Diabetes

Risk Factors For Diabetes

• People who are overweight
• People with a family history of diabetes
• People who are 40 and older
• Blacks
• Hispanics
• Native Americans
• Hypertension
• A cholesterol level of 240 or greater
• A triglyceride level of 250 or greater
• Non-pregnant women with history of gestational diabetes
  or delivery of babies greater than 9 lbs

Types Of Diabetes – Warning Signs and Statistics

• Insulin-Dependent (Type I) (Juvenile onset)
  (symptoms usually develop rapidly)
• Frequent urination (including frequent bed-wetting in children who have been toilet trained)
• Excessive thirst
• Extreme hunger
• Sudden weight loss
• Weakness and fatigue
• Irritability
• Nausea and vomiting
• Accounts for 10% of diabetes
• Can occur at any age but usually occurs at 11 or 12 years
• Nearly all patients diagnosed before age 30
• Twin studies indicate that 50% of identical twins of Type I develop the disease
• In some patients a viral infection may precipitate the clinical syndrome
• Pancreatic Beta cells destroyed
• Increased prevalence among first degree relatives

Non-Insulin-Dependent | Type II – Adult Onset

(symptoms usually develop gradually)

• Any or none of the insulin-dependent symptoms
• Adults greater than 30 years of age. Accounts for 90% of the diabetes in the United States
• Blurred vision or any change in sight
• Tingling or numbness in legs, feet, or fingers
• Slow healing of cuts (especially on the feet)
• Frequent skin infections, itchy skin, and yeast infections
• Drowsiness
• Insulin levels may be normal, depressed, or elevated
• Typically, insulin resistance (decreased tissue sensitivity to insulin) is present
• The insulin resistance of Type II diabetes is partially reversible
• Effects 6 million people in the United States or 2.5% of the population and 6% of the population over the age of 40
• Probably an equal number of undiagnosed cases
• 38% of all diabetics are over the age of 65. Of the 27-28 million Americans now over 65, 8% have diabetes

Impaired Glucose Tolerance (IGT)

• Plasma glucose levels that are higher than normal but lower than those which indicate diabetes.
• 25% of patients with IGT eventually develop diabetes.
• Symptoms of diabetes are usually absent.
• Increased likelihood of developing coronary heart disease, and or hypertension.
• Increased cholesterol and triglycerides.

Gestational Diabetes Mellitus (GDM)

• Glucose intolerance that has its onset or is first detected during pregnancy. (Women who have diabetes before pregnancy are not part of this class)
• Occurs in about 3% of pregnant women
• 60,000-90,000 women with gestational diabetes give birth each year, and gestational diabetes is associated with increased perinatal morbidity
• Usually occurs during the second or third trimester when levels of insulin antagonist hormones increase and insulin resistance normally occurs
• Because fetal morbidity and mortality are increased in the presence of gestational diabetes, it is important to identify women with this condition by screening all pregnant women between the 24th and 28th weeks of pregnancy with a 50 gram glucose tolerance test. All pregnant women should be given this test for screening purposes
• In most cases, glucose tolerance in women with gestational diabetes returns to normal after delivery
• Within 5 to 10 years after delivery, 30% to 40% of women with gestational diabetes develop overt diabetes usually type II
• Women who have been diagnosed with gestational diabetes should be followed postpartum to detect diabetes early. They should be evaluated initially at the first postpartum visit by a 2 hour oral glucose tolerance test with a 75 gram glucose load

Secondary Complications Of Diabetes

• Third leading cause of death by disease nationally
• Twice as likely to suffer stroke or heart attack
• Four times as likely to suffer peripheral vascular disease
• Six times as likely to go blind
• Sixteen times as likely to require an amputation
• Seventeen times as likely to develop renal failure
• Accounts for more than 50% of non-traumatic amputations, approximately 25% of kidney failures; and about 12% of new cases of blindness
• More than 92% of all diabetics who become blind are over the age of 50, and 40% are older than 70
• Amputation rates in diabetics increase from 12 per 10,000 in those below age 44, to 45 per 10,000 in those aged 45 to 64, and to 100 per 10,000 in those over age 64
• Diabetic patients are more susceptible to foot ulcers because of poor circulation
• Diabetes Mellitus is associated with a two to threefold increase in death due to cardiovascular disease. It is the leading cause of death in non-insulin dependent
• Diabetes Mellitus or Type II, and death from heart attacks has replaced renal failure as the major source of mortality in insulin dependent Diabetes Mellitus

What Does Diabetes Cost Our (U.S.) Society?

• The personal, social, and financial cost of diabetes of the some 12 million diabetes in the United States and approximately 500,000 newly diagnosed case per year, particularly its late complications, are enormous
• Diabetes acute and chronic complications cost an estimated $20 billion annually
• Diabetes and its complications account for more than 12 million hospital days annually
• In 1989, 2.4 million work days were lost because of diabetes
• Approximately 205,000 deaths in the United States occur annually
  The burden of diabetes appears to fall disproportionately on some minority populations. According to the National Diabetes Data Group, the estimated prevalence of diagnosed cases of Type II diabetes in the United States from 1979 to 1981 was 2.1% of white men and 2.4% white women, compared with 2.4% of black men and 3.6% of black women, 4.5% of Mexican Americans, by far the largest Latino population in the United States, and 20% of Native Americans. The prevalence among American Indians varies greatly from tribe to tribe; however, ranging from less than 1% in some Alaskan groups to epidemic proportions, almost 50%, in adult Pimas.

Will my disease go away?

No, unfortunately diabetes will not go away; but it can be treated, controlled, and prevented in nearly all Type II adult onset cases. Diabetes can be controlled and you can lead a very healthy life

Prevention

To alleviate the growing cost of diabetes for all groups, the traditional crisis-centered orientation must be replaced by an educational preventative program.

Some people argue that providing increased funds for screening, education, or early intervention is economically unfeasible and that the healthcare system, particularly in minority neighborhoods, can not handle new cases uncovered by wider screening. But spending extra money now, to help prevent the disease and its complications and minimize their severity, is an invaluable investment that would be amply repaid.

Goal Of Treatment

For those who have diabetes, the major goal of treatment is to achieve blood glucose levels that are as close as possible to normal. It is hoped that maintenance of normal blood sugar may attenuate, or alleviate, the chronic complications associated with diabetes mellitus; that is, blindness, kidney failure, heart attacks, strokes, impotence, orthostatic hypotension, and foot and leg ulcerations that eventually necessitate amputation. In addition, tight glucose control can decrease the incidence of fetal malformation during pregnancy.

What can I eat?

Most diabetics in this country eat a typical American diet–the cause of the disease in the first place. If diabetics continue to eat this way they will end up with one or more of the major complications of diabetes: heart attack, stroke, kidney failure, or blindness.

In studies where Type II diabetics were given very low fat diets (20 to 30 grams per day), over 60% of the patients no longer required insulin by the sixth week. Excess fat in the diet prevents insulin from working, and therefore ones blood sugar increases.

Excess protein in the diet causes the kidneys to work very hard and leads to diabetic nephropathy (the failure of the kidneys to function properly).

Consumption of simple sugars (such as those in pies, cakes and pastries) will cause an elevation in the triglyceride level. Triglycerides are fats that are circulating in the blood. High levels of triglycerides in the blood cause resistance to insulin activity, and worsen the diabetic state.

If one eats a very low-fat, low protein, low sugar, high fiber diet the chances that one’s insulin dose or oral diabetic pills can be lowered or even discontinued are great. The incidence of complications is also reduced.

The benefits of this enjoyable and inexpensive therapy include:

• Improvement in insulin sensitivity and potential improvement in glucose tolerance
• Promotion of weight loss and maintenance of ideal body weight
• Decrease of cardiovascular risk factors
• Reduction in dosage or need for insulin or oral hypoglycemic agents
• Enhancement of work capacity
• Enriched quality of life and improved sense of well-being

What Can I Do to Take Care Of Myself If I Have Diabetes?

1. Eat Right. The most important thing you can do is control your weight. If you are overweight, you should follow a meal plan to lose weight and eat healthy foods. The DOC Clinic recommends a very low-fat, low-protein, low-sugar, high fiber diet which the staff will help you implement.
2. Exercise 5 to 7 days per week. Brisk walking 30 to 60 minutes is the exercise of choice for most
3. Know Your Blood Sugar. Measure your blood sugar level routinely by doing a finger-stick blood test and by keeping a record
4. Follow Doctor’s Orders. Your doctor might have you take medicine, such as diabetes pills or insulin shots. Always take it as prescribed

Back To Glossary