Diabetes Mellitus

According to the American Diabetes Association, more than 20 million Americans suffer from diabetes, and nearly one-third of them do not know that they have the disease. Diabetes does not only affect older people; in 2005, 1.5 million new cases of diabetes were diagnosed in patients 20 years old and up. Diabetes is a major risk factor for heart disease. As many as two-thirds of patients with diabetes die from some form of heart or blood vessel disease.

What is Diabetes?
Diabetes mellitus is a serious condition in which the body cannot make or properly respond to insulin. Insulin, a hormone that is secreted from the pancreas, changes sugar and starch from food into energy. People with diabetes cannot properly use the energy from the food they eat. When this energy transfer fails, cells are damaged. Because this disease prohibits cells from using it, the amount of glucose in the blood increases to dangerously high levels. Too much glucose in the blood is called “high blood sugar” or diabetes. The major forms of diabetes are:

Type 1 or Juvenile Diabetes. Type 1 diabetes accounts for 5% to 10% of all cases of diabetes. Although it may occur at any age, it usually begins early in life—during childhood or the teenage years. There is no way to prevent type 1 diabetes. It is an autoimmune disease in which the cells in the pancreas that make insulin are damaged. People with type 1 diabetes produce very little or no insulin. These patients must take insulin to control their blood sugar levels to stay alive.

Type 2 Diabetes. This metabolic disorder is the most common form of diabetes, accounting for 90% to 95% of all cases of diabetes. It is usually diagnosed in people older than 30, but it can also occur in children and young adults. People with type 2 diabetes can produce insulin, but it is either not enough or the body does not use it properly. As a result, cells are starved of energy. Blood sugar levels can usually be controlled through diet and exercise. In a mild form, type 2 diabetes can go undetected for many years. It tends to develop more gradually than type 1; for this reason, symptoms can be overlooked. If left untreated for too long, it can lead to serious medical problems, including heart and blood vessel disease.

Gestational Diabetes. A form of type 2 diabetes called gestational diabetes affects approximately 4% of pregnant women and causes unusually high blood sugar levels during pregnancy. This type of diabetes can pose a risk to the unborn baby and needs to be managed throughout pregnancy. Although blood sugar levels usually return to normal after giving birth, studies show that women who have had gestational diabetes have a greater risk of developing type 2 diabetes.

Who Can Get Diabetes?
Although anyone can get diabetes, a hereditary link does exist (the disease is passed down through family members). Because certain fats in the body interfere with insulin-glucose activity, anyone who is obese is also at risk. Damage to the pancreas can lead to diabetes. Diabetes is not caused from eating too much sugar.

Because of their genetic makeup, people of American Indian, Alaskan Native, African American, and Hispanic descent are all at higher risk for diabetes. Also, more women are affected by diabetes; 60% of all people with diabetes are women. Although researchers still do not know why, diabetes also runs a more severe course in women, putting them at greater risk than men for heart disease and blindness.

Forty-one million people in the United States between the ages of 40 and 75 currently have pre-diabetes. Pre-diabetes is a condition in which blood sugar levels are higher than normal but are not high enough to be fully diagnosed as diabetes. The American Diabetes Association now recommends that obese people over the age of 45 be screened for pre-diabetes. Obese people who are younger than 45 years of age should be screened for diabetes if they have other risk factors. Most patients with pre-diabetes usually develop type 2 diabetes within 10 years.

What Are The Risks?
Diabetes weakens the body’s ability to fight infection and heal wounds, so infections last longer, and wounds are slower to heal. People with diabetes are more likely to have foot problems (including amputation), eye problems (including blindness), heart disease, kidney disease, stroke, and a type of gum disease (periodontal disease) that can lead to tooth loss.

A survey on behalf of the American Diabetes Association found that 68% of people with diabetes did not know that heart disease and stroke are a serious threat to their health. Even with blood sugar levels under control, people with diabetes are two to four times more likely to develop heart disease or stroke and to have it at an earlier age than people without diabetes. Part of the reason for this is that diabetes affects cholesterol and triglyceride levels. People with diabetes often have high blood pressure and obesity, further increasing their risk. Approximately 75 percent of patients with diabetes die from a form of heart or blood vessel disease.

Type 2 diabetes is nearing epidemic proportions due to an increase in obesity, sedentary lifestyles, and the number of older Americans. Overweight or obese individuals are at risk of developing type 2 diabetes because body cells are less sensitive to insulin, leaving sugar circulating in the bloodstream.

Symptoms
Blood sugar levels rise quickly in type 1 diabetes, causing the patient to become very ill in a short period of time. Symptoms include increased thirst and hunger, sudden weight loss, extreme fatigue, and frequent urination.

The early stages of type 2 diabetes may not produce any symptoms. If symptoms do surface, they may include increased hunger or thirst, frequent urination, weight loss, fatigue, frequent infections, infections that are slow to heal, blurred vision, dry/itchy skin, and numbness or tingling in the hands or feet. Some patients ignore these symptoms or attribute them to the aging process. Most cases of type 2 diabetes are discovered during a routine doctor visit.

Diagnosis
Diabetes is diagnosed with a blood test that measures the glucose (sugar) levels in the blood. The test is performed after the patient has fasted (no food or drinks besides water) for 8 to 12 hours the night before.

A glucose tolerance test may be used to diagnose type 2 diabetes. The patient fasts the night before the test. Blood and urine tests are performed before and then at timed intervals after the patient drinks a measured amount of a glucose-rich drink. All medicines that the patient is taking will be reviewed, because they may interfere with the test results. If the levels of glucose are higher than 140 mg for every tenth of a liter of blood, the test is positive for diabetes. This amount of glucose is about the same as dissolving three tiny grains of sugar in a large glass of water.

Treatment
After diabetes has been diagnosed, diet, weight control, and exercise all play an important role in its treatment and management. Medicines can also be used to control blood sugar.

The treatment for type 1 diabetes includes a special diet and a regular exercise program. Patients must monitor their blood sugar levels using a blood sugar meter and they must take insulin.

The treatment for type 2 diabetes also includes a special diet and a regular exercise program. If diet and exercise do not control blood sugar levels, medicines or insulin may be prescribed.

It is critical that people with diabetes have regular check-ups, control their weight and cholesterol levels, follow an exercise program, manage high blood pressure, and refrain from smoking.

Preventing Diabetes
Approximately 27% of people diagnosed with type 2 diabetes would have been able to prevent it had they avoided weight gain. Findings from the Diabetes Prevention Program suggest that the onset of type 2 diabetes can be delayed through regular exercise and healthful eating patterns, especially in people with impaired glucose tolerance. Impaired glucose tolerance is a condition that often precedes the diagnosis of diabetes. On average, study participants reduced their weight by 5% to 7% by eating a low-fat diet and exercising 30 minutes per day. The risk of developing type 2 diabetes can be further reduced:

• Make regular doctor appointments, especially those individuals who have a family history of diabetes.

• Eat a balanced diet of healthful foods with plenty of fruits, vegetables, and whole grains. Pay close attention to portion sizes, especially when eating out.

• Exercise using a variety of enjoyed activities for at least 30 minutes on most (if not all) days of the week. Individuals who lead an active lifestyle decrease their chances of developing type 2 diabetes by 30% to 50%.

• Achieve and maintain a healthy weight. Combine diet and exercise for long-term weight management. If necessary, lose weight at a safe rate of 1/2 to 2 pounds per week. A registered dietitian can provide support and education for weight loss.

There is no cure for diabetes, but it can be well managed by taking medications as prescribed, regularly testing blood sugars, eating healthy, and exercising.


Resources

Texas Heart Institute www.texasheartinstitute.com/HIC/Topics/Cond/Diabetes.cfm
American Heart Association http://www.americanheart.org/hearthub/hc-diabetes.htm
Minneapolis Heart Foundation www.mplsheartfoundation.org/education/education_riskfactors_diabetes.asp
American Diabetes Association www.diabetes.org/diabetes-heart-disease-stroke.jsp
American Diabetes Association www.diabetes.org/makethelink
The National Institute of Diabetes & Digestive & Kidney Disorders http://diabetes.niddk.nih.gov/