How Diabetes Works

Diabetes is one of the biggest killers of people on the planet. And yet, it also seems to be tied to diet and exercise, which makes it preventable. Learn about the fascinating mechanisms that can make your body go haywire and lead to this disease. 

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Episode Transcript

Speaker 1 (00:00):
Hey, everyone, We're coming to Salt Lake City, Utah, and Phoenix,
Arizona this fall. Yeah, October, we're gonna be at Salt
Lake Cities Grand Theater and then the next night October
will be in Phoenix. And we added a second show
to our Melbourne show, right, that's right, a second earlier
show in Melbourne. So you can get all the information
for all of these shows at s y s K

(00:22):
live dot com. Welcome to Stuff you Should Know from
how Stuff Works dot com. Hey, and welcome to the podcast.
I'm Josh Clark, There's Charles w Chuck Brie, there's Jerry
over there, and here we are doing maybe what's gonna

(00:45):
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.

(01:07):
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

(01:28):
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

(01:50):
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

(02:11):
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,

(02:33):
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

(02:55):
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

(03:18):
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

(03:39):
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

(03:59):
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

(04:20):
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

(04:40):
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,

(05:01):
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

(05:25):
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.

(05:47):
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

(06:07):
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

(06:29):
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.

(06:51):
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

(07:11):
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,

(07:34):
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

(07:55):
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

(08:16):
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

(08:37):
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

(08:59):
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

(09:21):
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.

(09:42):
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,

(10:04):
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

(10:26):
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

(10:46):
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

(11:06):
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.

(11:32):
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

(11:54):
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

(12:16):
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

(12:37):
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

(13:00):
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,

(13:22):
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

(13:43):
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

(14:03):
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

(14:25):
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

(14:45):
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

(15:06):
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

(15:30):
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

(15:52):
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

(16:16):
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

(16:38):
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.

(17:15):
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

(17:35):
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,

(17:56):
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,

(18:18):
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

(18:40):
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

(19:01):
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

(19:24):
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

(19:45):
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

(20:08):
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

(20:29):
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

(20:49):
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,

(21:12):
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

(21:33):
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

(21:56):
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

(22:18):
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

(22:41):
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

(23:04):
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

(23:26):
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

(23:47):
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

(24:12):
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

(24:33):
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

(24:54):
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

(25:16):
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,

(25:39):
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,

(26:03):
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,

(26:24):
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

(26:45):
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.

(27:06):
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

(27:27):
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

(27:49):
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

(28:09):
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

(28:30):
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

(28:50):
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,

(29:15):
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

(29:36):
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

(29:59):
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

(30:21):
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

(30:41):
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

(31:04):
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,

(31:26):
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.

(31:46):
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

(32:07):
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

(32:28):
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,

(33:10):
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

(33:32):
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,

(33:55):
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

(34:18):
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,

(34:39):
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

(35:06):
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

(35:27):
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,

(35:48):
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

(36:10):
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

(36:31):
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

(36:53):
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

(37:15):
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

(37:36):
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

(37:58):
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

(38:18):
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,

(38:42):
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

(39:05):
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.

(39:30):
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.

(39:51):
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

(40:11):
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

(40:34):
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

(40:54):
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

(41:14):
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

(41:36):
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

(41:58):
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

(42:18):
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

(42:41):
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

(43:03):
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.

(43:28):
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

(43:50):
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,

(44:10):
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.

(44:32):
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

(44:55):
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

(45:20):
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

(45:43):
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

(46:04):
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

(46:27):
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

(46:52):
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

(47:16):
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

(47:37):
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

(48:01):
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.

(48:22):
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

(48:43):
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

(49:05):
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.

(49:28):
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

(49:49):
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

(50:10):
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

(50:31):
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

(50:52):
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

(51:13):
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?

(51:39):
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

(51:59):
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?

(52:24):
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.

(52:45):
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

(53:08):
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.

(53:30):
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.

(53:52):
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

(54:14):
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

(54:34):
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

(54:57):
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
for more on this and thousands of other topics. How
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