Diabetes

Woman checking her bloods sugar levels

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What is diabetes?
–Types and risk factors:
––Type 1 diabetes
––Latent autoimmune diabetes of adults (LADA)
––Gestational diabetes
––Prediabetes
––Type 2 diabetes
Type 2 diabetes (and prediabetes) can be prevented

Definition and Overview:

Our cells depend on a single simple sugar, glucose, for most of their energy needs. The body has intricate mechanisms in place to make sure glucose levels in the blood don’t go too low or soar too high. When you eat, most digestible carbohydrates are converted into glucose and quickly absorbed into the bloodstream. Any rise in blood sugar signals the pancreas to make and release the hormone insulin, which instructs cells to sponge up glucose. Without insulin, glucose floats around the bloodstream, unable to slip inside the cells that need it for energy.

Diabetes mellitus is a condition of abnormally high levels of glucose in the blood because either the body is not making enough insulin or can’t properly use the insulin it makes. Normally, blood glucose rises after eating a meal but then drops in 1-2 hours as the glucose is shuttled out of the blood and into cells. In people with diabetes, their blood glucose may remain elevated for several hours. Their blood glucose may also rise much higher after eating a meal than someone who does not have diabetes.

There are different types of diabetes, including prediabetes, type 1 diabetes, type 2 diabetes, latent autoimmune diabetes, and gestational diabetes. The most common types in the U.S. are prediabetes and type 2 diabetes, which are largely influenced by carrying excess body fat, a poor diet, and lack of exercise.

Almost 30 million Americans have diabetes; of those, about 7 million don’t know they have the disease. [1] About 84 million adults have a condition called prediabetes that is a precursor to full-blown diabetes. In 2017, the total estimated cost of diagnosed cases of diabetes in the U.S. was $327 billion including direct medical costs and reduced productivity. (1) If the spread of type 2 diabetes continues at its present rate, the number of people diagnosed with diabetes in the United States will increase to about 48 million in 2050. [2] Worldwide, the number of adults with diabetes will rise to 439 million in the year 2030. [3]

Secondary health problems stemming from diabetes are equally alarming. High blood glucose levels can damage organs and tissues. Diabetes is the leading cause of blindness and kidney failure among adults. It causes mild to severe nerve damage that, coupled with diabetes-related circulation problems, often leads to the loss of a leg or foot. Diabetes significantly increases the risk of cardiovascular disease including heart attacks and strokes. It is the seventh leading cause of death in the U.S., directly causing almost 80,000 deaths each year and contributing to thousands more. [1,4,5]

Types of Diabetes

Type 2 diabetes (and prediabetes) can be prevented

Type 2 diabetes, once called adult-onset diabetes, is striking an ever-growing number of adults. Even more alarming, it is now showing up in teenagers and children. With the rising rates of childhood obesity, it has become more common in youth, especially among certain ethnic groups.

    • In the U.S., the SEARCH for Diabetes in Youth Study found that type 2 diabetes accounted for only 6% of new diabetes cases in non-Hispanic white children ages 10 to 19, but anywhere from 22-76% of new cases in other ethnic groups [8]. The highest rates were found in Asia-Pacific Islander and Native American youth.

Although the genes you inherit may influence the development of type 2 diabetes, they take a back seat to behavioral and lifestyle factors. Data from the Nurses’ Health Study suggest that 90% of type 2 diabetes in women can be attributed to five such factors: excess weight, lack of exercise, a less-than-healthy diet, smoking, and abstaining from alcohol. [13]

  • Among 85,000 married female nurses, 3,300 developed type 2 diabetes over a 16-year period. Women in the low-risk group were 90% less likely to have developed diabetes than the rest of the women. Low-risk meant a healthy weight (body mass index less than 25), a healthy diet, 30 minutes or more of exercise daily, no smoking, and having about three alcoholic drinks per week.
  • Similar factors are at work in men. Data from the Health Professionals Follow-up Study indicate that a “Western” diet, combined with lack of physical activity and excess weight, dramatically increases the risk of type 2 diabetes in men. [14]

Information from several clinical trials strongly supports the idea that type 2 diabetes is preventable.

  • The Diabetes Prevention Program examined the effect of weight loss and increased exercise on the development of type 2 diabetes among men and women with high blood sugar readings that hadn’t yet crossed the line to diabetes. In the group assigned to weight loss and exercise, there were 58% fewer cases of diabetes after almost three years than in the group assigned to usual care. [15] Even after the program to promote lifestyle changes ended, the benefits persisted: The risk of diabetes was reduced, albeit to a lesser degree, over 10 years. [16]
  • Similar results were seen in a Finnish study of weight loss, exercise, and dietary change, and in a Chinese study of exercise and dietary change. [17–20]

Is diabetes reversible?

Is it possible to reverse or cure diabetes? The answer is maybe. When someone reports that they have “reversed” their diabetes, this actually means that they were able to stop using diabetes medication after making healthy lifestyle changes, such as losing weight, following a healthful diet, and exercising. If prediabetes, type 2 diabetes, or gestational diabetes is detected early in an individual who immediately initiates healthy lifestyle changes, it may be possible to reverse or at least stop the progression of the disease.

However, if these types of diabetes are not diagnosed early or are not well-controlled for a long period, the cells of the pancreas can become permanently damaged so that they no longer produce insulin. If this happens, chances are higher that diet and exercise alone may no longer be effective in controlling the diabetes and lifelong medication may be needed. The same is true with type 1 diabetes and LADA, in which the pancreas already does not make enough insulin. With these conditions, the diabetes can be managed but not reversed.

The good news is that type 2 diabetes (as well as prediabetes) are largely preventable. About 9 in 10 cases in the U.S. can be avoided by healthy lifestyle practices, including controlling your weight, following a healthy diet, staying active, and not smoking.

Steps to preventing type 2 diabetes

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