Diabetes

When most people hear the word “diabetes,” they think about disease of the pancreas (an organ behind your stomach) whereby the pancreas fails to produce insulin. While this is a form of diabetes, called type1 diabetes, it is not the most common type. It is estimated that only 5-10% of Americans who are diagnosed with diabetes have type1. People with type1 diabetes must use insulin injections to control their blood glucose. Type1 diabetes most commonly starts in people under the age of 20, but may occur at any age.

The most common type of diabetes, type2 diabetes, occurs when the pancreas produces insulin, but the body is unable to use it appropriately.

To understand why insulin is important, it helps to know more about how the body uses food for energy. The millions of cells in your body need fuel in a very simple form in order to create the energy they need. When you eat or drink, much of your food is broken down into a simple sugar called glucose. This is the basic fuel for all the cells in the body. Glucose is transported from place to place in your bloodstream, but it can’t get from the bloodstream to the cells where it’s needed on its own. Insulin is the “helping agent” that transports the glucose to the cells. When the amount of glucose in the bloodstream reaches a certain level, your pancreas releases insulin, which then carries the glucose to the appropriate cells. As the glucose enters these new cells, its level in the bloodstream decreases.

When insulin isn’t able to work in the body, or when the pancreas does not produce enough of it, the glucose is trapped in the bloodstream. That’s why people with diabetes have high levels of glucose in their blood. This is referred to as “hyperglycemia.” Having a blood glucose level of 126 milligrams per deciliter (mg/dL) or more after an overnight fast (not eating anything) on two separate occasions is diagnostic of diabetes.

When a person has high blood sugar, it causes two problems. First, the cells in the body become starved for energy. Second, over time this can hurt your eyes, kidneys, nerves or heart.

In addition to type1 and type2 diabetes, there is a third type, gestational diabetes. Gestational diabetes is triggered by hormone changes during pregnancy, which affect insulin's ability to work properly in the body, resulting in high blood glucose levels. Gestational diabetes affects about 4% of all pregnant women - with about 135,000 cases in the United States each year.

Certain women have an increased risk of developing gestational diabetes. This occurs when a woman is over 25 years old, is above her normal body weight before pregnancy, has a family history of diabetes or is Hispanic, black, Native American or Asian. In most cases, blood glucose levels return to normal after childbirth. However, women who have had gestational diabetes have an increased risk of developing type2 diabetes later in life.

Type2 diabetes, which affects almost 17 million Americans, is by far the most common form of diabetes. Type2 diabetes is often associated with being overweight (although not always), and it is estimated that over 91 percent of this type of diabetes could be prevented with proper diet, nutrition and exercise. Type2 diabetes is the leading cause of blindness, non-traumatic amputations and chronic kidney failure in adults.

Type2 diabetes is often referred to as “adult onset” diabetes because is usually starts in people over the age of 40. This may be changing, however. Because of a rise in obesity in young people, type2 diabetes has started to appear in children. A recent survey from the National Center for Health Statistics shows that from 1999 to 2000, 15 percent of children between the ages of six to 19 were overweight. Some studies have found children as young as four with abnormally high insulin levels. Researchers say that childhood obesity is on the rise and this is a cause for concern because compared with children of normal weight, overweight children are much more likely to become overweight adults -- with all the health problems linked with adult obesity, such as diabetes and heart disease.

Even though obesity can have a genetic component, other factors play important roles in maintaining a healthy lifestyle. Parents can serve as role models for their children, showing them how to make good food and beverage choices for snacks and meals. Having healthy food available at home can also help kids avoid overdo it with foods high in sugar and fat content.

Too much time watching TV, playing computer games or doing other sedentary activities can help contribute to obesity. Making the connection between nutrition and activity levels, by keeping exercise a priority for the whole family can help kids develop good habits that will benefit them throughout their lifetime.

Some people can manage their type2 diabetes by controlling their weight, watching their diet, and exercising regularly. Others may also need to take a pill that helps their body use insulin better, or take insulin injections. Often, doctors are able to detect the likelihood of type2 diabetes before the condition actually occurs. Commonly referred to as glucose intolerance, this condition occurs when a person's blood glucose levels are higher than normal but not high enough for a diagnosis of type2 diabetes. It is estimated that 16 million Americans have glucose intolerance.

Diabetes is a lifelong disease. As yet, there is no cure. People with diabetes need to manage their disease to stay healthy. Most often the best method for managing diabetes is through a team approach. The individual with diabetes can be helped and supported by his family, a physician, a dietician and a diabetic educator.

The goals of managing diabetes are to keep blood glucose levels as near to normal as possible by balancing food intake with medication and activity. Also maintaining blood cholesterol and triglyceride levels as close to normal ranges as possible is important. Other goals include controlling high blood pressure and preventing the development of diabetes-related health problems such as kidney disease, blindness heart disease and circulatory problems. This is accomplished through following a recommended diet, maintaining a regular exercise routine, taking medications exactly as prescribed and monitoring blood glucose and blood pressure levels at home.

Hearing the diagnosis of diabetes can be scary, but by careful monitoring of blood sugar levels, diet and exercise, you can put yourself back in control. Many people with diabetes live long and healthy lives. You can, too, by taking good care of yourself.

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Dr. Ripp is a certified family practice physician at Raiter Clinic in Cloquet.