Problemas en la implementación del Programa MAMA

After World War I, when insulin was first discovered, the medical profession thought diabetes would be totally curable as a medical problem. Diabetes was believed to be due to insulin deficiency, and everyone thought that since insulin would now be given to patients there would be no more problems. It seemed this way for a few years, but terrible things started happening to patients with diabetes who were given insulin to control their blood sugar levels. They developed eye disease, kidney disease, and, most important, accelerating atherosclerosis leading to blood vessel disease and early heart attacks. Their problems were worse than ever.

Decades later, when the insulin assay became available and doctors were able to measure insulin levels in their patients' bloodstreams, they found most interesting results: the insulin levels of type I (childhood-onset) diabetics were indeed low, but the levels in type II (adult-onset) diabetics were not only not low, but also were higher than those of people without diabetes.

It became clear that type II diabetics is a disease of insulin resistance, not insulin deficiency. Type II diabetics produce plenty of insulin, but for some reason still not enough to drive the glucose from the bloodstream into the cells.

If we measured the insulin level in prediabetic people (those who will become diabetic years later), we would find insulin levels much higher than normal. These persons consume excesses of fat, sugar, protein, and refined or processed foods and have excess fat on their bodies; as a result their pancreas must secrete increased amounts of insulin to overcome the insulin-blocking effects of their fat cells and the fat they ingest.

All overweight individuals, whether diabetic or not, have abnormally high levels of circulating insulin. In fact, being overweight can force one's body to manufacture up to four to five times as much insulin as a normal person. Many obese individuals eventually become diabetic. About 85 percent of adult diabetics are significantly overweight.

Some of the obese may never become diabetic because their pancreatic reserve may enable them to continue to produce this excessive amount of insulin for years. Even if they never become diabetic, however, the high levels of insulin contribute to their cardiovascular risk by increasing the process of atherosclerosis. Insulin increases the rate at which cholesterol-laden plaque builds up on arterial walls. The abnormally high levels of insulin produced by all overweight individuals, diabetic or not, is an independent risk factor for early

cardiac death.

After years of this unusual stress, the pancreas starts to tire out and eventually can secrete only normal amounts of insulin in response to the high demand by the body. This occurs because we all lose some beta cell function as we age (beta cells are the cells in the pancreas that secrete insulin) and excessive demand causes an acceleration of this process. Now, 8 to 20 years later, the pancreas finally says "enough is enough" and slowly stops producing high levels of insulin. At this point the glucose level in the blood begins to rise, and the person may notice the first signs that something is wrong, such as increased urination. Diabetes is then diagnosed. These are the major factors causing adult-onset diabetes.

The seeds of diabetes are planted by high insulin levels many years before a person becomes a diabetic. This is when the damaging effects of the elevated insulin begin to hurt the body, long before the disease is diagnosed. When a person first develops the signs and symptoms of type II (adult-onset) diabetes, the problem has existed for a long time. Typically the body has been battling with excessive insulin requirements and the pancreas has been overworked to exhaustion for more than ten years before the level of glucose rises in the bloodstream. If we could have tested insulin levels of an individual every year for ten years before diagnosis, we would have found high and rising insulin levels.

When the diagnosis of diabetes is first made, the individual may already have other related medical complications. In fact, many of these patients actually come to physicians because of these complications, such as a heart attack, and then the physician notices this person's glucose is a little high. But such individuals so often never knew they had diabetes until a medical complication of diabetes made them come to the doctor. This is because excess insulin is very damaging to the body—especially to the circulation, including the large blood vessels as well as the small ones in the eyes and kidneys. All those years of excessive insulin secretion take their toll, resulting in extensive damage to the body.

The tendency of the pancreas eventually to lose the ability to produce such excessive amounts of insulin may be influenced by genetics. Thirty to 40 years ago the Pima and Tohono O'odham Indian tribes of the American Southwest ate cactus, roots, berries, beans, corn, and greens. Diabetes was unknown in their ancestry. Eventually these Native American tribes adopted the standard American diet. As a result, more than half of these Indians presently become diabetic by the age of 35, although before 1945 diabetes was unknown in this population.9

Multiple other studies show similar patterns when societies adopt modern diets.10,11 _{Therefore, the inherited tendency to develop diabetes may be there,}

but that does not mean we have to stress our bodies so much that this inherited weakness becomes evident.

more traditional Native American diet of mesquite meal, beans, and cactus fruit, his weight dropped from 239 pounds to less than 150 pounds and his severe diabetes was controlled without medication.

So fat and glucose are not the only villains. The high levels of insulin present in diabetics also promote hardening of the blood vessels and aging of the body. Findings from numerous studies have shown that insulin blocks cholesterol removal, stimulates the formation of atherosclerotic plaques, and contributes to the delivery of cholesterol to the cells. Insulin also promotes other damage such as smooth muscle and connective tissue proliferation.12,13 _{This leads to}

even more blood vessel stiffness and damage, because the muscular wall of the blood vessel becomes thicker. and less elastic as the interior lining becomes laden with atherosclerotic plaque, thus increasing the diabetic's risk of stroke and heart attack.

So insulin is a great villain. In fact, if you want to have your blood taken for just one blood test that will be the best indicator of your risk for heart attack in the next ten years, get a serum insulin level, not a serum cholesterol.

Insulin obviously has some essential functions in the body. It allows the uptake of glucose by the cells, thus giving our cells energy, but it also drives the growth of fat and helps us store our excess nutrients in the form of body fat. Extra insulin also can slow down one's metabolic rate .as it efficiently aids the process of packing away more fat on the body. So the heavier one becomes, the more insulin the body needs to make, and the more insulin the body produces (or is given), the fatter—and the more diabetic, or insulin- resistant—one becomes.

So it is absolutely essential that type II diabetics maintain a slim physique. Sometimes type II diabetics who think they are not overweight can loose ten pounds of fat they didn't think they had and, like magic, their glucose levels normalize.