By Stephen T. Sinatra, M.D., F.A.C.C., F.A.C.N., C.N.S., C.B.T.
Diabetes is a disease characterized by high levels of glucose in the blood which are due the body’s inability to produce and/or effectively use insulin.
Because (type II) diabetes is so closely associated with overweight and obesity and the national need for healthy weight management, these topics of interest are addressed as closely-linked and often interdependent health concerns. Researchers have referred to this phenomenon as “diabesity.”
Thirteen percent of all adults in the United States have diabetes, and it has become increasingly prevalent among children and adolescents as well. There are several types of diabetes, with type II diabetes accounting for 90-95% of the cases. Type II diabetes is three times as common today in the U.S. as it was forty years ago, mainly because of its sister public health concern, obesity. Nearly two-thirds of American adults are overweight, and one-third of this group is obese. While such obesity in adults has doubled since 1980, the incidence of overweight in children and adolescents, ages six to nineteen has tripled.
Both diabetes and obesity are linked with numerous other health complications including cardiovascular disease and cancers. In addition to physical suffering, obesity and unmanaged diabetes can result in monumental U.S. healthcare expenses associated with treating related health concerns. In 2007 estimated direct medical costs for diagnosed diabetics amounted to $116 billion. Healthcare costs associated with obesity alone are estimated as being between $26.8 and $47.5 billion. Clearly, there is a need for promotion, on a large-scale basis, of prevention of controllable risk factors through lifestyle intervention.
Types of Diabetes
Type I diabetes, once known as “juvenile diabetes,” is a condition in which the body does not manufacture insulin, a hormone necessary to digest sugars and starches. It usually affects children and adolescents and accounts for approximately five to ten percent of diabetes cases. A person with type I diabetes does not produce insulin because his or her immune system has attacked pancreatic beta cells, the sole producers of insulin in the body. As such, to regulate blood glucose, the type I diabetic must receive insulin from an outside source, usually through an injection.
Type II, or adult onset, diabetes is much more common, and has become almost epidemic in the U.S. A person with type II diabetes either does not generate adequate amounts of insulin to regulate blood glucose, or the person’s cells have become insulin resistant. Insulin resistance characterizes most cases of adult-onset diabetes.
Insulin resistance is a condition in which insulin cannot transport glucose into cells for metabolism. No matter how much insulin the pancreas releases into the bloodstream in response to glucose in the blood, insulin receptors on the cells don’t recognize the insulin. Blood glucose remains high, causing hyperglycemia, which leads to diabetes when chronic. In addition to many of the health complications caused by continual hyperglycemia, chronically high insulin levels are associated with increased levels of inflammatory chemicals. Related inflammation contributes to coronary artery disease and hypertension, and can exacerbate other inflammatory conditions like arthritis.
A deadly cycle where both glucose and insulin accumulate in the blood while cells starve, insulin resistance is caused by continual, excessive ingestion of high-glycemic carbohydrates. It is therefore preventable through dietary and other lifestyle interventions.
Gestational diabetes is another form of diabetes which affects some pregnant women. Women with gestational diabetes receive treatment to normalize their blood glucose levels in order to avoid complications with the infant. It is more common for Hispanic, African American, and Native American to develop this condition, as well as women who are obese or have a family history of diabetes. Gestational diabetes also increases a woman’s risk of developing diabetes independent of the pregnancy. While she has a 5-10% chance of independently developing type II diabetes during pregnancy, the likelihood of becoming diabetic reaches 40-60% after delivery.
Diabetes Prevention and Management
Mismanagement of diabetes can lead to numerous health complications such as cardiovascular disease, kidney disease, loss of vision, nerve damage and amputation, some cancers, and death. These complications are primarily due to changes in microvasculature caused by chronic hyperglycemia (high blood glucose levels). Prevention or management of diabetes, then, is crucial for health maintenance. While there is no known way to prevent type I diabetes, type II diabetes is preventable through lifestyle intervention which includes daily dietary measures to prevent excess insulin release and weight gain, effective stress management, and exercise.
If you are diabetic, you can maintain your quality of life and help prevent related health complications by controlling levels of glucose and lipids (fatty acids and cholesterol) in your blood, as well as your blood pressure levels. Receiving education and training from your doctor about how to self-manage diabetes and blood pressure is key, as is taking a proactive approach to learning about your condition. For many type II diabetics, controlling blood glucose involves committing to appropriate daily lifestyle choices, such as a healthy meal and exercise program, as well as possible medication and loss of excess weight.
Diabetes Risk Factors
Risk factors for type I diabetes may be related to autoimmune, environmental, or genetic issues. Between 1-5% of all cases of diabetes have causes related to surgery, medications, genetics, pancreatic diseases, infections, and other illnesses.
Risk factors for type II diabetes include older age, obesity, a family history of diabetes, physical inactivity and other lifestyle choices such as a high-sugar diet, glucose dysfunction, and race and/or ethnicity. Type II is more prevalent in African Americans, Pacific Islanders / Asian Americans, Native Americans, and Hispanic Americans / Latinos. Conversely, researchers have determined that Caucasians have a greater risk of developing diabetes-related health complications, and Caucasian youth are more prone to type I diabetes than other races and/or ethnicities.
Before developing type II diabetes, people usually exhibit symptoms of prediabetes, a condition where their blood sugar levels exceed what is normal, but aren’t high enough for a diabetes diagnosis. To determine whether someone has prediabetes, a health professional will test for impaired fasting glucose (IFG) and/or Impaired Glucose Tolerance (IGT). A person displays IFG when his or her blood glucose levels are within 100-125 mg/dL after an overnight fast. IGT may be demonstrated when a person’s blood glucose levels are fall within 140-199 mg/dL after a glucose tolerance test.
Testing blood sugar levels with a health care practitioner is important, especially if symptoms of diabetes are present. Symptoms include weight loss, excessive hunger and/or thirst, frequent urination, irritability, fatigue, and /or blurry vision.
As diabetes carries with it risk factors for other serious conditions, preventing or controlling it is crucial for health, and, on a large-scale basis, requires a multifaceted approach to education and/or treatment. The good news is diabetes is largely preventable through healthy lifestyle practices which include a low-glycemic (non-inflammatory) diet, adequate exercise, and stress management. People who have diabetes can also significantly decrease the likelihood of developing related health disorders through effective management of their condition. Truly, awareness can be curative.
Learn More:
Want to eat healthy, but don’t feel too at home in the kitchen? My son, Step, and I show you how quick and easy healthy food preparation can be in our What’s Cooking? web show series, through which we demonstrate how to make our favorite snacks and meals while explaining the health benefits of regularly consuming them. We give you lots of great recipes to download too!
References:
- American Diabetes Association website
- Centers for Disease Control (CDC) website
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- Karter, A. et al. Ethnic Disparities in Diabetic Complications in an Insured Population. JAMA 2002;287:2519-2527.
- National Institutes of Health website
- Ogden, C. et. al. “Prevalence of Obesity and Overweight in the United States 1999-2004.” JAMA 2006; 295(13):1549-1545 available at http://www.ncbi.nlm.nih.gov/pubmed/16595758
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- Sinatra ST, Punkre J. The Fast Food Diet. Hoboken, NJ: John Wiley & Sons, Inc.; 2006.
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