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Diabetes

Incidence

Diabetes has reached epidemic proportions in the U.S. over the past 10 years. This graph from the CDC web site shows the increase in cases in this country over the past 2 decades. From 1989 through 2002 the number of diabetic cases nearly doubled. 

The incidence of diabetes is even more prevalent among Blacks, Hispanics and older individuals. The latest figures from 2002 show that 4.8% of Americans have diabetes, with 1.3 million new cases diagnosed that year alone. Among those over 65, nearly 17% are diabetic or one in six people and the numbers are increasing.

What is Diabetes?

Diabetes is a disorder which results in the body being unable to properly handle glucose (sugar).  There are two types of diabetes.

Type I is known as juvenile diabetes because it is usually first diagnosed in children and young adults. This type of diabetes is thought to occur when the immune system incorrectly attacks the cell of the pancreas that make insulin and destroys them. The body is no longer able to make enough insulin, and cannot control glucose levels properly. Patients with this type of diabetes usually need to take insulin injections.

Type II diabetes is also known as Adult Onset Diabetes because in the past it was mostly found in adults. This has begun to change in recent years as we are seeing more cases of this type of diabetes in children. This is the type of diabetes that has risen so dramatically in recent years. In the early stages of type II diabetes the pancreas is still making enough insulin but the body has become resistant to it and no longer reacts the way it should. The development of type II diabetes is determined partly by genetics ( you inherit the tendency) but is strongly affected by factors such as poor diet, obesity, and inactivity. We believe the increased incidence of these factors in our society is the reason so many children are starting to develop type II diabetes.

Risk Factors for type II diabetes

• Age 45 years or older
• Being overweight ( Body Mass Index greater than 24)
• Having a parent, brother, or sister with diabetes
• Being of African-American, American Indian, Asian-American, Pacific Islander, or Hispanic-American/Latino descent
• Having had diabetes that developed during pregnancy (called gestational diabetes) or giving birth to at least one baby weighing more than nine pounds
• Having high blood pressure
• Having abnormal cholesterol levels -- either HDL "good" cholesterol of 35 or lower or triglyceride levels of 250 or higher
• Exercising fewer than three times a week

Diagnosis

         Diabetes is diagnosed using one of two methods, either a standard fasting blood sugar level or a 3 hr glucose tolerance test. Most often the fasting blood sugar level is done because it is much more convenient for the patient. The table below shows how the fasting blood sugar is interpreted.

Treatment and Management

           Patients in the normal category obviously need no treatment. Those in the pre-diabetic category are usually advised to follow "Lifestyle Modification" recommendations. This includes increased exercise, weight control, and a healthy diet.  Diabetic patients are advised to follow the same lifestyle modifications, but may also require medication for proper control.

           For diabetic patients on medication, regular monitoring is important to ensure good control and reduction of complications. Patients on oral medications can usually be monitored on a quarterly basis or less frequently with a test called a hemoglobin A1c ( HGB A1c).  This test is more useful than a random blood sugar level because it tells your doctor how you have been doing over the past 30-60 days. This table summarizes how the HGB A1c is interpreted.

           In contrast, a blood sugar level only tells you what you sugar is at that exact moment in time. It can vary by several hundred points through the course of the day. Blood sugar monitoring is helpful when a patient is on insulin and may have to adjust their dose at different times of the day depending on their sugar levels. Oral medications do not take affect as quickly as most types of insulin, and therefore can not really be tailored to the sugar level at that moment. For this reason I usually do not have my Type II diabetics check their insulin regularly if they are on oral medications alone.

Further Information  - If you've been diagnosed with diabetes, are at risk for diabetes, or know someone who is, there is a lot you can do. Educating yourself about the disease is the first step.

A great resource for information concerning diabetes is the American Diabetes Association web site. Click on the link below for wealth of information on this subject.