If you want to know more about diabetes, go check out this painfully confusing article on how stuff works by typing that word in And since I said painfully confusing, it's time for a listener man. Hey, guys want to share some thoughts and comments on the Skyscraper podcast. So we got a lot of feedback. We

got what do we get wrong? Steel? Yeah? Who cares? It's not like we were telling people who were going to go purify iron and then try to build a skyscraper out of it. I mean for the number of things that we say, of course we're going to get something like dead wrong once in a while. Well, this guy was nice about it, uh, and we asked for corrections. Uh.

Thank you. Guys did a great job, Josh of summarizing the issue with the thicker bass I E pyramid not being economical for the building owner for recuperating their initial investment. You also did a good job bringing up that elevators coincided allowed the jump and building height technology would allow us to build nearly as tall as you want. You just shouldn't be able to find someone willing to pay for it. The difference, however, between iron and steel is

in fact not that steel is more pure iron. It is iron with carbon added that increases UH and improves the strength and ductility of pure and or naturally found iron. Different steels have other elements added in addition to carbon, but really carbon and iron are what makes steel steel. Other elements have relatively minor impact on the properties, like stainless steel has chromium, etcetera. Uh. There are also multiple

types of footings, not just spread footings. Spread footing spread the load on underlying soil or ideally rocked because like you said, the columns going straight into the soil would push right through. But most, if not all, skyde scrapers are so heavy it's it's so far above the rock.

Then instead of spread footings, they have a deep foundation. UH. This looks very similar to a spread footing from the bottom of the concrete footing up, but then also have columns that reach further into the ground to increase the resistance to the sinking. This resistance usually is provided by those columns reaching down to very strong rock. Essentially, you're creating a large table with lots of legs that the whole building is built upon. That as an analogy I

can get down with. There you go, so look forward to coming to another Atlanta show. This is Grant Hollis, who lives right here. Thanks Grant, and he went to the Pinto show. Grant Hollis man of Steel. That's right, and Grant, I would normally just put you on the guest list for tickets, but Atlanta is always tight because their friends and family, So I'm sorry, we have to like claw them from the promoter's hand. Yeah, and we have to deny friends and family. Yeah, and they're cheap

so they don't buy tickets. They're like all right if I I'm just not coming pretty much. Uh well, thanks again, Grant, and thank you to our friends and family who show up or even consider. Shall we go to right Lands shows. If you want to get in touch with us, visit us at our home on the web, Stuff you should know dot com. He you can find our social all over the place there, and you can also send us an email to Stuff podcast at how Stuff Work. Stuff

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