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Sunday, December 8, 2013
You or a loved one might already be living with diabetes, just like 16 million Americans. Or maybe there was a recent diagnosis of diabetes. Either way, it's important that you know the facts about this lifelong and serious-but manageable-medical condition.
Let's start with what causes diabetes. To do that, we'll begin with a quick lesson on one of our internal organs: the pancreas.
One of the purposes of the pancreas is to manufacture a hormone called insulin, and then secrete it into your bloodstream. To understand the pancreas we must understand how a normal pancreas functions without diabetes. When we eat, our food (carbohydrates, fats, and proteins) is broken down in the intestine and absorbed in the bloodstream as glucose. Our bodies use glucose for energy. As the level of glucose rises in the blood stream, the pancreas receives a signal to release insulin. Insulin works a little bit like a key opening a gate. Insulin, produced by the pancreas, allows glucose to enter the cells, and therefore lowers the blood glucose level. When there is not enough insulin, or if our cells do not respond as well to insulin, the gate does not open and insulin cannot enter cells to provide energy.
Insulin redirects the glucose from the bloodstream and into some of your body's cells. First, the insulin acts like a key opening the "lock" on some of the cells. After creating an opening in the cell wall, the insulin drives the glucose in. This is a critically important task because your body cells need the glucose in order to give you energy.
So that's what happens when your pancreas is working as it should. But when it's not...
Just like an engine part in your car, the pancreas does not always act normally. When it fails, it can no longer keep up with the amount of insulin production that your body needs.
Or, in some cases, a person's body simply becomes resistant to insulin, so the insulin can no longer do the job as well. This condition is known as "insulin resistance." When a person becomes insulin resistant, the pancreas reacts by producing more and more insulin to try to keep up. Over time, the pancreas wears out and can no longer function as it should.
So the glucose stays in your bloodstream instead of in the rightbody cells, where it belongs. Now you've got two problems:
Unlike most diseases, diabetes can affect patients in different ways, depending on where the excess glucose goes. If left untreated, complications of the disease can include the following:
As a result of the pancreas not producing enough insulin - or, in some cases, not producing any insulin at all - people get diabetes. More than 16 million Americans have this serious disease. It takes several forms.
Those with Type 1 diabetes have a pancreas that isn't producing any insulin. They will have to receive insulin for the rest of their lives.
Those with Type 2 diabetes have a pancreas that produces some insulin, but not nearly enough to meet their needs. Type 2 is by far the most common form of diabetes. Between 90% and 95% of the people who have diabetes have Type 2.
Another common form of the disease is gestational diabetes, a condition that occurs during pregnancy. Women who deliver babies over nine pounds in weight are at the most risk of developing this pregnancy-related type of diabetes. Gestational diabetes usually (90% of the time) disappears after delivery, but patients with gestational diabetes have a 3-4 times greater risk of Type 2 diabetes later in life.
Type 1 diabetes can be developed at any age, most commonly in childhood or adolescence. It's an inherited trait, with several environmental factors contributing, and there's nothing you can do to lower your risk of getting Type 1 diabetes. Symptoms usually come on suddenly, and may include thirst, frequent urination, weight loss, and fatigue.
With Type 2 diabetes, there are several risk factors involved, including heredity, age, race, lifestyle and medical conditions. You have little or no control over some of these risk factors, but other factors can be controlled - by decisions you make. But other factors can be controlled - by decisions you make.
If you fall into one or more of the following high-risk categories and haven't yet contracted diabetes, you should be especially concerned about reducing the risks as much as possible. And if you do already have Type 2 diabetes, you can control the course of your disease and how well you live with it by working to lower the risk factors.
Age - If you're over 45, you're at a heightened risk. And up to 20 percent of Americans over age 65 have diabetes.
Heredity - If a parent had diabetes, you're likelier to also develop the disease.
Race - For reasons we don't yet fully understand, various minority groups in the United States are likelier than white Americans to develop diabetes. These groups include African Americans, Asians, Hispanics and native Americans.
The best news about diabetes is that even those who are at an increased risk because of their age, race or heredity can reduce the risk in other ways. The biggest risk is being overweight, and the second biggest risk is not exercising (being sedentary). To lower the risk of diabetes, people can exercise, control their weight and diet, and see their doctors regularly for education and medication. Here are the risk factors you can control.
Obesity - If you're overweight, you are at a higher risk for diabetes. If you lose the weight through proper diet and exercise, you cut the risk.
High blood pressure - By a combination of medication, exercise and good eating habits, this risk can also be controlled.
High cholesterol - Again, your doctor can show you how to lower your levels of total cholesterol and decrease your risk of developing diabetes.
Studies have shown that individuals who have what's called a "predisposition" or an increased likelihood of getting diabetes due to heredity can dramatically lower the risk by making some sensible lifestyle changes:
People who are overweight are at greater risk of becoming insulin resistant and eventually contracting diabetes. That's because excess weight makes the cells more resistant to glucose.
But recent studies have shown that nutrition and exercise programs can decrease the development of diabetes in high-risk groups by as much as 71 percent.
When you eat well, lose weight and begin a regular exercise program, there are bonus benefits. In addition to cutting the risk of developing diabetes, these good lifestyle choices also protect you against a whole host of other diseases and medical conditions, including cardiovascular disease and various cancers. And exercise increases your energy and helps make you feel great!
Many people have diabetes for years before it's ever diagnosed. You should see a doctor if you have one or more of the following symptoms:
Keep in mind that simply having one or more of these symptoms doesn't automatically mean you have diabetes. That's why it's important to see a doctor for a diagnosis.
If your physician suspects the possibility that you have diabetes, one of three or more tests will be administered. If you get a positive reading on any of these tests, you'll be tested again on another day, just to be sure. Here are the three main tests:
You can do everything you're supposed to do to cut the risk, and still get diabetes. While it's a serious condition and one that must be treated properly, it's a disease that can be controlled. In fact, millions of Americans lead active lives without their medical conditions controlling them. Some have even been able to successfully fight back.
If you have diabetes, it can sometimes be contained purely through a combination of diet and exercise.
If blood sugar levels are still too high even with the diet and exercise regimen (you'll learn how to monitor your blood sugar levels), your doctor will probably prescribe some kind of pills or insulin or a combination of the two.
There are several oral medications available, all with the goal of keeping blood glucose levels within the normal range which are effective in people with type 2 diabetes. Depending on how the disease is affecting you, your doctor might get you started on any combination of the following pills:
Some patients with Type 2 diabetes and all patients with Type 1 must take insulin, which has to be injected. If it's necessary in your treatment, your doctor will prescribe insulin in one of the following ways based on your medical condition and needs:
Some Type 2 diabetics feel that they've "failed" by having to go on insulin, but nothing could be farther from the truth. Every case is different, and every patient responds in different ways to treatment. The natural course of diabetes in the vast majority of patients with diabetes leads to pancreas "burn-out," and therefore insulin needs to be taken. How quickly pancreas "burn-out" happens is related to a variety of factors, including weight, diet, and genetics.
Keep in mind how millions of Americans have managed to control their diabetes and live perfectly functional lives. By working with your team of healthcare professionals and never being afraid to ask questions or discuss treatment options, you can make the most of the situation. So don't just survive diabetes - go on and live your life in a positive manner.
This article is a NetWellness exclusive.
Last Reviewed: Sep 14, 2004
Robert M Cohen, MD
Professor of Clinical Medicine
College of Medicine
University of Cincinnati
Laurie Sadler, MD
Formerly, Assistant Professor of Medicine
School of Medicine
Case Western Reserve University
Saul Genuth, MD
Professor of Medicine
School of Medicine
Case Western Reserve University