November is national diabetes month; a time to promote awareness of the challenges faced by those with diabetes. In 1958 there were just over 1.5 million cases of diabetes in the US. In recent decades that number has steadily, and dramatically, climbed. In 2015 there were 23 million American adults with diabetes. this is a combined total of both type 1 and type 2 diabetes. Of the combined totals, only about 5 percent is attributed to type 1 diabetes. And the rest are type 2.
Understanding diabetes requires a little knowledge about metabolism and hormones. We derive energy from the food we eat. Specifically, from the fats, proteins, and carbohydrates in food. Our cells take these energy sources from the bloodstream and, in a complicated feat of chemistry, convert them into a usable form. When carbohydrates are consumed from foods like pasta, bread, fruit, starchy vegetables and sugary beverages our blood sugar rises. Depending on the food this could be a dramatic spike or a gentle rise. The rise in blood sugar then causes a hormonal response that, if everything is working, will lower the sugar levels in the blood back down to normal. The hormone in charge is called insulin. Insulin is manufactured in specific cells in your pancreas and it tells your cells to open their doors and let the sugar enter to clear it out of the bloodstream. Diabetes occurs when this hormone signal is disrupted.
This is where the two types of diabetes are important. In type 1 diabetes the cells in your pancreas do not make an adequate amount of insulin. According to Michael Johnson, MD of Sheboygan Internal Medicine Associates, “Type 1 diabetes is often due to an autoimmune condition in which the immune system has attacked and damaged the pancreas.” This often happens in childhood but it can also happen in adulthood. Type 1 diabetes is also known as insulin-dependent diabetes because those individuals with type 1 are unable to make their own insulin and dependent on medications.
In type 2 diabetes, the pancreas is functioning but your cells stop listening to insulin’s commands. They stop opening their doors to let in blood sugar. This sets off a progressive cycle in which more and more insulin is needed but has less and less effect on blood sugar levels. “This cycle of insulin resistance can go on for years, eventually leading to a damaged pancreas and insulin dependence not unlike what is seen in type 1 diabetes,” said Dr. Johnson.
Whether it is type 1 or type 2 diabetes, the result is the same. Chronically high blood sugar levels in the bloodstream where it slowly causes oxidative damage and inflammation. “When these high blood sugar levels are not controlled it can damage vulnerable tissues,” said Dr. Johnson. This explains why individuals with diabetes are often at risk for many other serious health problems. Dr. Johnson explains, “The patient’s eyes, kidneys, nerves, and blood vessels are all very vulnerable to chronically elevated blood sugar levels.” Damage to these tissues then leads to problems such as blindness, neuropathy, renal disease, stroke, and heart disease.
According to the Centers for Disease Control the symptoms of diabetes include:
● Frequent urination, often at night
● Excessive thirst
● Weight loss without trying
● Excessive hunger
● Blurry vision
● Numb or tingling hands or feet
● Feeling very tired
● Very dry skin
● Sores that heal slowly
● More infections than usual
There are a few ways diabetes is diagnosed. One is known as Hemoglobin A1C which is an indicator of how much sugar has damaged your red blood cells over time. Another test is the oral glucose tolerance test in
which you are given a sugar drink to see how well your body regulates blood sugar levels two hours after consuming the drink. Perhaps the most common test is the fasting plasma glucose test. This test measures your blood sugar after you have had nothing to eat for a minimum of eight hours. This fasting plasma glucose test gives us the ranges that are commonly used to diagnose diabetes and flag prediabetes:
● Normal: <100 mg/dl ● Prediabetes: 100 - 125 mg/dl ● Diabetes: 126+ mg/dl The fact that 84 million American adults, a full third of the population, have prediabetes reminds us that, unlike type 1, type 2 diabetes is a process that progresses over time. This also means that efforts aimed at prevention can really pay off. Prediabetic blood sugar levels are a warning sign to you and your doctor that some action is needed. Dr. Johnson says, “some healthful changes to diet, as well as regular exercise, can prevent cases of prediabetes from progressing into type 2 diabetes. It is easier to prevent than it is to treat the full disease.” Sources: Centers for Disease Control and Prevention. National Diabetes Statistics Report, 2017. Atlanta, GA: Centers for Disease Control and Prevention, U.S. Dept. of Health and Human Services; 2017. http://www.diabetes.org/diabetes-basics/diagnosis/?loc=db-slabnav