NOVEMBER 1, 2016
One in eleven Americans has diabetes – that’s 29.1 million people. Another 86 million – one out of every three Americans – has prediabetes. What is this disease that affects so many people and can result in such serious health consequences? November is Diabetes Awareness Month, and Texas Health Care physicians want you to have the facts about diabetes, including how to significantly reduce your risk for ever developing it.
“Diabetes is a serious health condition and one that’s affecting more and more people,” says Dr. Karen Grant, a primary care physician. “The good news is that through lifestyle changes, many people can significantly reduce their risk of the most common form of this disease, type 2 diabetes.”
Diabetes is a disorder of the metabolism, meaning the body is not properly using the food it is consuming. Under normal circumstances, our liver breaks down carbohydrates into glucose, also known as blood sugar. The liver releases the glucose into the blood stream. Meanwhile, the pancreas, a gland located near the stomach, produces insulin, which is a hormone that helps the body’s cells absorb the sugar in the blood. Our cells then use the glucose for energy.
If a person’s cells are unable to absorb enough glucose, blood sugar levels rise. This can lead to diabetes.
Types of Diabetes
There are three main types of diabetes:
- Type 1 diabetes, formerly called “juvenile diabetes,” occurs when the body is unable to create insulin, usually due to an attack on the immune system. Type 1 diabetes is usually diagnosed in childhood but can also occur in adults. About five percent of people with diabetes have Type 1 diabetes.
- Type 2 diabetes is the most commonly diagnosed form of all diabetes, accounting for 90-95 percent of all cases. Type 2 diabetes is generally caused when the pancreas is still producing insulin, but the body’s cells are unable to use it properly. This leads to elevated blood sugar levels.
- Gestational diabetes affects some pregnant women. The hormones naturally produced during pregnancy require additional insulin in the body. If insulin levels don’t keep up, gestational diabetes can develop. This condition goes away after the baby is born; however, it is a risk factor for later developing Type 2 diabetes.
How Diabetes Harms the Body
The elevated blood sugar levels associated with diabetes can cause a number of serious health problems:
- Heart disease: diabetes is one of the main causes of heart disease, heart attack and stroke. People with diabetes are twice as likely as those without the disease to suffer from heart disease and stroke. They are also more likely to experience these conditions at a younger age.
- Nerve damage & amputations: Diabetes can cause pain, numbness and tingling in the arms, hands and feet. Diabetics are prone to developing sores and infections on their feet, sometimes necessitating amputation to halt the spread of infection. Diabetes is the leading cause of lower-limb amputation.
- Kidney damage: Diabetes is the leading cause of kidney failure. High blood sugar damages the kidneys, causing the buildup of waste and fluid in the blood.
- Vision loss: Diabetes can cause various eye problems, including diabetic retinopathy, in which the blood vessels in the eyes are damaged; cataracts, which occurs when the lens becomes clouded; and glaucoma, which results from the buildup of fluid in the eye. Diabetes is the leading cause of adult-onset blindness.
- Mouth problems: Diabetes can cause gum disease, loss of teeth and thrush, a fungus that grows in the mouth.
As you can see, the damage diabetes does to the body is considerable. Diabetes is the seventh-leading cause of death in the United States.
The causes of type 1 diabetes are not fully understood, but it is known that genetics and some environmental factors play a role in the disease. If a parent or sibling has type 1 diabetes, your risk is greater. Some people have autoantibodies – harmful immune system cells – in their systems, which increase the risk of type 1 diabetes.
For type 2 diabetes and prediabetes, family history also increases risk. There are several additional risk factors:
- Being overweight or obese
- Sedentary lifestyle
- Race – African Americans, Hispanics, Asian Americans and Native Americans are at greater risk
- Age – our risk increases the older we get
- Gestational diabetes
- High blood pressure
- High cholesterol levels (LDL cholesterol and triglycerides)
- Low HDL (“good”) cholesterol
For gestational diabetes, women older than 25 and women who are overweight are at greater risk. As with type 2 diabetes, African Americans, Hispanics, Asian Americans and Native Americans are at greater risk.
It is possible to have one or more of these risk factors and never develop diabetes. The exact causes of diabetes remain unknown.
Symptoms & Screening
Some of the common symptoms of diabetes include:
- Extreme thirst
- Frequent urination
- Dry skin
- Sudden and unexplained weight loss
- Extreme hunger
- Numbness and tingling in arms and feet
However, diabetes will often present no symptoms initially. It is estimated that 25 percent of people with diabetes have no idea they have it and 90 percent of those with prediabetes are unaware. These alarming statistics underscore why regular visits to your doctor are so important.
As a general guideline, men and women age 44 and older should be screened for diabetes every three years. Your physician may recommend more frequent and/or earlier screenings, depending on your health history.
A diabetes screening is a simple blood test which measures the glucose level. This is generally done at the same time as a cholesterol screening, which allows you to get a picture of several important health benchmarks at the same time. Fasting glucose levels, measured in mg/dL, are categorized as follows:
- Normal: 99 or lower
- Prediabetes: 100 to 125
- Diabetes: 126 or higher (measured on at least two separate occasions)
Living with Diabetes
“A diabetes diagnosis can be frightening, but remember that there are millions of people with diabetes living full lives,” says Dr. Amber Lesley, who specializes in internal medicine. “The key is to properly manage the disease through monitoring, treatment and wise lifestyle decisions. Your doctor will be your partner in this effort, but the most important person to manage your diabetes is you, the patient.”
The most important thing someone with diabetes must do is manage their glucose levels at all times. This starts with monitoring blood sugar levels. A patient checks blood sugar levels with a skin prick test, which provides an instant reading. The goal is to not allow blood sugar to rise too high or drop too low. Your doctor may tell you to test your blood sugar several times per week or a few times a day. One of the benefits of monitoring blood sugar levels is that you’ll learn what events trigger readings outside of your recommended range – eating, not eating, eating certain foods, exercise, not exercising, etc. As you learn these patterns, it becomes easier to adjust behavior to optimize your blood sugar levels.
In addition to knowing what your blood sugar readings are at a given moment in time, it is important for you and your physician to know what your blood sugar levels are over an extended period of time; this helps determine if the glucose numbers are moving in the right direction. The A1C test does just that, measuring average blood sugar over a three-month period.
It is also important for patients with diabetes to pay close attention to their blood pressure and cholesterol levels. If either one or both is too high, these conditions, combined with diabetes, can cause additional health complications and further elevate the risk of heart disease and other illnesses.
For anyone with type 1 diabetes, regular insulin injections (or insulin administered through a pump attached to the body) are required to compensate for the lack of insulin naturally produced in the pancreas. For some patients with Type 2 diabetes, insulin injections may also be necessary. These are done by the patient, utilizing a very thin syringe.
A physician may also prescribe oral medications for some patients. Some medicines help stimulate the production and release of insulin from the pancreas and others help to slow the release of glucose from the liver. For patients who are obese, bariatric surgery may be an option, as well.
For both Type 1 and Type 2 diabetes, it is necessary to be physically active and eat a healthy diet. These are two of the most important things someone can do to manage their diabetes. Your physician will help you determine which foods to eat, which to avoid and how much to consume overall, as well as how much and what type of exercise to get.
Preventing Type 2 Diabetes
The good news for most people – including many of the 86 million people who have prediabetes – is that the risk of getting type 2 diabetes can be significantly reduced through lifestyle changes. In fact, according to the U.S. Centers for Disease Control and Prevention, “people with prediabetes who take part in a structured lifestyle change program can cut their risk of developing type 2 diabetes by as much as 58%.”
So what are those lifestyle changes? “People with prediabetes can significantly reduce their risk for type 2 diabetes through adopting a healthy diet, getting enough physical activity and losing weight if overweight,” says Dr. Daniel Kutzler, an internal medicine physician.
Your physician will likely visit with you about your diet and make specific recommendations. Here are a few general rules:
Control Portion Size
Many of us simply consume too many calories. “We have all gotten accustomed to portion sizes that are much larger than our body requires,” says Dr. Lesley. “We don’t need to eat a huge bowl of pasta or a 16-ounce steak, yet that’s what we tend to get when we go to a restaurant and our brains tell us that’s what a ‘normal’ meal should look like. We have to retrain ourselves and resist the temptation to eat meals two or three times larger than what they should be, simply because we can.”
Your physician will tell you about how many calories you should consume each day. Pay attention to serving sizes, though: a serving of meat is 4 ounces, about the size of the palm of your hand. A serving of pasta is 1 cup, dry. Start taking time to measure or weigh your foods (using a kitchen scale), and you might be surprised how easy it is to cut back on calories while still getting enough to eat.
Eat Balanced Meals
Our bodies need different types of food – meats, beans and nuts provide protein and some healthful fats; whole grains give us the carbohydrates we use for energy and help our digestive process, and fruit and vegetables provide essential minerals and vitamins. Strive for meals which are 25 percent meat or fish, 25 percent whole grains and half fruits and vegetables.
Foods to Have in your Diet
Keeping in mind portion control and overall calorie consumption, these foods are generally friendly to a prediabetes management program:
- Whole grain breads, pasta, cereals and rice
- Fresh or frozen fruits and vegetables (canned produce may contain unhealthy amounts of salt and sugar)
- Low-fat dairy products
- Lean meats, such as chicken and turkey without skin; fish
Food to Avoid/Cut Back on
These foods should be avoided or eaten only infrequently and in moderation:
- “White” foods, such as bread, pasta and rice
- Foods high in sugar, saturated fat and salt
- Fruit juices, soda and alcoholic beverages
- Fatty meats
- Whole milk dairy products
Foods containing trans-fat should be avoided at all times.
We should all get exercise most days of the week, ideally 30 minutes a day, 5-7 days a week. This is especially important for someone with diabetes or prediabetes. Beneficial exercise can include brisk walking, light jogging, bicycling, swimming and strength training. Exercise moves blood sugar into cells to be converted to energy and helps insulin work more efficiently. Additionally, exercise provides a good workout for our hearts and burns calories, helping us lose weight. Be sure to consult your physician before beginning an exercise program to ensure that it is safe for you to do so.
Is a Cure on the Horizon?
Researchers continue to work to understand the exact causes of diabetes and discover a cure for this disease that affects so many people. Until then, increased awareness of the serious nature of diabetes – and the ways its risk can be reduced – is essential.
“For so many people out there, especially those who have prediabetes, taking this risk seriously and adjusting lifestyle to reduce the chances of developing type 2 diabetes will improve and save lives,” says Dr. Jason Ledbetter, an internal medicine physician. “If you’re 44 or older and haven’t had a diabetes screening in the last three years, call your doctor and schedule an appointment. It’s worth knowing what your risk is.”
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