Understanding Diabetes

By Michele Freeman, MD

Epidemiology:

The prevalence of Type 2 (adult onset) Diabetes Mellitus in the United States has increased dramatically in the past 60 years. In 1935 there were approximately 1.5 million people in the U.S. with Type 2 Diabetes compared to nearly 8 million in the early 1990's. At the present time, it affects 6 % of the U.S. population, or nearly 16 million people, and results in significant health complications and death. The cost of treating this disease and its complications is about ninety billion dollars a year. Diabetes is the 7th leading cause of death in this country.

Cause:

Diabetes Mellitus is caused by an alteration in the blood sugar (glucose) regulation, resulting in elevated blood glucose after eating a meal. The primary agent controlling the blood sugar level is a hormone called insulin. Insulin is manufactured and released by the Pancreas in response to certain body signals to keep blood sugar normal. Glucose (blood sugar) is produced from the breakdown of carbohydrates eaten in our diet and is used by the body as fuel, for energy.

Types:

Diabetes Mellitus occurs in two distinct forms:

• Type 1 (Juvenile) or insulin dependent
• Type 2 (Adult onset) or non-insulin dependent

Type 1 Diabetes Mellitus is due to a lack of insulin production and release from the pancreas thereby interrupting the normal regulation of blood glucose. This type typically occurs in youth or early adulthood thus the term juvenile onset. This form occurs in only 5-10% of people with the disease. Type 2 Diabetes Mellitus is caused by insufficient amounts of insulin production and /or an inability of the body to use the insulin produced by the pancreas. This type has been termed insulin resistance. Type 2 Diabetes Mellitus occurs in 90-95% of people with the disease. Obesity is the major factor leading to insulin resistance, ultimately leading to the development of Type 2 Diabetes Mellitus.

Risk Factors:

Type 1 Diabetes Mellitus:

• Siblings of persons with Type 1 disease
• Children of parents with Type 1 disease

Type 2 Diabetes Mellitus:

• Age greater than 45
• Being over-weight
• Lack of regular exercise
• Native Americans, Hispanic Americans, African Americans have a much higher incidence compared to the general population

Complications:

• Blindness (12,000- 24,000 cases/yr.)
• Kidney failure (Diabetes accounts for 40% of all cases)
• Heart disease and Stroke ( 2-4 times greater incidence in diabetics)
• Poor circulation (Leads to amputations, which occurs 15-40 times greater in diabetics)
• Nerve damage (Occurs in 60-70% of diabetics resulting in loss of sensation and contributes to the risk for amputation)

Therapy:

• Type 1 diabetics always require insulin to control blood sugar to maintain life
• Type 2 diabetics may never need insulin to control blood sugar and sometimes can be controlled with an appropriate diet and exercise program
• Type 2 diabetics who are unable to control their sugars with diet and exercise alone typically require a blood glucose-lowering pill taken one to three times daily
• If blood sugar remains poorly controlled with a combination of diet, exercise, and pills, the final modification is the addition of insulin to the medical regimen of persons with Type 2 disease
• Type 2 Diabetes Mellitus can be fully controlled in many cases with weight loss i.e., achieving ideal body weight or coming close to this weight. If this can be achieved, drug therapy can often be lowered or even discontinued
• Insulin can never be discontinued in Type 1 Diabetes Mellitus

In summary, type 2 Diabetes Mellitus can be controlled and treated with appropriate lifestyle management that focuses on controlling obesity. Normalization of blood sugar is the key to preventing the complications of diabetes in Type 2 and to some degree in Type 1 Diabetes. So, making a commitment to yourself to eat healthfully and to incorporate exercise into your daily routine can greatly improve your quality of life when living with diabetes.