Diabetes: How Sweet it Isn’t

Things are going to get a lot worse before they get worse.”  —Lily Tomlin

If the current trends continue, it is predicted that by 2050, one in three Americans will have diabetes.  Currently, 8.3% of the adult population in the world has diabetes.  This accounts for 387 million people in 2014.  According to the 2014 National Diabetes Statistics Report, 29 million Americans—9% of the population—were living with diabetes in 2012.   Of that 29 million, 1.7 million were new cases, and the growth rate is expected to continue to progress.

Diabetes was one of the first diseases described in early medical history.  In Egyptian manuscripts, it was called “too great emptying of the urine.”  Indian doctors noted that the urine would attract ants, thus calling it “honey urine.”  The word “diabetes” means “to pass through.”

There are essentially three types of diabetes:  Type One, Type Two, and Gestational Diabetes.  This post will discuss primarily Types One and Two.

Type One accounts for approximately 10% of the cases.  This type is partly inherited, with certain genes known to influence the risk.  When certain environmental (such as a viral infection) and diet factors line up, it is the perfect storm:  the onset of Type One Diabetes occurs.  Most affected people are otherwise healthy and of a normal weight when onset occurs, which is primarily in childhood.  The onset is relatively sudden in comparison to Type Two.

The classic symptoms of untreated diabetes include:

  • weight loss
  • frequent urination
  • increased thirst
  • increased hunger

Additional symptoms, though not specific to diabetes include:

  • blurry vision
  • headache
  • fatigue
  • slow healing of cuts
  • itchy skin

People with Type One diabetes may also demonstrate the following symptoms of diabetic ketoacidisos, constituting a medical emergency:

  • nausea and vomiting
  • abdominal pain
  • acetone smell on the breath
  • deep breathing known as “Kussmaul breathing”
  • decreased consciousness in severe cases

 Long-term risks of diabetes include:

  • cardiovascular disease
  • stroke
  • kidney failure
  • foot ulcers
  • damage to the eyes. 

 Type One diabetes cannot generally be prevented, but it can typically be well controlled.  It is caused by the body’s failure to produce enough insulin.  It has previously been referred to as “insulin-dependent diabetes mellitus” or “juvenile diabetes” because the onset is typically in childhood.  Insulin is the hormone that carries glucose to cells throughout the body to be converted to energy.  The glucose molecule is created after food is broken down in the digestive system.

Type One diabetes is managed by keeping blood sugar levels close to normal.  Typically, this is accomplished with diet, exercise and use of appropriate medications—typically insulin.

  TYPE TWO DIABETES

  •  Type Two diabetes accounts for 90% of cases worldwide and in America.
  • It has equal rates in men and women.
  • It is caused primarily by lifestyle factors and genetics.
  • Lack of physical activity, obesity, poor diet, stress and urbanization are risk factors.
  • Consumption of sugar-sweetened drinks in excess increases the risk.
  • Over-consumption of white rice increases risk, especially in countries that include white rice as a staple in their diets such as India, China and Japan.
  • Lack of exercise is estimated to cause 7% of cases.

 

In the early stages of Type Two diabetes, the predominant is reduced insulin sensitivity.  If detected early enough, this can be reversed by a variety of measures, including medication that increases insulin sensitivity or reduced glucose production by the liver, thus avoiding the full-blown onset of Type Two.

Prediabetes  is defined as the condition whereby a person’s blood sugar levels are higher than normal, but not high enough for a diagnosis of Type Two diabetes.  Many people stay in this state of prediabetes for many years, never fully developing Type Two diabetes.

While obesity is listed as a risk factor, it is notable that while 80% of people with Type Two diabetes are overweight, most overweight people do not develop diabetes.

Experts are not sure why it occurs in the remaining 20% who are not overweight.  This suggests that environmental factors and genetics are to be accounted for.  Researchers know that excess body fat produces compounds that lower sensitivity to insulin, which could explain the 80% figure.

One fact that all experts are certain of is this:  Diet and exercise are crucial.  Carbohydrates have long been the enemy, but whole grains are embraced as being high in fiber, and won’t send a rush of glucose into the bloodstream the way processed carbohydrates such as white bread, pasta and refined sugar do.  Whole grains improve insulin sensitivity and lower the glucose spike after a meal.

Exercise is always a good idea.  Doctors have long known that muscle contractions stimulate glucose uptake from the blood.  Brisk walking is a highly recommended exercise, as it is easiest for most people, and an all-around good exercise.

Gestational Diabetes is the third major type of diabetes.  It occurs in 2-10% of all pregnancies, and may improve or disappear after delivery.  However, after pregnancy, it is found that 5-10% of those women who did have gestational diabetes, do indeed have diabetes mellitus, typically Type Two.  Gestational diabetes is fully treatable and requires medical management as well as lifestyle changes.

While it can come and go, untreated gestational diabetes can damage the health of the fetus and/or the mother.  Fetal risks include:  congenital cardiac and central nervous system anomalies, as well as skeletal muscle malformations.   Respiratory distress syndrome may also occur.

There are many important aspects of treatment, specifically Metformin as the first medical pharmaceutical treatment for Type Two, while insulin is the primary medication for Type One.

Lifestyle plays a pivotal role in the management of diabetes.  Adequate exercise and good nutrition are the primary focus of keeping the blood sugar levels under control, generally for the lifetime of the person with diabetes.

In extreme cases of Type One, a pancreas transplant is considered who have severe complications, including end-stage renal disease that requires kidney transplantation.

The good news is this:  the vast majority of diabetes cases—90%–could likely be prevented.   Constituting that 90% is Type Two diabetes, which is typically caused by poor diet and lifestyle choices.   Some persons are predisposed to Type Two diabetes, but with careful food choices, exercise, and keeping one’s weight in check, the risk is significantly lowered.