Diabetes

Diabetes is becoming epidemic in the United States with 16 million affected individuals or approximately 6% of the population. Unfortunately an estimated 5 million people are unaware that they have diabetes. Women account for half of the diabetes cases in the United States. People with diabetes either cannot make enough or properly utilize the hormone insulin. Insulin is responsible for allowing cells in the body to utilize the sugars that are necessary for proper functioning. Diabetes is a chronic disorder that has many life threatening complications such as heart attack, stroke, kidney disease, blindness and limb amputations.

There are two main types of diabetes. Type 1 diabetes usually starts in children or young adults and accounts for 5-10% of all cases of diabetes. People with type 1 diabetes do not produce any insulin. It is caused by damage to the cells in the pancreas that produce insulin. The majority of diabetics have type 2 diabetes, also known as adult onset diabetes. In type 2 diabetes insulin is produced but the body can’t utilize it properly. Affected people are considered insulin resistant. The "epidemic" of diabetes in the United States is largely due to an increase in type 2 diabetes, which will be the focus of this article.

One of the reasons for the increasing numbers of people with type 2 diabetes is its association with obesity, lack of exercise and older age (over age 45). It is also more common in people with a family history of diabetes, in women who had gestational diabetes or who have had a baby weighing over 9 pounds at birth and in certain ethnic groups (African Americans, Native Americans and Latinos). Of concern to physicians is an increase in type 2 diabetes in children and adolescents. The majority of these children are obese. Because diabetes can be without symptoms for many years it is recommended that all people with one of the above risk factors be tested for diabetes on a regular basis.

Frequent urination, excessive thirst, extreme hunger, unusual weight loss or extreme fatigue are some symptoms of Type 1 diabetes. Type 2 diabetics may have frequent or recurrent infections, blurred vision, numbness in the hands and feet, any of the symptoms of type 1 diabetes or no symptoms at all. Early detection and good control of diabetes is very important in reducing the long-term complications of this chronic disease.

Diabetes is diagnosed when blood sugar levels are elevated. This signifies that insulin is not getting the glucose into the cells where it is needed. The most common and simplest test for diabetes is a fasting blood glucose. If this level is 126mg/dl or higher on 2 separate occasions then diabetes is diagnosed. A random blood glucose (e.g. not in a fasting state) of more than 200mg/dl is very suggestive of diabetes but must be confirmed with a fasting value.

The initial management of type 2 diabetes focuses on diet, weight control and exercise. If this does not result in normalization of blood glucose levels then medications are started. With type 2 diabetes oral medications that help the body use insulin are usually prescribed first. If these are not effective then insulin injections may be needed. Type 1 diabetes is treated with insulin injections, as affected people don’t produce any insulin.

Complications of diabetes are the seventh leading cause of death in women. When diabetes is diagnosed it is important to check for both other risk factors for and signs of cardiovascular disease, kidney disease and visual impairment. Prompt recognition of early stage disease and good control of blood sugars, with both medications and lifestyle changes, will improve the quality and quantity of life for diabetics. For more information about diabetes the American Diabetes Association has a web site at www.diabetes.org.