Diabetes
is a complicated disease
of energy metabolism. The diagnosis for diabetes is usually high blood
sugar (blood glucose). Do not be fooled! There is no such thing as
“borderline” diabetes or “a touch of sugar”. These are
antiquated phrases. You either have diabetes or you don’t, and if
you do, you must take action to control your blood sugar.
If
diabetes is uncontrolled, the results can be devastating. Diabetes can
lead to blindness, heart disease, and amputations of the legs due to
poor circulation, and kidney failure. The quality of life for a person
with uncontrolled diabetes is quite dismal, but luckily there is a
great deal a person can do to prevent complications, and lead a
normal, healthy life.
There are
basically two types of diabetes: Type I and Type II, although there
are some variations. Type I diabetes usually occurs in young people
and is very quickly diagnosed because the body is unable to produce
insulin, causing blood sugar to rise to disastrous levels. Type I
diabetes can only be controlled with insulin from an outside source,
and patients must take insulin to live. No one knows exactly what
triggers Type I in a susceptible person. There is a genetic component,
but it is not that strong (the risk of Type I diabetes in an identical
twin is 35-50% not 100%). Type I diabetes usually (not always) occurs
in youth or young adults. This type of diabetes is not associated with
increased body fat, and only about 10% of diabetes is Type I.
About
90% of people who have diabetes have Type II diabetes. This
usually occurs later in life (not always), and is strongly associated
with obesity and a family history of diabetes. About 30% of people who
have Type II diabetes eventually require insulin, but often it can be
controlled through diet, exercise and medication. It is more prevalent
in some ethnic groups: Blacks, Hispanics, and Native American Indians
are especially prone to developing diabetes. It tends to have a more
gradual onset; you can have diabetes for years and go untreated. This
is why it is so important not to ignore “mildly elevated” blood
sugar. Thirty percent of Type II diabetes requires insulin at some
point. In the general population the risk for Type II is less than 6%.
If it is in your family, Type II in one parent, risk is 4-7%, in both
parents, it increases to 12%. If a brother or sister risk has
diabetes, your risk is increased to 13%, and if Type II is present in
an identical twin, your risk is 90%.
A Silent Disease
Symptoms may be mild or nonexistent in some people, it can be a
“silent” disease. In other cases, the symptoms are quite obvious:
frequent urination, excessive thirst, weight loss without other
explanation, general fatigue, and frequent vaginal infections in
woman. The word “diabetes” comes from the Greek word for siphon -
describing the symptoms of drinking water and then urinating
constantly like a siphon, flowing water in and out.
The
diagnosis for diabetes depends upon the level of blood sugar or plasma
glucose. Normal blood sugar is about 60-115 mg/dl (milligrams per
deciliter) in the fasting state. It is normal to have some blood
glucose in the blood, and abnormal to have too much or too little. The
brain requires blood glucose for normal function. If blood sugar drops
too low (hypoglycemia) the brain’s function is impaired and coma can
result. It is normal for blood sugar to rise after eating, but in
diabetes, the blood sugar rises higher and stays high longer than in
people without diabetes. New criteria for diagnosis is a fasting blood
sugar of 126 mg/dl or more,. or a non fasting or “random” blood
sugar over 200 with symptoms.
Diabetes
and Obesity
Eighty percent of people who are obese have hyperinsulinemia which
means that they have high levels of insulin in their blood. Their
body’s cells become insulin resistant, so the body must produce more
insulin to keep blood sugar in a normal range. With extra body fat,
the muscle cells are particularly insulin resistant, so blood sugar
cannot be broken down as well compared to thin people. The pancreas
(which produces insulin) must work harder in the body of a person who
is obese to produce more insulin and to keep blood sugar in control.
Losing weight improves the body’s sensitivity to insulin, so that
all aspects of glucose uptake are improved.
High blood
sugar increases risk for atherosclerosis, and chances are if you have
uncontrolled diabetes, your blood fats will be abnormal too,
increasing the risk for heart disease.