Diabetes: A destructive disease that often goes undetected

The American Diabetes Association estimates there are 17 million Americans with diabetes—nearly 6 percent of the U.S. population. More troubling is the fact that half of them don’t know they have it.

Diabetes is a terribly destructive disease. It silently destroys circulation to the heart, brain, kidneys, legs, eyes and skin. It increases the risk of heart attack, stroke, and kidney failure. More than 60 percent of non-traumatic amputations are due to diabetes and it is the leading cause of blindness in the adults 20 to 74.

Yet, about 90-95% of those with diabetes have Type 2, which typically takes decades to cause symptoms. Many people have heard the “classic” symptoms of diabetes: increased thirst, increased urination, hunger and weakness, but these are symptoms of Type 1 diabetes which is most commonly seen in children and which is a very different disease from Type 2. Because most diabetics have no symptoms, it is important to understand what to look for.

Type 1 diabetes, formerly called insulin dependent or juvenile diabetes, typically starts in childhood. Research has shown that Type 1 diabetes results from the immune system attacking and destroying the pancreas cells that produce insulin. Our bodies use insulin to control blood sugar levels. Although Type 1 diabetes is genetically based, it is not inherited from parents as other traits would be.

Symptoms of Type 1 diabetes are increased thirst, fatigue, weight loss, increased urination, hunger, and blurred vision. Left untreated, Type 1 diabetes causes the blood sugar to rise and produce acids which can cause nausea and vomiting, abdominal pain, loss of consciousness and even death. Type 1 diabetes is treated with insulin injections as it does not respond to pills. Type 1 diabetics must be rigorous in their diet and insulin treatment to avoid hypoglycemia or low blood sugar, which can result in coma and death.

While Type 1 is not an hereditary illness, Type 2 diabetes is more common in those who have family members with a history of the disease. People with a parent or sibling with Type 2 diabetes have a forty percent chance of developing it themselves.

Unlike Type 1 diabetics, Type 2 diabetics actually make enough insulin—but their bodies don’t produce it at the right time, and can not effectively use the insulin to control blood sugar levels. Normally, our pancreas responds to eating by producing a surge in insulin. Early in Type 2 diabetes, the normal surge in insulin does not occur and blood sugars rise too high after eating. This is called post-prandial hyperglycemia. After a few hours, the blood sugar returns to normal. After some years, the body’s natural ability to get the blood sugar back down to normal is lost.

Type 2 diabetes usually does not cause symptoms. Eventually it increases the chance of fungal infections and slows healing of wounds, particularly on the feet. Very high blood sugars can cause sluggishness, blurred vision and occasionally double vision.

Because symptoms occur late, doctors look for diabetes before it causes damage. Doctors no longer test urine to look for diabetes because by the time sugar shows up in the urine the diabetes is often advanced. Typically a blood sugar is checked after an 8-12 hour fast when it should be less than 110. Unfortunately, diabetes begins to damage the system in the early stage when blood sugar is too high after eating but normal fasting. Often diabetes has been present for 10 years by the time the fasting sugar becomes abnormal.

Type 2 diabetes is caused by being overweight not by consuming too much sugar. Early humans had to store extra calories for times of famine. Some believe the gene that allows us to store extra calories may be the reason for the increased incidence of diabetes in modern America where more than half the population is overweight. Type 2 diabetes is occurring more often in adolescents because of the increase in obesity. The good news is that just as being overweight causes diabetes, losing and maintaining normal weight can stop diabetes and prevent the related complications.

Everyone over 40 should have a fasting blood glucose about once a year. Overweight people and those with a family history of diabetes should probably be tested earlier than age 40. The goal in treating diabetes is to prevent complications. Many doctors are now looking at the blood sugar after eating to detect diabetes earlier, particularly in cases where diabetes runs in the family.

If you have Type 2 diabetes in your family, try to maintain a normal weight through proper diet and exercise. Ask your doctor about screening tests for diabetes including whether testing for elevated blood sugar after eating would be appropriate.

For more information go to the American Diabetes Association www.diabetes.org or The National Institute of Diabetes, Digestive and Kidney Diseaeses at http://www.niddk.nih.gov/

You can also find information about Type 1 and Type 2 diabetes, as well as diabetic related blindness and kidney diseases on the Penn State Milton S. Hershey Medical Center website at http://www.hmc.psu.edu/healthinfo/d/index.htm.