November is Diabetes Awareness Month, a good time to turn attention to a chronic disease that affects more than one out of ten Americans. Diabetes is serious and can lead to several health complications. However, while there is not a cure, diabetes can be managed to improve someone’s quality of life and lessen the long-term health consequences.
Here are some key diabetes statistics, according to the U.S. Centers for Disease Control and Prevention (CDC) 2019 Diabetes Report Card:
- More than 34 million Americans had diabetes in 2018.
- This figure represents more than 13% of all adults
- More than 7 million people who have diabetes are not aware of it because they have not been diagnosed.
- In Texas, 10.9% of adults age 18 or older had been diagnosed with diabetes in 2016, the most recent year for which the CDC has state-level statistics available.
Over the last decade, the annual rate of new diabetes cases in adults has decreased, but the rate of new cases in children and adolescents has increased.
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.
What is Diabetes?
A disorder of the metabolism, diabetes results in the body not properly using food. Normally, 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 cells are unable to absorb enough glucose, blood sugar levels rise. Blood sugar levels that are consistently too high can cause diabetes.
Types 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 5% of people with diabetes have Type 1 diabetes.
- Type 2 diabetes is the most commonly diagnosed form of diabetes, accounting for 90-95% 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.
Prediabetes is a precursor to full-blown diabetes – think of it as a warning. 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, not getting enough physical activity and being 45 or older are key risk factors for prediabetes.
Prediabetes is very common: 88 million people—one-third of American adults—have prediabetes. Screening is essential to knowing if you have prediabetes – nearly 85% of people with prediabetes do not know they have it.
Screening for Diabetes & Prediabetes
Diabetes often produces no symptoms, one of the main reasons why many people who have the disease are unaware of it. That’s why screenings are so important. A diabetes screening is a simple blood test that 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 common 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%
- Prediabetes: between 5.7 – 6.4%
- Diabetes: 6.5% 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.
The following are general screening guidelines for diabetes:
- Men and women age 45 and older, every three years.
- If overweight or obese, men and women ages 19-44, every year.
- Women who have had gestational diabetes.
- Children between ages of 10-18 who are overweight and have at least two other risk factors.
(These are general screening guidelines. Your physician will provide screening guidance specific to you based on your medical history and other factors).
Possible Symptoms of Diabetes
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, especially at night
- Dry skin
- Sudden and unexplained weight loss
- Extreme hunger
- Numbness and tingling in arms and feet
- Blurry vision
- Sores that don’t heal quickly
- Frequent infections
These symptoms can be caused by other conditions unrelated to diabetes, but if you experience any of them, be sure to schedule a visit with your physician.
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:
- Having prediabetes
- Being overweight
- Physically active less than three times a week
- 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
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 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.
Living with Diabetes
Diabetes can often be successfully managed by working with your doctor, taking prescribed medications, following a meal plan and increasing physical activity.
The most important thing someone with diabetes must do is manage their glucose 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 or drop too much.
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 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 people who have prediabetes – is that the risk of getting type 2 diabetes can be significantly reduced through lifestyle changes. People with prediabetes can reduce their chances of developing type 2 diabetes, primarily by modifying their diet, getting more exercise and quitting smoking.
Your physician will likely visit with you about your diet and make specific recommendations. Here are a few general rules:
If overweight, shedding some pounds can make a big difference in reducing risk and improving overall health. A small weight loss of just 5-7% of total body weight has been shown to be meaningful. For a 200-pound person, that would mean a weight reduction of 10-14 pounds. The main ways we can lose weight and keep it off are changing what we eat, eating less and getting more exercise.
Control Portion Size
While 2,000 calories per day is considered the amount the average person should consume, our individual recommended totals vary. Your physician can help you determine 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.
Measuring and weighing food is important. Many of us have gotten used to large portion sizes that we accept as normal; however, food servings are often much larger than they should be. This is especially true when we go out to eat at a restaurant.
Eat Balanced Meals
Our bodies need different types of food:
- Meat, fish, beans and nuts provide protein and some healthful fats
- Whole grains give us the carbohydrates we use for energy and help our digestive process
- Fruit and vegetables provide essential minerals and vitamins.
Our goal should be to eat meals that are 25% meat or fish, 25% whole grains and 50% fruits and vegetables. These ratios apply to everyone, but especially to people who have been diagnosed with prediabetes.
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 should be avoided, as it often contains 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.
If you have not had a diabetes screening before or are not sure the last time you had your blood sugar checked, make an appointment with your doctor. It’s fast, easy and can help you avoid a lot of problems down the road.
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