The Diabetes Epidemic
While Type 2 Diabetes is not actually contagious it has reached epidemic levels and not just in America, but worldwide in developed and developing nations. Once known as adult onset diabetes it is now becoming frighteningly more common among children and teenagers. Between 2000 and 2009 the occurrence of childhood diabetes rose 30%. Overall in the United States 30 million Americans now have diabetes with type 2 being the most prevalent form.
What Causes Diabetes?
First let’s distinguish between Type 1 and Type 2. Type 1 diabetes is an autoimmune disease in which the body’s own immune system attacks the cells in the pancreas that produce insulin. The cause may be genetic or environmental. Only 5% of diabetic occurrence is Type 1.
In Type 2 diabetes obesity is the number 1 risk factor. Lack of exercise and a poor diet add to the risk as does ethnicity and age. Diabetes is more prevalent among African Americans, Hispanics, Native Americans and Asians. The western diet is a likely culprit in these groups.
Insulin is a hormone that is secreted by the pancreas into the blood stream in response to elevated blood sugar levels from eating. The insulin circulates enabling sugar in the form of glucose to enter the cells where it is used as fuel. As sugar enters the cells blood sugar levels naturally drop as does insulin secretion. Sugar is stored in the muscles and the liver as glycogen. When glucose levels are low, such as when not eating in a while, the liver converts glycogen back into glucose for use as cellular food. Excess sugar is often stored as fat.
In Type 2 Diabetes the pancreas generally still produces sufficient insulin, but the body’s cells become resistant to the insulin. For a while the pancreas might over produce insulin in an attempt to make up for the resistance, but won’t be able to keep up indefinitely and blood sugar levels will rise. In some cases the pancreas might stop producing insulin entirely.
Untreated Type 2 Diabetes is a chronic disease that can lead to a 10 year shorter lifespan. There is a 4 times greater chance of heart disease and stroke. Add to this a 20 fold increase in risk of lower limb amputation, an increase risk for blindness, kidney disease and dementia.
Symptoms and Diagnosis
Type 2 symptoms often develop slowly and may take years to recognize. Elevated blood sugar can cause fluids to be pulled from the body tissues causing increased thirst and urination. Inability to metabolize sugar can increase appetite and cause weight loss. Fatigue, nausea, dizziness, blurred vision, slow healing sores, frequent infection and areas of darkened skin are all also symptoms.
If your doctor suspects diabetes or a routine blood or urine test shows elevated sugar levels your doctor can order one of several different tests.
1) A1C Test – This test can measure your average blood sugar level for the last 2-3 months by measuring the amount of sugar attached to your hemoglobin (oxygen carrying protein in red blood).
2) Fasting Blood Sugar Test – This blood test measures blood sugar levels after a 12 hour fast. Is generally repeated on tests indicating 126mg/dl or higher.
3) Glucose Tolerance Test – after a night of fasting your levels are tested followed by drinking a glucose liquid. Levels are test periodically for 2 hours.
Treatment and Preventative Care
Obviously the best solution is to not get type 2 diabetes in the first place. Your best option is lifestyle changes. If you are overweight or obese losing weight is the most effective. Even just 20 lbs can have a significant effect. Increasing activity is also important as exercise increases insulin sensitivity. It doesn’t have to be trips to the gym, even walking can do wonders. The key is consistency. Start with 20-30 minutes a day. More vigorous exercise has an even bigger benefit. Diet is also crucial, cutting back on carbohydrates in the form of simple sugars and starches. Clearly all of these go hand in hand. A fourth healthy change is adequate sleep. A lack of sufficient sleep increases insulin resistance. Aim for 7-8 hours nightly.
In cases where lifestyle changes alone aren’t enough there are several classes of medication that may be prescribed by your doctor. Here are a few.
1) Metformin – Makes the body tissues more sensitive to insulin and lowers the livers production of glucose.
2) Sulfonylureas and Meglitinides – encourage the pancreas to secret more insulin.
3) Thiazolidinediones – Makes tissues more insulin sensitive, but has been linked to weight gain.
4) SGLT2 Inhibitors – Prevent the kidneys from reabsorbing blood sugar and instead excreting it.
5) Insulin Therapy – Can be one or a combination of injectables.