by Heather McCombs, DPM
The Center for Disease Control (CDC) estimates that diabetes affects 16 million Americans, and approximately 798,000 new cases are being reported each year.
Diabetes is a myriad of small diseases that affect multiple organ systems in the body. As a result of its involvement in many parts of the body, it is a poorly understood disease. It can develop gradually over many years without symptoms. It may be so silent in its progression that it may first be diagnosed when you develop one of its complications; and at this stage, irreversible damage may have already been done.
A diagnosis of diabetes can be frightening, but with proper understanding of the disease, one can make the necessary lifestyle adjustments and continue to live life as they did prior to diagnosis.
What is diabetes?
It is a group of diseases that are characterized by high glucose (sugar) levels in the blood. Blood glucose is high because of a problem with the pancreas’ ability to manufacture insulin. The pancreas is an organ that makes hormones, including insulin. Insulin is used for regulating the absorption and processing of glucose within the body. Glucose is what the body uses for fuel; cells use it to grow, function, and produce energy.
Insulin and glucose share an intimate relationship in that insulin acts like the key that opens the cell so glucose can enter. Without glucose, the cells cannot function, maintain their structures or perform their duties to the body. Without insulin, there may be plenty of glucose in the blood, but it passes by cell after cell, unrecognized. Thus, the cells are starving while there is an abundance of glucose just outside their walls. They have no way of recognizing the glucose, as it is not accompanied by insulin. This unused glucose can build up in the body and cause a condition called hyperglycemia. It is hyperglycemia that, given enough time, damages multiple body systems.
There are actually four types of diabetes, according to the American Diabetes Association (ADA): Type I, known as insulin-dependent diabetes mellitus (IDDM); Type 2, non-insulin dependent diabetes mellitus (NlDDM); Gestational, which is associated with pregnancy; and other types resulting from genetics, surgery, drugs, or illness.
The most common are Types 1 and 2, with Type 2 being the most prevalent, encompassing 90-95% of cases. Type 1 has been termed IDDM or juvenile onset diabetes. It typically affects a younger age group than Type 2 and requires that patients be treated with insulin. Often this condition is the result of an autoimmune disease. The immune system destroys the islet cells of the pancreas (these are the cells that produce insulin); thus the body loses its capability to create insulin that must be supplied to the body through daily injections.
Type 2 diabetes is also referred to as NIDDM, adult-onset, or late-onset. It is generally diagnosed after age 40 and requires different types of management. Depending upon the severity of the disease, it may be managed with diet and exercise, oral medications or injections. With this form of diabetes, several physiological phenomenon occur in combination or separately. The pancreas does not produce enough insulin to meet the body’s need. Cells can become resistant to the effects of insulin, causing the cells not to receive enough glucose. Different modes of treatment must be tried to determine which is most effective for each individual.
Gestational diabetes is a transient disorder that occurs during pregnancy and resolves afterward. It is theorized that the weight gained during pregnancy contributes to its onset. The body still produces insulin, however it no longer utilizes that insulin properly. It has been suggested that this occurs because the hormones present during pregnancy affect the metabolic functions of the body. Although the disease disappears after pregnancy, roughly half of the women who experience it develop Type 2 diabetes later in life.
Some of the known risk factors of diabetes include: obesity (90% of people who develop diabetes are obese), family history, age (risk for TYPE 2 increases after age 40), high fat diet, and race (in western countries, type 2 diabetes occurs twice as often in native American Indians, Hispanics, African-Americans, and Asians than whites).
Signs and symptoms of diabetes are the direct result of high blood glucose levels. They are diverse, affecting the entire body. Unlike other disorders, there is not any part of the body that can be removed to cure diabetes. Initially, some people notice weight loss, fatigue, frequent urination, hunger, or blurred vision. All of these may indeed have another etiology, but diabetes should be suspected when these symptoms persist and occur together.
The fasting plasma glucose test is routinely used to diagnose diabetes. It requires fasting for eight hours prior to a sample of blood being obtained and analyzed to measure the glucose level. A confirmed fasting plasma glucose of >126 ml (milligrams per deciliter) indicates diabetes. Different parameters are used to diagnose gestational diabetes in pregnant women. The ADA recommends that adults have a fasting plasma glucose test at age 45 and every three years thereafter. If you are at risk of diabetes, the test should be performed at a younger age or with more frequency.
Diabetes treatment is multi-faceted. Type I diabetics require insulin simply because their body does not produce it. Type 2 diabetics can hold their blood glucose levels at an acceptable range through diet and exercise, oral medications, insulin or a combination. What your acceptable glucose level is and which drugs are most appropriate is determined by your physician and is based on age, weight, exercise level, type of diabetes, and difficulty in regulating your blood sugar level.
Comprehension of the complications of diabetes is critical. The most important thing a person with diabetes can do is educate themselves about their disease, because many people do not take it seriously until the damage done is irreversible. More often than I care to recall, I have taken care of patients in the hospital with complications of the disease. They relate again and again how they thought it was a diet problem and that they did not really give much thought to their blood sugar levels. They are brought to a stark reality when the silent effects of extended periods of poorly controlled blood glucose begin to manifest in the form of eye, kidney, nerve, blood vessel and heart disease.
Allow me to place you in my shoes as a clinician. I receive a page to see a patient that has been admitted to the hospital for an infection. I examine the patient and find that the source of the infection is in their foot. They were diagnosed with Type 2 diabetes ten years prior and have poorly controlled their blood sugar. They have been throwing up with a fever and chills for the last 24 hours and deny stepping on anything. Their blood sugar is high and the x-ray shows a needle in their foot. This patient will need an emergency trip to the operating room to remove the needle and remove any tissue that has been killed by the infection in addition to a course of serious antibiotics. This may not be the end of the infection; subsequent trips to the operating room may be necessary. You ask yourself, “Why did that person not feel the needle as it entered their foot?” They did not feel it because the nerves in their feet had been damaged by years of the disease. They walked around with the needle in their foot until the bacteria it brought with it created the infection that got their attention. Sadly, this example is often the rule rather than the exception.
Some complications will occur as the natural course of disease progression, but may be delayed by careful monitoring of blood sugar on a regular basis and following the advice of your physician.
With proper attention to the disease and education about its complications, one can enjoy a full and active lifestyle. Education is the key to prevention. If you or someone you care about fits the at-risk profile seek a medical professional to answer any questions that you have. An excellent source of information is the American Diabetes Association at (800) 342-2383, or write:
Customer Service, American Diabetes Association, 1701 N. Beauregard St., Alexandria, VA 22311, or visit: www.diabetes.org. .
Dancing USA Jun/Jul 2001