Health News
Health News
November 1, 2018
Diabetes Awareness

November is Diabetes Awareness Month, a time to focus on a disease that affects more than 30 million Americans, or nearly ten percent of all people in the United States.  This includes more than 12 percent of adults, according to the U.S. Centers for Disease Control and Prevention’s (CDC) 2017 Diabetes Report Card.   While diabetes impacts a large percentage of our population, a sizable number of people who have diabetes – about 25 percent, or 7 million people – are not yet aware of it.  In Texas, 11.2 percent of adults age 18 or older had been diagnosed with diabetes in 2015, the most recent year for which the CDC has state-level statistics available. 

Diabetes is costly to our society.  The CDC reports that in 2017, the estimated cost of diabetes in the U.S. totaled $327 billion. That figure encompasses medical care, as well as lost productivity.  Diabetes accounts for about one quarter of all health care spending and a person with diabetes spends, on average, more than twice as much on health care costs than someone who is not diabetic. 

“Diabetes is one of the more common serious chronic health conditions I see in my patients,” says Dr. Aroon Kalakunja, a hospitalist.  “If not diagnosed and managed proactively, diabetes can have serious and lasting impacts on a person’s health.  Diabetes is the seventh-leading cause of death in the United States, so it’s imperative that people who have diabetes or are at risk of getting it work closely with their health care provider to protect their health.”

What is 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.  Blood sugar levels that are consistently too high can cause diabetes. 

Forms of Diabetes

There are three main types of diabetes. Type 2 diabetes is by far the most common. 

  • 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 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. 

A condition that is considered a precursor to type 2 diabetes is known as prediabetes.  People are diagnosed with prediabetes when their blood sugar levels are elevated, but not yet high enough to be classified as type 2 diabetes.  If lifestyle adjustments are not made to lower blood sugar levels, prediabetes is likely to lead to type 2 diabetes.  Being overweight, limited physical activity and being 45 years old or older are key risk factors for prediabetes.   

Prediabetes is very common: one-third of Americans, about 90 million people, have prediabetes. 

How Do You Know if You Have Diabetes?

Diabetes often produces no symptoms, one of the principle reasons why up to a quarter of people who have the disease are unaware of it and 90 percent of those with prediabetes have no idea they have the condition.  That’s why screenings are so important.  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)

The A1C Test is another commonly-used diabetes screening. A1C measures the average of blood sugar levels over the course of 2-3 months.  A1C results are expressed as a percentage:

  • Normal: below 5.7 percent

  • Prediabetes: between 5.7 – 6.4 percent

  • Diabetes: 6.5 percent or higher

A random blood sugar test can be conducted at any time and does not require fasting.  A glucose reading of 200 mg/dL or more is indicative of diabetes. 

All adults who are normal weight should be screened for diabetes beginning at age 45 and then again every three years.  Any adult who is overweight or obese should be screened every year, regardless of age.  Women who have had gestational diabetes should also be screened regularly, regardless of age.  (These are general screening guidelines.  Your physician will provide screening guidance specific to you based on your medical history and other factors). 

Again, diabetes often produces no symptoms, which is why screening is so important.  When the disease does cause symptoms, those can include:

  • Extreme thirst

  • Frequent urination

  • Dry skin

  • Sudden and unexplained weight loss

  • Extreme hunger

  • Exhaustion

  • Numbness and tingling in arms and feet

These symptoms can be caused by other factors unrelated to diabetes, but be sure to schedule a visit with your physician to discuss any of these symptoms. 

Diabetes Risk Factors

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

  • Excess belly fat

  • Sedentary lifestyle

  • Race – African Americans, Hispanics, Asian Americans and Native Americans are at greater risk

  • Age – our risk increases the older we get.  People age 45 or older are more at risk. 

  • History of gestational diabetes

  • High blood pressure

  • High cholesterol levels (LDL cholesterol and triglycerides)

  • Low HDL (“good”) cholesterol

  • Depression

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. 

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 damageDiabetes 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. 

Living with Diabetes

“Diabetes is a serious disease, but it can often be successfully managed by working with your doctor, taking any prescribed medications, following a meal plan and getting the appropriate amount of physical activity,” says Dr. Sara Saginaw, a family medicine physician.

The most important thing someone with diabetes must do is manage their glucose levels at all times.  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 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.  The A1C test measures average blood sugar over a three-month period, helping determine if the glucose numbers are moving in the right direction.

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. 

Most type 2 diabetes can be treated with oral medications.  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 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.  See more about diet and exercise below. 

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. “Studies have shows that people with prediabetes can dramatically reduce their chances of developing type 2 diabetes, primarily by modifying their diet and getting more exercise,” says Dr. Timothy Jones, an obstetrician and gynecologist.  “And while smoking is dangerous for anyone, it is especially important that those with prediabetes quit – smoking narrows blood vessels and forces the heart to work harder, which is the last thing someone in danger of developing type 2 diabetes needs.” 

Your physician will likely visit with you about your diet and make specific recommendations. Here are a few general rules:

Losing Weight

As being overweight is a key risk factor for developing type 2 diabetes, losing weight can make a big difference in reducing risk and improving overall health.  A small weight loss of just 5-7 percent of total body weight has been shown to be meaningful.  For a 190-pound person, that would mean a weight reduction of 10-13 pounds.  There are two main ways to lose those pounds and keep them off: changing what and how much we eat, as well as getting more exercise. 

Control Portion Size

Many of us simply eat too much. “Portion sizes are often wildly out of proportion to the amount of food our bodies really need,” explains Dr. Lynne Tilkin, a primary care physician.  “Think about it: it’s not uncommon to go to a restaurant and see a 16 oz steak on the menu.  That steak is four times the amount of meat we should be eating in one meal, but our brains have become conditioned to thinking these huge servings are ‘normal.’  We have to retrain ourselves to understand what an appropriate amount of food is.” 

While 2,000 calories per day is considered the amount the average person should consume, our individual recommended totals vary.  Your physician will tell you about how many calories you should consume each day.  Pay attention to serving sizes to help control calorie intake: 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

  • Beans

  • Lean meats, such as chicken and turkey without skin; fish

  • Water

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. 

Exercise

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. 

If in Doubt, Get Screened

If you have not had a diabetes screening before, or if you are over 44 and it has been more than three years, make an appointment today to get this quick and easy screening.  “It’s important to understand your risk,” says Dr. Jason Ledbetter, an internal medicine physician.  “If it turns out you have diabetes or prediabetes, the sooner you can take steps to improve your health and effectively manage these conditions.  And if you don’t have either one, you’ll have peace of mind in knowing that.”   

This article contains information sourced from:

The U.S. Centers for Disease Control and Prevention

The National Institute of Diabetes and Digestive and Kidney Diseases