What Exactly is Diabetes?
Diabetes mellitus or “sugar diabetes” is a condition where an abnormal response to insulin and/or inadequate insulin production causes high blood sugar levels. This is usually defined by a fasting blood sugar of greater than 125 on two occasions, or a positive glucose tolerance test (the individual drinks a specified amount of glucose, usually 75 grams and their blood sugars are evaluated over a two hour period). Over time, these high blood sugar levels and the other metabolic changes that go along with diabetes are extremely taxing on the body. Consequently, diabetes dramatically increases one’s risk of death and disability.
Current statistics are sobering. In America there are now three times as many diabetics as there were in 1958. Estimates are that some 16 million Americans now have this condition, up from 11 million as recent as 1983. Depending on their type of diabetes and other characteristics, they run anywhere from 2 to 12 times the risk of death when compared to their non-diabetic peers. Diabetes increases the risk of heart disease and other diseases related to atherosclerosis such as stroke or the loss of an arm or leg from blood vessel blockage. Diabetes also dramatically increases one’s chances of infections, kidney failure, and an eye disease called retinopathy, which can result in blindness.
The myriad of afflictions that result from diabetes is listed here:
Although heart disease is the leading cause of death among diabetics, sometimes the debilitating effects of blindness and kidney disease are more frightening. Within only seven years of diagnosis, as many as 50 percent of children with diabetes have developed diabetic retinopathy, a disease of the eyes that can result in blindness. Diabetics need to get checked by eye doctors regularly. Diabetic eye disease is preventable, not only through lifestyle, but also by early treatment. Furthermore, diabetics run a significant risk of developing kidney disease. In any given year, some 55,000 Americans are suffering with what is called “end-stage renal disease” due to their diabetes. These individuals have such poor kidney function that they are alive only by virtue of a transplant or regular dialysis treatments. End-stage renal disease among diabetics is increasing dramatically in the United States. Whereas 5,000 new cases were being diagnosed per year in the early 1980s, a decade later the figure had jumped to 18,000 new cases per year. In fact, over 35 percent of all patients with end-stage kidney disease are diabetic. Diabetic women are also more prone to develop breast and uterine cancer.
No dollar amount can eclipse the thousands of personal tragedies due to diabetic complications. Nevertheless, in a nation where health care costs are skyrocketing, the financial impact of diabetes is truly relevant. The direct and indirect cost to society for diabetes is estimated to be between 90 and 130 billion dollars per year in America alone.
All Diabetics Are Not the Same
Diabetics are often divided into four categories. Of these four categories, there are actually two main types of diabetes: insulin-dependent diabetes mellitus (IDDM), often referred to as Type I, and non-insulin-dependent diabetes mellitus (NIDDM), often designated Type II. Although some diabetes purists will take pains to use the terms IDDM and NIDDM, in this chapter I will use the terms Type I and Type II. A third type of diabetes occurs in pregnancy and is called gestational diabetes mellitus. The fourth category of diabetes takes in a host of rarer causes of the disorder such as those due to hormonal abnormalities or other medical conditions.
Type I diabetes is the most severe form of the disease. It typically occurs in childhood (but can develop at any age) and for this reason was previously called “juvenile diabetes.” The most common cause of Type I diabetes is destruction of the insulin-making cells in the pancreas by the person’s own immune system. This is referred to as “autoimmune destruction.” The specific factors that trigger this autoimmune process have proved elusive. Although some cases have been linked to viruses or chemical toxins, much is still unknown about the beginnings of the Type I diabetes process. There does seem to be a genetic susceptibility to the disease, plus an environmental factor that triggers the disease process. Some of the most interesting recent research links some cases of Type I diabetes to an abnormal immune reaction to milk protein. We now know that children who are breast fed for a shorter time or who are started on cow’s milk earlier have an increased risk for this type of diabetes. In fact, the drinking of cow’s milk may be the trigger that initiates the disease in over half of all Type I diabetics. Regardless of the cause of their Type I diabetes, affected individuals lose their ability to make adequate amounts of insulin and are left with an absolute life-and-death need for insulin shots. Without those shots, they go into a condition called diabetic ketoacidosis, which is fatal if not promptly treated. Because of their absolute need for insulin, individuals with Type I diabetes are usually diagnosed early in the disease process. Typically they have symptoms like excessive urination (polyuria), excessive thirst (polydipsia), excessive hunger, and excessive eating (polyphagia). They often are also bothered by fatigue and weight loss.
Why does the Type I diabetic develop these symptoms? The answer is best arrived at through a brief review of some of the main facts about blood sugar and how it is controlled. The main fuel for our bodies is a simple sugar called glucose. There is a potential problem, however, with this fuel source. It can only get into each cell of the body if insulin is present. Some have compared insulin to a key that opens “the doors” in body cells so that the vital fuel, glucose, can get into the cell. However, if there is an insufficient amount of insulin (as in Type I diabetes) or if the locks on the doors are “gummed up” so that the insulin key has difficulty opening them (as can occur with the insulin resistance of Type II diabetes), then blood sugar levels can rise. When blood sugar levels rise sufficiently, the ability of the kidney to contain the sugar is overwhelmed, and sugar comes out in the urine. The sugar takes water with it, thus leading to the excessive urination so familiar in uncontrolled diabetes. The loss of water results in another diabetes symptom: increased thirst. At the same time, sugar is not moving into the body’s cells adequately. In a sense, the body’s cells are starving for energy. This can cause fatigue, weight loss, and excessive hunger.
Fortunately, only about 5 to 10 percent of diabetics in America fall under the Type I diabetes category. The remainder are Type II diabetics. These individuals either have a problem called “insulin resistance” or a less severe underproduction of insulin than those with the Type I variety. In actuality, most fully developed Type II diabetics have both of these problems. There appear to be many different causes of Type II diabetes; most seem to have a genetic basis. The majority of individuals with this type of diabetes have a family member that had also been diagnosed with the disease. For example, many Native Americans have this genetic tendency; however, it appears they did not have diabetes until they adopted a Western diet with an overabundance of sugar and fat. Simply put, it usually takes a combination of two factors to develop adult onset diabetes. One is genetics, and the other is a poor diet—like that consumed by the average American.
Many individuals with Type II diabetes generate plenty of insulin but their body is resistant to it. This condition of insulin resistance can be addressed by lifestyle changes. By maintaining an excellent diet, achieving an ideal weight, and embarking on an exercise program, many Type II diabetics can control their blood sugars with these lifestyle changes alone. Some may need diet changes plus a pill to help control their blood sugar.
Because of the more subtle nature of Type II diabetes compared to Type I, it often goes undiagnosed. A person with Type II diabetes may not have any of the classic diabetes signs like excessive urination, excessive thirst, excessive hunger, fatigue, or weight loss. At any point in time, it is estimated that fully 50 percent of Type II diabetics have not yet been diagnosed. Of course, unrecognized diabetes still does its damage steadily and silently. About 20 percent of newly diagnosed Type II diabetics already had damage to their eyes (retinopathy). Sometimes an unsuspecting person will be told they have diabetes when a routine blood screening reveals high blood sugar. If the blood sugar is above 125 after an overnight fast, it indicates diabetes. Individuals can have diabetes, however, with fasting blood sugars below that level. If a doctor suspects diabetes in a person with a relatively low fasting sugar, further testing can be done. The oral glucose tolerance test checks for diabetes by measuring a person’s blood sugar response to a sugary beverage. Pregnant women routinely have such a test to make sure they are not diabetic. Some doctors recommend that others in the general population should have a glucose tolerance test. Depending on the physician, some will recommend the test for those with significant obesity and/or genetics. Others advise the glucose tolerance test in anyone with fasting sugars higher than a certain level. Some will check all those with fasting sugars over 105; some very conservative doctors will advise the test to all their patients who have fasting sugars consistently over 95, since this usually indicates that at least the individual has the gene for Type II diabetes. A glycosylated hemoglobin level (discussed later in the lesson) may be able to substitute for the glucose tolerance test in detecting diabetics with fasting blood sugars less than 125.
Although Type II diabetes can be picked up by such blood tests for elevated sugar, many Americans do not seek out health professionals for such preventive services. They wait until they are sick. This is unfortunate. As a result, many Type II diabetics only become aware of their disease when they experience potentially irreversible problems like eye or kidney disease, nerve problems, or a heart attack.
Regarding gestational diabetes, two to five percent of all pregnant American women are affected. This translates into about 200,000 children being born to mothers with gestational diabetes each year. This is significant, because those children experience an increased risk of health disorders such as birth trauma, lower blood sugars at birth (neonatal hypoglycemia), and even premature death in infancy (perinatal mortality). The message is clear: if you are a diabetic who becomes pregnant, or if you develop gestational diabetes, you should have your blood sugar monitored closely. Your diet and lifestyle need to be well regulated. Furthermore, any woman who develops gestational diabetes has a genetic tendency for diabetes. She is at high risk to develop full blown diabetes later in life. Practicing healthy habits throughout her life span thus becomes critical.*
*Above Reference in whole or in part is from the book "Proof Possitive" by Neil Nedley, M.D.
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