Understanding and diagnosing diabetes

The different Effects of Diabetes In an era of SARS, Ebola, bird flu, and HIV/AIDS, many people are worried about epidemics. It’s a reasonable concern, but it often overlooks a major epidemic that is already gripping our nation: diabetes. Unlike epidemics that begin with biologic agents in other parts of the world, diabetes is already with us — right now. Like other epidemics, though, single measures can prevent the disease from spreading — but only if we understand diabetes and heed the call to action.

The Epidemic

Today, more than 245 million people worldwide are living with diabetes. Many more have impaired fasting glucose, which is better known as pre-diabetes. It is a silent killer with a devastating human social and economic impact. Unfortunately, about 50 percent of people afflicted with the disease do not even know about it. It is estimated that every 10 seconds, two persons develop diabetes due to lack of ample knowledge.

Tomorrow, Nov. 14, has been declared by the United Nations as World Diabetes Day to highlight the severe risks that the disease pose to “families, countries, and the entire world.” The UN further noted that “the growing pandemic is set to overwhelm healthcare resources in every country, and in many, it is disabling or killing people of working age.” Statistics show one person dies of diabetes somewhere in the world every 10 seconds! These are worrisome figures, but the explosive increase in the disease is more worrisome still. The prevalence of diabetes increased by about 40 percent during the 1990s and rose by another eight percent in the year 2000, with the greatest increase occurring in children and adolescents. Every projection indicates that it will continue to grow further in the future.

Does it matter?

It sure does matter. People with diabetes are about twice as likely to develop heart disease as those without diabetes. In addition, diabetes is a cause of kidney failure, loss of vision, peripheral artery disease, leg amputation, and cognitive impairment. And if that’s not bad enough, remember that men with diabetes are much more likely to develop erectile dysfunction than healthy men, and the problem starts 10 to 15 years earlier in diabetics. Diabetics also have a higher risk for benign prostatic hyperplasia (BPH).

All in all, diabetes shortens life expectancy by about 13 years; no wonder it’s one of the leading causes of death in many countries. And diabetes is expensive. In the United States for instance, it drains the economy of over $120 billion a year and consumes about one in four Medicare dollars.

What is diabetes?

To understand diabetes, you should first understand how your body handles glucose, the sugar that fuels your metabolism. After you eat, your digestive tract breaks down carbohydrates into simple sugars that are small enough to be absorbed into your bloodstream. Glucose is far and away the most important of these sugars, and it’s an indispensable source of energy for your body’s cells. But to provide that energy, it must travel from your blood into your cells.

Insulin is the hormone that unlocks the door to your cells. When your blood glucose levels rise after a meal, the beta cells of the pancreas spring into action, pouring insulin into your blood. If you produce enough insulin and your cells respond normally, your blood sugar level drops as glucose enters the cells, where it is burned for energy or stored in your liver as glycogen for future use. Insulin also helps your body turn amino acids into proteins and fatty acids into body fat. The net effect is to allow your body to turn food into energy and to store excess energy to keep your engine running if fuel becomes scarce.

A mild elevation of blood sugar doesn’t produce any symptoms, which is why diabetes often goes undiagnosed for four to six years, if not longer. But even mild diabetes is dangerous, since it damages blood vessels and other vital organs. When sugar levels get higher, they produce symptoms that may include fatigue and blurred vision. Excess sugar spills into the urine, taking water with it. This produces excessive urination and dehydration, which lead to increased thirst. Excess hunger is another symptom, and weight loss may develop despite a hearty appetite. This happens because while the blood has too much sugar, the cells don’t get enough. Diabetes is starvation in the midst of plenty. Over time, some people develop symptoms of diabetes-related heart disease, kidney disease, eye disease, or blood vessel disease. And since prompt and aggressive treatment can head off many complications of the disease, every healthy person should also be tested regularly starting at age 45.

The Three Types Of Diabetes

The name diabetes encompasses three different disorders that are all marked by abnormally high blood sugar levels. All forms of diabetes develop when the pancreas is unable to supply enough insulin to meet the body’s demands. In some cases, the problem is a low supply; in others, the tissues don’t respond to insulin as they should; and in still others, it’s both.

• Type 1 diabetes was formerly known as juvenile or insulin-dependent diabetes. It usually begins abruptly before age 20, often with a critical rise in blood sugar levels. The disease is caused by a combination of genetic abnormalities and environmental triggers that cause the body’s immune system to attack the pancreas, destroying its ability to produce insulin. Since insulin is required for glucose to enter the cells, blood sugar levels rise sharply. Type 1 diabetes is the most severe form of the disease, but it accounts for only about five percent of cases. Lifelong insulin therapy is mandatory.

• Type 2 diabetes was once called adult-onset or non-insulin-dependent diabetes. In most cases, the main problem is insulin resistance. The pancreas produces reasonable amounts of the hormone, but the body’s tissues don’t respond properly, so blood sugar levels are abnormally high. Oral medications can help many patients compensate for insulin resistance. But over time, the ability of the overtaxed pancreas to secrete insulin may run down, requiring insulin therapy. More than 90 percent of diabetics have type 2 disease. Genes play a role in risk, but lifestyle factors are the major contributors to the disease, with obesity leading the list. Type 2 diabetes depends less on who your parents are than on how you live. And that means you can protect yourself from this major chronic illness with a series of simple lifestyle choices.

• Gestational diabetes, which occurs during pregnancy, increases the risk of complications for mother and child. Blood sugar levels return to normal after delivery, but many women develop type 2 diabetes later in life.

Diagnosis

Diabetes experts have proposed a simple standard for the diagnosis of the disease: a fasting blood sugar (FBS) of 126 mg/dL or higher, providing the result is confirmed on a second test. To be accurate, the blood should be obtained after eight hours without any caloric consumption. Fasting blood sugars between 100 and 125 indicate impaired glucose tolerance, a milder condition that may lead to diabetes; levels below 100 are officially normal. Still an important 2005 study of 74,309 healthy young men found that glucose levels between 87 and 99 indicate an increased risk for diabetes. It’s a warning for all of us.

Although an FBS of 126 is the new standard for diagnosing diabetes, two other criteria are available. Any blood sugar level above 200 suggests the diagnosis, even if it’s obtained after eating. To be officially diagnosed as diabetic, however, people with random sugars of 200 or higher should also have symptoms of the disease, such as increased thirst and urination or unexplained weight loss. A third way to evaluate diabetes is to see what percent of the oxygen-carrying hemoglobin molecules in a person’s red blood cells has glucose attached to them. A single glycosylated hemoglobin (HbA1C) level reflects a person’s average blood sugar during the preceding 30 days. Normally, it’s about 5.0, meaning that five percent of the hemoglobin molecules has glucose attached to them. A level above 7.0 almost always indicates diabetes.

When should you be tested for diabetes? The ADA recommends a test every three years for people 45 or older. Individuals with risk factors such as being obese or overweight, having a diabetic parent or sibling, or having high blood pressure or high cholesterol levels should begin testing earlier and should have repeat tests as often as once a year. Needless to say, people who have had borderline or high blood sugar readings in the past should also be tested regularly.

Diagnosing diabetes early is important because prompt and aggressive treatment can help ward off the often deadly complications of the disease. It sounds too good to be true, but it can be done!

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