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Diabetes

Diabetes affects 25.8 million people in the U.S. 8.3% of the U.S. population

DIAGNOSED

18.8 million people

UNDIAGNOSED

7.0 million people

According to the Center for Disease Control

  • Among U.S. residents 65 and older, 10.9 million, or 26.9%, had diabetes in 2010
  • Approximately 215,000 people below the age of 20 were diabetic (type 1 or type 2) in the United States in 2010
  • Approximately 1.9 million people over the age of 20 were newly diagnosed with diabetes in 2010 in the United States
  • In 2010 an estimated 79 million American adults over age 20 were pre-diabetic
  • Diabetes is the leading cause of kidney failure, non-traumatic lower-limb amputations, and new cases of blindness among adults in the United States
  • Diabetes is a major cause of heart disease and stroke
  • Diabetes is the seventh leading cause of death in the United States

The facts about diabetes

The facts about diabetes are astounding; millions of Americans are affected directly or indirectly by this devastating disease. The statistics are pretty bleak, but there is good news that must be shared; it is the fact that Diabetes is preventable in many cases, and can be controlled or reversed in many others. Serious and consistent diet and lifestyle change has been shown to have a tremendous impact on this disease.

One major study spotlighted the effect of lifestyle on the development of Type 2 Diabetes. The “Diabetes Prevention Program” (DPP) was a major multicenter clinical research study aimed at discovering whether dietary changes and increased physical activity or treatment with the diabetes drug metformin (Glucophage) could prevent or delay the onset of type 2 diabetes. At the beginning of the DPP, participants were all overweight and had blood sugar levels higher than normal but not high enough for a diagnosis of diabetes. People in this category are often referred to as pre-diabetic. The participants were divided into a lifestyle intervention group who received support and instruction on effective diet, exercise, and behavior modification, and a group that was given the commonly prescribed diabetic medication metformin.

The study findings were quite remarkable. Participants in the lifestyle intervention group reduced their risk of developing diabetes by 58 percent. This finding was true for all participating ethnic groups and for both men and women alike. Lifestyle changes worked particularly well for participants over age 60, reducing their risk by 71 percent. Participants taking metformin reduced their risk of developing diabetes by 31 percent. Metformin was effective for both men and women, but it was least effective in people aged 45 and older. The risk of developing diabetes was reduced in both groups, but the risk reduction in the lifestyle modification group was significantly greater.

This is amazing news! It means that you can change your lifestyle, eat healthier, move more and decrease your risk of developing one of the most life altering diseases in medicine today.

What is diabetes?

Diabetes is a disease in which blood sugar levels are above normal. When we eat, most of the food is broken down into glucose; this provides energy for our bodies to use. The pancreas, one of our vital organs which lies adjacent to the stomach, makes the sugar regulating hormone insulin. Insulin is needed to facilitate the entrance of glucose into the cells of our bodies. It serves as a key of sorts which unlocks the gateway for sugar to enter the cells. Diabetes occurs when the pancreas makes too little insulin, or when the body cannot use the insulin that is produced properly. This improper use or production of insulin causes sugar to build up in the blood. This blood sugar build up, damages the body’s tissues.

Symptoms of diabetes

Every human being is different, so the symptoms differ from person to person. The following are some of the most common symptoms experienced by diabetics. You may experience all or none of them:

  • Dry Mouth
  • Urinating frequently
  • Extreme thirst
  • Unexplained weight loss
  • Extreme hunger
  • Sudden vision changes (especially after meals)
  • Tingling or numbness of extremities
  • Fatigue
  • Frequent infections
  • Dry, cracking skin
  • Sores that are slow to heal
  • More frequent and longer lasting infections

Some patients also report gastrointestinal symptoms like nausea or vomiting.

Several versions of the same disease

Diabetes is not one disease, it is actually has several forms.

Type 1 Diabetes

Type 1 Diabetes was originally called juvenile diabetes because it was first discovered in young patients. More recently this form of diabetes has been referred to as insulin-dependent (IDDM). Type 1 diabetes accounts for 5% to 7% of all diagnosed cases of diabetes. In type 1 diabetes there is a problem with insulin production. The body is not making enough insulin to maintain healthy blood sugar levels. The problem is not with using insulin it is with producing it.

Type 2 Diabetes

Type 2 Diabetes was initially referred to as adult-onset diabetes or non-insulin-dependent diabetes mellitus (NIDDM). It is the more common form of the disease and accounts for 90% to 95% of all diagnosed diabetics. In Type 2 diabetes there is a problem with insulin utilization. The body in most cases, particularly early on, is making enough insulin but the cells are unable to use that insulin properly.

Gestational Diabetes

Gestational Diabetes is a type of diabetes that only affects pregnant women. If not treated, it can cause problems for mothers and babies. Gestational diabetes develops in 2% to 10% of all pregnant women but usually disappears when pregnancy is over. Gestational diabetes just like type 2 diabetes is a problem with insulin utilization not production. Women who develop gestational diabetes have an increased risk of developing Type 2 diabetes later in life.

Other forms of Diabetes

Other forms of diabetes resulting from genetic mutations, surgery, drugs, malnutrition, infections, and other illnesses may account for 1% to 5% of diagnosed cases of diabetes. These may be the result of a problem with either production, utilization, or both.

Pre-Diabetes

Pre-Diabetes is a precursor to Type 2 diabetes. Many in medicine say that pre-diabetes is simply early diabetes, they believe that the development of full blown diabetes is inevitable. A person with pre-diabetes has a blood sugar level higher than normal, but not high enough for a diagnosis of diabetes. This puts them at higher risk for developing type 2 diabetes and other serious health problems, including heart disease, and stroke. Without lifestyle changes to improve their health, 15% to 30% of people with elevated blood sugar or pre-diabetes will go on to develop type 2 diabetes within five years. I actually think that the number is probably much higher. It is easy to see why we would want to correct the problem of elevated blood sugar in its’ preliminary stages.

Risk factors for developing diabetes

Risk factors for type 2 diabetes include obesity, family history of diabetes, history of gestational diabetes, impaired glucose tolerance, physical inactivity, being over 45, and ethnicity. African Americans, Hispanic Americans, American Indians, some Asian Americans and Pacific Islanders are at particularly high risk for developing Type 2 diabetes.

Risk factors are less well defined for Type 1 diabetes than for Type 2 diabetes, but autoimmune disease, genetic, and environmental factors are theorized to contribute to its development.

Gestational diabetes occurs more frequently in African Americans, Hispanic/Latino Americans, American Indians, and people with a family history of diabetes. Obesity is also associated with higher risk for gestational diabetes.

Factors contributing to Type 1 Diabetes

The causes of type 1 diabetes appear to be much different than those for type 2 diabetes. The appearance of type 1 diabetes is suspected to follow exposure to an "environmental trigger," such as an unidentified virus. This exposure is thought to stimulate an immune attack against the beta cells (insulin producing cells) of the pancreas. There have also been studies to indicate a connection between exposure to the proteins in cow’s milk and the development of type 1 diabetes. This relationship continues to be investigated.

Factors contributing to Type 2 Diabetes

The cause of Type 2 diabetes is multifactorial. Many factors contribute to development of this disease, factors such as genetic propensity, obesity, diet, and sedentary lifestyle. These factors contribute to insulin resistance and the resultant development of Type 2 diabetes. As stated earlier people with Type 2 diabetes produce insulin; however the insulin they produce is either insufficient in quantity or the body is unable to use it properly (insulin resistance).

Insulin resistance

Understanding Insulin Resistance is a critical element for understanding the root cause of type 2 diabetes, so let’s discuss the whole insulin resistance issue to facilitate that understanding.

Under normal circumstances when the blood sugar increases after a meal the pancreas secretes insulin into the bloodstream. This insulin facilitates the transport of sugar into the cell where it can be utilized. When the cells are resistant to the action of insulin a different scenario ensues. With insulin resistance, the normal amount of insulin secreted is not sufficient to move glucose into the cells, in other words the cells are "resistant" to the action of insulin. To compensate for this dysfunction, the pancreas secretes higher and higher amounts of insulin, in an attempt to maintain adequate blood-sugar movement into the cells and preserve normal blood-sugar levels. Instead of having low levels of circulating insulin the type 2 diabetic actually in many cases has higher levels of insulin. There is adequate insulin available, but that insulin is essentially useless. I know it sounds confusing so maybe the following story will help you understand the issue better.

Diagnosing Diabetes

When the whole blood sugar regulating system malfunctions, blood sugar is poorly controlled and diabetes is the end result. There are several ways to make the official diagnosis of Diabetes.

  • A person is diagnosed as diabetic when blood glucose levels rise to greater than or equal to126 milligrams per deciliter (mg/dL) after an overnight fast (not eating anything overnight).
  • A patient can also be diagnosed diabetic if they have a random non-fasting blood glucose level greater than or equal to 200 mg/dL on two subsequent occasions, along with the symptoms of diabetes.
  • A diagnosis of diabetes can be made with a glucose level greater than or equal to 200 mg/dL on a 2-hour glucose tolerance test.
  • Finally the diagnosis of diabetes can be made when a patient has a hemoglobin A1c greater than or equal to 6.5, Hemoglobin A1c is a blood test that gives an estimate of the blood sugar level over the previous 90 days.

If you or someone you love has diabetes, “The ABC’s of Diabetes” will provide a easy to understand and follow guide to help you control it or turn it around.

GET IN TOUCH

Dr. Jill Waggoner
Charlton Medical Group
3450 West Wheatland Road
Physician Offices II, Suite 340
Dallas, Texas  75237

T 972.217.3007

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Desoto, Tx 75213

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