Dr Mariela Glandt

As a strong advocate of integrated treatment of patients with diabetes, endocrinologist Dr. Mariela Glandt, is the medical director of DCM - Diabetes Medical Center, a new diabetes center in Israel that strives to offer all services for diabetes under one roof.

Although the center is based in Tel Aviv, people come from south and north (Eilat to Nahariya) to take care of their diabetes when they feel that they are "falling between the chairs".

Dr. Mariela Glandt did her training at Harvard and Columbia before moving to Israel. For over a decade she has been dedicating her work exclusively to diabetes.

Given that half a million people in Israel have diabetes, and 250,000 have it but don't know it, we interviewed Dr. Glandt in order to have a better understanding of what this condition entails.

Dr. Glandt, could you simply explain what diabetes is?

Diabetes is a term used to describe the condition of having high sugar in the blood. It generally encompasses two big categories, called type 1 and type 2 diabetes. In order to explain what diabetes is, I actually first have to explain what insulin is.

Insulin is a hormone made by the pancreas whose function is to allow sugar to go from the blood into the cells in order to give cells energy. It acts as a doorman for sugar. When there's not enough insulin around, then the sugar stays in the blood and cannot be properly utilized by the cells. The other nutrients we eat, fat and protein, can go into the cells by themselves - they do not require "someone to open the door for them".

So, back to what diabetes is:

Type 1 diabetes refers to a condition typically presenting in children (but also in adults), where the body gets confused and thinks that the cells in the pancreas which make insulin (beta-cells) are foreign to the body, and hence attacks them. This is called an autoimmune disease and it leaves the patient without insulin. Without treatment, the patient would shortly die. This type of diabetes affects about 10% of the diabetic population. It was formerly called insulin-dependent diabetes and also juvenile diabetes.

Type 2 diabetes (formerly called adult-onset or non-insulin dependent diabetes) affects about 90% of the diabetic population. It's a totally different disease. Here the cells throughout the body that are supposed to respond to insulin are actually resistant to it. They are lazy, one could say. The pancreas, in response, secretes more and more insulin to overcome this resistance, but over time it gets tired and starts to secrete much less. At that point the sugar starts to go up in the blood and diabetes sets in. People with type 2 diabetes tend to be overweight.

What is the connection between being overweight and having diabetes?

We once thought that fat was just a white blob that simply stood there. We now know that fat is metabolically very active. It sends all sorts of messages (through cytokines) to the cells that tell them not to respond to the insulin. It actually creates something akin to a state of inflammation in the body. In fact, if you look at fat under the microscope, you can see cells that are present in inflammation.

What are the symptoms of diabetes?

People with diabetes feel tired and hungry. They can eat and eat, but still the sugar stays in the blood instead of going to the cells and being used for energy.  People with diabetes go to the bathroom to urinate all the time because the sugar is spilling over from the blood into the urine. They are also thirsty and often dizzy because they are dehydrated.

Sometimes their vision is blurry because high sugar concentration in the lens of the eye makes the vision foggy. The good news is that all of these symptoms go away once treatment begins.

Can diabetes be cured?

When type 2 diabetes is detected very early on, it can often be reversed through diet and exercise. Just losing 5% of your body weight helps to wake up the cells that were once resisting the insulin, to better respond to it. Exercise is also wonderful, because at the time of exercise sugar goes into the cells without the help of insulin, and hence, the sugar in the blood goes down.

But most of the time diabetes cannot be cured. It is usually a chronic condition, but one we can certainly treat. In today's world, there's no reason to have complications from diabetes.

What are the complications of diabetes?

Diabetes affects mostly the circulation of the large and small blood vessels.

When the circulation of large vessels is affected we can suffer heart attacks and strokes. When the circulation of small vessels is affected, we can be afflicted with kidney problems, blindness, problems with nerves, impotence, etc. There is no need for any of it, as long as we treat the diabetes correctly.

At what stage do you have to take insulin?

Patients with type 1 diabetes have to take insulin from the beginning. When patients with type 2 diabetes should start insulin is something which is currently being hotly debated. Some studies show that starting insulin early on gives the pancreas a rest and preserves its function for much longer. Typically, most doctors start insulin once one or two other medications have been tried, but the sugars remain high.

People are very afraid of starting insulin because they often think it represents "the end”, but in actuality, having high sugars is what leads to all the problems. If we had a way of taking insulin by mouth, then people would not be so afraid of it. And there are many companies currently working on making oral insulin.

Is it genetic?

If genetic means that we get it from our parents, then the answer is yes, especially so in the case of type 2 diabetes. 

Dr. Mariela Glandt can be contacted at mariela.glandt@dmc.org.il Tel: 03-690-0300

Caroline Chisin-Bats is CEO of DMC center.