A Patient’s Guide to Diabetes

Diabetes is one of the most prevalent chronic diseases in America today. The American Diabetes Association reports that in 2015, 30.3 million Americans – about 9.4 percent of the population – had diabetes. The ADA also estimates that of that 30.3 million, 7.2 million people don’t know they have diabetes, but 1.5 million Americans are diagnosed every year. It’s the seventh leading cause of death, claiming nearly 80,000 lives in 2015.

The National Institute of Diabetes and Digestive and Kidney Disease defines diabetes as “a disease that occurs when your blood glucose, also called blood sugar, is too high.” The body uses blood glucose to power everything from running a marathon to thinking hard about a problem. This sugar comes from the foods we eat and is absorbed by the cells that need energy with the assistance of a hormone, called insulin, that’s produced in the pancreas. Insulin helps your cells take up the glucose they need to function, but in some people, the pancreas doesn’t produce any or enough insulin to facilitate this process. This results in too much sugar in the blood, which in turn causes sometimes very serious health problems.

Types

Diabetes always involves a problem with insulin and blood sugars, but diabetes isn’t just one single disease. There are three primary types: Type 1, Type 2 and gestational. They tend to affect different people at different ages and stages of life, but all are considered serious conditions.

  • Type 1. The NIDDK reports that people with Type 1 diabetes make very little or no insulin. “Your immune system attacks and destroys the cells in your pancreas that make insulin,” and you’ll need to take insulin every day to replace what your body should be making but isn’t. Type 1 diabetes is considered a progressive, autoimmune disease. Because this form of the disease often affects children, it’s sometimes referred to as juvenile diabetes, but it can affect anyone at any age. Type 1 diabetes accounts for about 5 to 10 percent of all cases of diabetes in the U.S.
  • Type 2. Type 2 diabetes is the most common form of the disease, accounting for 90 to 95 percent of all cases in the U.S. In this disease, the body does not respond properly to insulin, a condition called insulin resistance. Over time, the pancreas may not be able to produce enough insulin. Type 2 diabetes can affect anyone at any age, but tends to be more common among middle-aged and older adults, especially those who are overweight or obese.
  • Gestational Diabetes. Pregnant women who did not previously have diabetes sometimes develop a condition called gestational diabetes, in which their blood sugar levels increase during pregnancy. It most often occurs during the third trimester of pregnancy, and although the condition usually resolves itself after the baby is born, some women may go on to develop Type 2 diabetes after birth. The Centers for Disease Control and Prevention reports that gestational diabetes affects more than 9 percent of pregnant women, and it’s a serious condition for both mother and baby. Elevated blood sugars can affect the development of the fetus and lead to health problems for the baby after birth.

In addition to these types of diabetes, the ADA reports that “before people develop Type 2 diabetes, they almost always have ‘prediabetes’ – blood glucose levels that are higher than normal but not yet high enough to be diagnosed as diabetes.” This condition is sometimes called impaired glucose tolerance or impaired fasting glucose. Prediabetes puts you at higher risk for developing full-blown Type 2 diabetes and cardiovascular disease. The CDC reported in July 2017 that some 84.1 million Americans have prediabetes.

Signs and Symptoms

The ADA reports “some people with Type 2 diabetes have symptoms so mild, that they go unnoticed.” But other people will show some signs of the disease, including:

  • Urinating often.
  • Feeling very thirsty.
  • Feeling very hungry, despite eating.
  • Extreme fatigue.
  • Irritability.
  • Blurred vision.
  • Bruises or cuts that heal slowly.
  • Losing weight, despite eating more (Type 1).
  • Tingling, pain or numbness in the hands and feet (Type 2).

Prediabetes doesn’t offer any clear-cut symptoms, so you may have it for some time before finding out. If you have prediabetes, your doctor will screen you for Type 2 diabetes regularly.

Risk Factors

No one really knows what causes Type 1 diabetes, but genetic predisposition and environmental factors may be involved. Some research suggests a viral infection, such as mumps or rubella, may be the initial trigger in people who are predisposed to develop it.

The NIDDK reports that Type 2 diabetes usually develops as the result of a combination of genetic and lifestyle factors. Family history, age and ethnicity all play a role, as does your diet and level of physical activity. You’re more likely to develop Type 2 diabetes if you’re overweight or obese, are over the age of 45 or if you have a family history of diabetes. Depression, high cholesterol, high blood pressure, heart disease, a history of gestational diabetes and a history of stroke are also risk factors for Type 2 diabetes.

“A person with a first-degree relative [your parent, child or sibling] with Type 2 diabetes has a 5 to 10 times higher risk of developing diabetes than a person the same age and weight without a family history of Type 2 diabetes,” says Sarah R. Rettinger, an endocrinologist with Providence Saint John’s Health Center in Santa Monica, California.

Diagnosis

If diabetes is suspected, your doctor will run some tests. One is the glycated hemoglobin or A1C test. According to the Mayo Clinic’s website, “this blood test indicates your average blood sugar level for the past two to three months. It measures the percentage of blood sugar attached to hemoglobin, the oxygen-carrying protein in red blood cells. The higher your blood sugar levels, the more hemoglobin you’ll have with sugar attached. An A1C level of 6.5 percent or higher on two separate tests indicates that you have diabetes.” Normal levels are below 5.7. If your A1C is between 5.7 and 6.4 percent, you have prediabetes.

You may also have a blood sugar test. For this, your doctor will draw a sample of blood either at a random time or when you’re fasting to see how much sugar is in your blood. If a random blood sugar test shows your blood sugar is more than 200 milligrams per deciliter or higher, you may have diabetes. With a fasting blood test – which is taken in the morning before you’ve had anything to eat or drink – if your blood sugar is 126 mg/dL or higher, you may have diabetes. A normal fasting blood sugar is 100 mg/dL or lower.

Your doctor may run these tests as part of your regular health maintenance schedule, especially if you have one of several risk factors for the disease, such as having a body mass index of 25 or higher (calculate yours here).

Treatment

With any type of diabetes, your doctor will prescribe medications and lifestyle interventions aimed at stabilizing your blood sugar levels. If you smoke, quitting as soon as possible should be your first order of business.

To keep on top of your sugar levels, you’ll need to monitor them regularly. Depending on the type and severity of your diabetes, you may need to check your sugars a few times a week or even a few times a day. “Careful monitoring is the only way to make sure that your blood sugar level remains within your target range,” the Mayo Clinic reports.

Patients with Type 1 diabetes will need to take insulin daily. Some people with Type 2 diabetes need to take insulin right from the start, but others are able to manage the condition through diet, exercise and losing weight, at least in the beginning. Oral medications, such as metformin, may also be prescribed to some patients with Type 2 diabetes.

Because diabetes requires daily treatment and planning, patients need to take a leading role in managing their care. Dr. Kevin Ray Campbell, assistant professor of medicine in the Division of Cardiology at the University of North Carolina at Chapel Hill School of Medicine, writes, “diabetes management requires lots of individual responsibility and involves family, friends, teachers and other school officials. The key to avoiding the complications associated with diabetes is to have a well thought out, comprehensive plan that allows you to have maximal flexibility while carefully controlling blood sugars every single day.”

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