ßeta-cells in the pancreas are the focus of attention in the study of diabetes. They produce insulin, a hormone that is essential for normal utilization of glucose. Insulin is a signal to muscle and liver cells to uptake glucose. ß-cells are located in the pancreas in the islets of Langerhans in the company of other sensor cells that respond to blood levels of glucose, amino acids, and fatty acids. The islets have a rich blood supply are innervated by the autonomic nervous system. The brain is a very important controller of all metabolic activities. Insulin is secreted in regular pulses continuously, providing basal concentrations in the blood. On demand insulin is secreted when blood glucose levels rise.

Insulin dependent diabetes (DB1) tends to appear in children and is caused by damage to the beta cells in the pancreas that secrete insulin.  Insulin must be replaced by injection and therefore the disorder is referred to as insulin dependent.  DB1 is one of the most common chronic disorders in children. The World Health Organization's Multinational Project for Childhood Diabetes shows that DB1 rare in most Asian, African, and Native American populations. Northern European countries, including Finland and Sweden, have high rates of DB1.

DB1 is a T-lymphocyte disease in which cytotoxic T-cells recognize antigens on ß-cells.  Because of evidence that cow's milk intake can trigger diabetes in rodents, a study of diabetic children showed that antibodies to cow serum albumin and a 17-amino-acid bovine serum albumin peptide appear in some children. These antibodies would bind to a pancreatic beta-cell surface antigen. Marked cells can be destroyed by killer T-lymphocytes.

Insulin Treatment of DB2

Eventually, many if not all people with type 2 diabetes have to take insulin to utilize blood glucose properly. Beta-cell function declines progressively creating insulin dependency.

Hirsch suggested: “Treatment goals for glycemic control in patients with type 2 diabetes are often not achieved or are difficult to maintain as the disease progresses. Too often, insulin therapy is either delayed or is suboptimal. New insulin analogs may help overcome some of the barriers to insulin use. If combination therapy with oral agents does not achieve glycemic control, the addition of a once-daily intermediate- or long-acting insulin is a simple strategy for initiating insulin. The combination of basal insulin with a short acting insulin with breakfast and dinner is a better choice.”

The dietary and exercise rules we have established for non-insulin dependent people still apply. Your food intake and amount of exercise determines your success or failure. The biggest mistake is to eat carelessly and increase insulin doses when blood glucose is too high.

The kind and amount of food you eat interacts with exercise, interacts with the insulin that is injected. You respond to higher blood glucose with corrections in your food, your timing and duration of exercise, and then if necessary, increase the dose of insulin.

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