[Host's Note: The msg below is unusual... There is a long segment, a
private msg to At with details about the systems involved in diabetes.
Skip it if you like, but at the end are At's comments about learning, his
difficulties in learning about this disease, and the "tyranny of the
experts," etc. I enjoyed reading the msg. ...Rick]
Dear Organlearners,
I think that the interest of getting the facts straight Rick will allow
the following private letter sent to me. I will answer to it by two notes.
~~~~~~ LETTER BEGINS ~~~~~
Dear Sir,
I greatly enjoy your postings although I am a little lost
sometimes since the subject matter can be quite esoteric,
and sometimes a little to metaphoric, but it all stimulates
thinking, where learning starts. Recently there was some
discussion on facts and learning, and disregarding my
viewpoint an important principle is to get your facts straight.
It thus disappointed me that the information you have on
insulin action and glucose is so incorrect. I really thought
you would have been more careful, you seem to be such a
precise man.
You wrote:
> The pancreas produces insulin.
To understand the discussion below, you need to have a basic
idea of the simpler actions of insulin:
1. Glucose transport is stimulated
2. Amino acid (bricks of proteins) transport is enhanced
3. Potassium uptake by muscle and fat is stimulated.
4. Membrane Calcium and intracellular Calcium concentrations
are altered
>The insulin is necessary for the osmosis of glucose (a
>basic form of sugar) from the blood vessels into the cells of
>every organ in the body.
Incorrect:
1. Osmosis: When a semi permeable membrane separates
a solution of a protein from pure water, the water moves across
the membrane into the compartment containing the solute. This
process is called osmosis. This process does not require energy,
however the water will flow in whatever direction which will make
it's thermodynamic acitvity uniform throughout all parts of the
system available to it.
Thus you can see that glucose cannot "osmose". Glucose
enters the cell by a specific carrier or active transport system.
Glucose transverses the cell membrane using an enzyme that
adds a phosphate in the process. This is handy since the cell
membrane is impermeable to sugar phosphates, i.e. the glucose
cannot "leak" back out, and also allows for regulation of the
acquisition of carbon sources. The system also requires energy,
it is not passive and is not regulated by the concentration in
different departments. You will see therefore how incorrect the
use of the word osmosis was.
2. a second error, Insulin is not necassary for the uptake of
glucose, insulin acts as a positive regulator of the process.
What drives the process is the blood concentration, if it high,
then insulin is secreted to stimulate uptake, if the blood level
drops, glucagon is released to inhibit uptake and stimulate
production. The problem is that without insulin when the
alarm bell rings to warn of rising blood concentration, nothing
happens.
>The glucose in the cells serves as the primary source of energy.
correct
>With too little insulin the cells become energy starved.
>The result is that a person tires more easily.
incorrect. If the cell lacks glucose it uses other sources of
energy, I'll come back to that, let us first look at the primary
disaster: increased blood glucose levels:
Insulin lack => decrease in glucose use => increased
glucose levels in blood
decreased glucose supply => glycogen and glucose
production by muscle => increased blood levels. At a certain
point the glucose rises above the kidney threshold and osmotic
diureses occurs (HERE THE WATER IS FOLLOWING THE
GLUCOSE TO MAINTAIN SOLUTE EQUILIBRIUM) the result is
water and electrolyte loss, dehydration, thirst. This leads to
haemoconcentration (Thicker blood). The consequence is
peripheal circulation "failure" and a lack of oxygen, (tiredness).
The cells revert to anaerobic respiration for energy requirements,
with lactic acid production. if this continues further you have
coma and death.
I've put the facts simply for glucose metabolism. Basically, a
lack of insulin causes hyperglycemia (high blood glucose).
supply to the cells (anoxia). As a result dehyration and anoxia
occurs, and a person tires easily.
>Another result is that the limbs shake easily, trying to step up
>the osmosis of glucose from the veins to the cells.
I will not comment on the osmosis part again. The shaking is
something else. If you look at the actions of insulin, not all of
them are wrt glucose. The shaking is caused by an alteration in
the potassiom and calcium concentrations, which effects the
nervous system, and the muscular tone, and shaking occurs.
In muscle the lack of insulin and glucose uptake result in the
breaking down of muscle protein. Both nitrogen and potassium
are lost. There is a concomitant cellular dehydration.
> Furthermore, unless a person follows a diet poor in glucose (no
>sugar, > little starch), the concentration of the glucose in the
>blood rises sharply, making the blood thicker. Hence the flow
>of blood in the thin capillary veins become less.
Rubbish, the blood gets thicker due to osmotic diuresis. I
don't know where you got your information from, but it is
totally incorrect, you as a result have learnt nothing but a load
of useless incorrect and dangerous information. The result is
that you do not have the slighest idea of exactly what is occuring
in your body, and if you think that your mind is now fixing the
body since it knows what is wrong, then you will never get well
at this rate.
I will not bother to comment on the rest of your version of
diabetes and the biochemical and physiological effecys thereof,
it is like reading old wives tales. There are excellent books easy
for amateurs to understand as well on the biochemistry and
physiology of diabetes. The facts that you have passed on to all
of us sound like a Sangomas understanding of a very complicated
desease. In the human body there is no such thing as stimulus
and respose, but rather stimulus and multiple response. God has
created a very complex and intracate machine. Looking at only
insulin and glucose is like saying that south african politics (from
1652) is only about black and white and explaining evergthing in
this context. It would be a very dangerous thing to do and you
would feel justifiably upset if I tried to interpret present day
problems via such a theory. similarly I feel extremely upset at
your explanation of your desease as if you were a fundi, in the
way you have. It is extremely unproffesional. Stick to what you
know, and when you don't know, find out the facts learn and
understand your symptoms in terms of the complexity of the
underlying interactions. This is a perfect example of the
interaction between facts, learning and understanding is.
my apologies for voicing my view so strongly, but to read such
junk really upsets me. It trivilises the human miracle.
To summarise: the events of insulin deficiency involve not merely
carbohydrate metabolism, but fat, protein, electrolyte and water
metabolism as well. The repercussions appear in the CNS, the
respiratory system, the cardovascular system, the renal system,
and the gastrointestinal system and represents a ghastly
caricature of the normal adaptation to starvation, many similar
changes occur- but the responses are inappropiately violent.
>I finally decided to pay the doctor a visit because almost
>every organ in my body began to fail. This includes the
>manager -- my brain. I suspected the immergence of my brain
>least, not realising that with less energy the neurons will function
>less efficiently.
And really anyone who cares for the body so little before doing
anything about it after describing your symptoms is a fool.
>I feel much better now. I have to follow a diet low in glucose --
>no sugar and little starch. I take pills which are intended to
>activate the pancreas again. It is slowly increasing the
>production of insulin, probably now at 25% the normal rate.
>It is also beginning to produce it more evenly on demand.
>Unfortunately, my eyes were the organs which took the
>worst hammering.
I wish you the best in your recovery, take it easy, your body
is a carefully built instrument that can repair itself to some
extent, but if you stress it, it won't repair to any reasonable
degree.
>While recovering, I had ample time to think secludedly -- not
>having to cope with the day to day "assault" of the information
>explosion on my mind. I now have a vivid mental picture of
>what happend with the Great Influenza eoidemy after WWI.
>Approximately 25 million people died in the developed
>countries alone as a result of this epidemy. Their bodies
>ceased to function as learning organisations.
Sociology and science are two disciplines that complement
each other greatly, specifically since rules of since (like
entropy etc.) can be translated into sociological terms.
However the reverse is not necassaily true. If you think that
you can function because you know your body: biochemists
would never die. Secondly, if you mean that it is due to the
interrelated teamwork, study the ethiology and patholgy of
infuenza first. I really doubt that your point is valid.
>Although the pancreas is a relative big organ in our body
>which plays a vital role through its production of insulin,
>we are unaware of this until the pancreas shuts its activty
>down. Suddenly every cell is starving of energy. In my case
>it was an infection by the ordinary flu virus. But there are also
>other possible causes. For example, in the past few weeks
>I have learned of several women who became full diabetes
>because of the shock of child birth. Any severe shock,
>physical or psychological, can do this to the pancreas.
??? For example, in the past few weeks I have learned??? i query your
use of the word learnt. Did you read up about it? in what Journal?
did you hear about it? from which respected leading virologist?
1. Diabetes is both genetic (inherited) and environmental
(circumstances).
2. There is an autoimmune component: i.e. the body kills of its
own cells
3. Mumps and viral infections are known to trigger it (Flu?) by
the way flu is a viral desease.
4. Thus the expression of the desease (often called a syndrome
look up the medical use of that term to figur out why) may be
the intergrated response to many factors. e.g. genetic
predisposition, environmental chemical and infectious agents,
autoimmune events, nutrition, physical activity and
pyschological stress) In your case you state it started a while
back and it took the flu to trigger it into a full blown state. The
same thing occurs with pregnant mothers: it is not a single
event but a multiple factor syndrome. Nutrition is often the
cause amongst young adults.
Out of interest, it has been related to increased incidence of
angiopathy, strokes and heartattacks, so if you are overweight
it would be proactive to see a good dietician who has an
understanding of your desease, and stay trim and lean.
I have only been an observer on this list, but as a result of your
rank amateur explanation of the pathology of diabetes and
inane conclusions, I am seriously thinking of leaving a list that
appears like a pool of fools decieving themselves withtheir own
importance.
This is written in my personal and private capacity.
~~~~~~ LETTER ENDS ~~~~~
Note 1
I am vey sorry that I have used the specific term "osmosis". I should
have used the general term "diffusion". I made an excusable error.
This is the one reason why I have written this note. The other reason
is as folllows because we can learn more about entropic force-flux
pairs.
Diffussion happens when atoms, ions or molecules move from a specific
concentration at a certain location in a medium to another location
with a different (lower) concentration.
When the movement has to go through a thin membrane permeable only to
water, the diffusion of the water is called specifically osmosis. When
the movement has to go through a thick medium having different
retentions (permeability) for different species of ions or molecules,
the diffusion is called chromatography.
All diffusion phenomena are caused by entropy production. If the
entropic force is caused by the difference in concentration of the
solute (and by implication also the solvent), the diffusion is called
passive diffusion. It is governed by Fick's law. This type of
diffusion stops when equal concentrations (thermodynamic activities)
at all locations (equilibrium) have been attained. Passive diffusion
may be facilitated by a catalyst. It means that the catalyst steps up
the rate of diffusion without affecting the final equilbrium and its
energy status.
It is a general myth that passive diffusion requires no free energy to
be driven. It does require a change in free energy, but only minute
amounts of it. This change in free energy is supplied by the
difference in concentration. The difference in concentration causes a
major difference in the specific entropy at the various locations--
the difference in chaos so as to speak of.
Active diffusion (transport) depends on chemical free energy to
happen. What now happens is that the change in free energy for the
movement of ions or molecules are not supplied by the normal
difference in their concentration, but by other chemical species
(usually enzymes or hormones) actively involved with the ions or
molecules which have to flow. It is then when other entropic forces
come into play in the flow (entropic flux) of the ions or molecules.
These cross inductions from other sources are collectively known in
irreversible thermodynamics as the Onsager reciprocal relationships.
For example when the oxidation (elctrochemical) state of the moving
ion or molecule is altered by an enzyme at one location, a difference
in electric potential between the two localities arises. It is then
the difference in electric potential rather than concentration
potential which drives the flow of the ions or molecules - ofetn in
the direction opposite to passive diffusion. Another example is when
the enzyme or hormone cause the emergence (synthesis) of a much larger
molecule as in the combination of glucose and phosphate regulated by
insulin. Movement of the larger molecule is then hindered (retended)
in some manner by its greater size.
It is these Onsager cross inductions which are fundamentally
responsible for a display of complexity. As the writer above
indicates, the lack of insulin (or its over production) impairs indeed
many processes than merely the utilisation of glucose as a source of
energy -- one stimulis with many responses to it.
Note 2
The name Sangoma refers to the herbalists (traditional doctors) of the
Banthu peoples. Some advocates (including medical scientists) of the
Western Civilisation perpetuate the myth that herbalists of other
civilisations have made only simple contributions, if any, to western
based medical science. Nothing can be further from the truth as a
study of any book on the chemical content of medicinal and poisonous
plants which also includes the inputs of herbalists will indicate.
(There are some well known South African books on this subject.) For
example, the influence of plant species of the genus Dioscorea on the
fertility of female mammals or the genus Adenia on the heart beat of
mammals were known to Sangomas centuries before the active substances
oestrogen or digitalis were isolated by chemists based on information
received from these very Sangomas!
I did not offer any expert physiological opinion on my diabetic
condition. In fact, the whole point of my contribution was to make
fellow learners aware that my condition deteriorated gradually during
approximately the past 9 months - so slowly that despite information
on diabates posted on the walls of the hospital where my wife was
treated two months ago, I was unable to apply it to myself. Thus I
consider myself as a striking example of the parable of the boiled
frog. Going for a medical check-up once a year is adviseable, but
running to a doctor for every pain or strain, however so slight, is
foolish. Furthermore, both the doctor and the patient may be so
focussed on another much more severe problem that both of them may
fail to notice the frog slowly getting boiled. The same applies to our
organisations which lacks in organisational learning. Ordinary workers
cannot run to the CEO with every problem, but neither can they close
their eyes to serious problems which the CEO might not be aware of
just because the CEO is the expert manager who ought to know about
such problems.
I also wrote that I had a severe loss of sight for three weeks, making
reading very, very difficult. Thus what I have learnt so far, was in
discussion with other people all over the spectrum (doctor, nurses,
diabetes, family members of diabetes and even the usual caretakers of
myths.) Furthermore, since day one I had to struggle with the doctor,
the dietrician and nurses to explain to me the WHY and not merely
order me to do the HOW in blind trust. What I presented on this list
was the result after four weeks of learning beginning from square
one -- not the learning of a professional who have studied all the
experts in the world.
Last Friday, four days after returning to work, I went to the main
library of our university to learn more about the diabetic condition.
Unfortunately, virtually all the medical books and many books on
physiology are kept at the medical and veterinary campusses several
kilometers away from the main campus. That afternoon I went to a
fairly large general book store and news agency to see what they had
available on the diabetic condition -- nothing at all. The only piece
of printed information which I have up to date is a small booklet
supplied with the glucose meter which I bought, written for the
medical expert rather than the layman.
I want to thank the author of this email (whose name I will keep
confidential because it is private) for further input on the diabetic
condition. This is why I hope that Rick will allow this message to be
distributed -- to illustrate what a Learning Organisation is about.
One of the advantages of a LO is to overcome the barriers brought
about by over-specialisation -- to make us aware and help us to learn
other things which are also important to our own lives than merely the
things which we have learnt along the course of events of the
individual's life. Learn form this author about diabetes and not only
from what I have written with my very limited perspective on the
issue.
It is not nice to be criticised by others for being a fool or not
having learnt about some things as one should have done. All of us can
witness to this -- even presidents and members of the royal families.
This is what happens so frequently in ordinary organisations. But it
is sheer bliss when we learn from each other in order to benefit more
from life itself. This is what makes the emergence of ordinary
organisations into learning organisations so important. Do you want to
measure a LO? Find an instrument or tool which will measure bliss.
One of the biggest problems which South Africans now have to deal
with, is HIV-AIDS. This problem is fast getting out of hand -- already
affecting 20% of our population. I believe that the reason why it is
getting out of hand is that there is very little organisational
learning with respect to health care in South Africa. Let me
illustrate it by an example. A couple of weeks ago one female student
of our university was raped by a gang of about 15 vagrants a few
hundred meters away from the campus. Fortunately for her, her
extremely concerned parents pressed for a rapid medical treatment of
some kind. As a result a treatment began with HIV suppressing drugs a
few hours afterwards. It soon appeared through letters in the local
newspapers and on radio interviews that the general public was
virtually ignorant of such an immediate treatment which reduces the
risk of contracting HIV with approximately 80%. In fact, some medical
authorities claimed that unless the patient specifically asks for this
rather very expensive treatment, they will not even suggest such a
possibility.
Can you believe it -- shut up and let the experts control your life!
You have probably wondered why so many people in South Africa of the
white minority were led into voting for the ideology of apartheid. It
was just another multiple case of "shut up and let the experts control
your life". In this case the first line of experts who controlled
almost every aspect of the South African society during half a century
of apartheid belonged to a secret society called the Afrikaner
Broederbond (AB) -- a society which cared very little for the learning
of each individual and organisation, other than their own members and
organisation. The second line of "experts", as the majority of black
people believed for a couple centuries, were the white people
collectively. Africa had to learn about the West and not vice versa.
The ruling schemes of Dutch Traders and Brittish Colonial Authorities
of the past two centuries became ingrained slowly in every fabric of
South African society -- the AB merely formalising it. When thinking
about it, I can probably make out another case study for the parable
of the boiled frog.
I have to stop now. If I have to stress one thing, it is to follow the
power of learning, individually and collectively. If we empower any
other person or body of persons in any other way to control our lives
without making them responsible to us, they will gradually become more
corrupt. If it happens slowly enough, most of us may not even notice
it, but eventually they will usurp absolute power which will corrupt
them absolutely. The consequences are too ghastly to contemplate,
unless we learn from from history. Let us note that according to Alvin
Toffler information (knowledge management) may very well be the heart
of the third wave. Thus we all should fear the future tyranny of the
experts, even if some of us are experts ourselves.
PS. Please note that I do not place the writer of the letter above
among such "expertise tyrants". There is far too much in the letter
which will not allow it.
Best wishes
--At de Lange <amdelange@gold.up.ac.za> Snailmail: A M de Lange Gold Fields Computer Centre Faculty of Science - University of Pretoria Pretoria 0001 - Rep of South Africa
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