What is diabetes? Most of the food we eat is turned into glucose, or sugar, for our bodies to use for energy. The pancreas, an organ that lies near the stomach, makes a hormone called insulin to help glucose get into the cells of our bodies. When you have diabetes, your body either doesn't make enough insulin or can't use its own insulin as well as it should. This causes sugars to build up in your blood. Diabetes can cause serious health complications including heart disease, blindness, kidney failure, and lower-extremity amputations. Diabetes is the seventh leading cause of death in the United States. What are the symptoms of diabetes? People who think they might have diabetes must visit a physician for diagnosis. They might have SOME or NONE of the following symptoms: • Frequent urination • Excessive thirst • Unexplained weight loss • Extreme hunger • Sudden vision changes • Tingling or numbness in hands or feet • Feeling very tired much of the time • Very dry skin • Sores that are slow to heal • More infections than usual. Nausea, vomiting, or stomach pains may accompany some of these symptoms in the abrupt onset of insulin-dependent diabetes, now called type 1 diabetes.

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What are the types and risk factors of diabetes? The following types of diabetes and some of their risk factors are quoted from the National Diabetes Fact Sheet: National estimates and general information on diabetes in the United States (Centers for Disease Control and Prevention. Atlanta, GA: US Department of Health and Human Services, 1997): Type 1 diabetes was previously called insulin-dependent diabetes mellitus (IDDM) or juvenile-onset diabetes. Type 1 diabetes may account for 5% to 10% of all diagnosed cases of diabetes. Risk factors are less well defined for type 1 diabetes than for type 2 diabetes, but autoimmune, genetic, and environmental factors are involved in the development of this type of diabetes. Type 2 diabetes was previously called non-insulin-dependent diabetes mellitus (NIDDM) or adult-onset diabetes. Type 2 diabetes may account for about 90% to 95% of all diagnosed cases of diabetes. Risk factors for type 2 diabetes include older age, obesity, family history of diabetes, prior history of gestational diabetes, impaired glucose tolerance, physical inactivity, and race/ethnicity. African Americans, Hispanic/Latino Americans, American Indians, and some Asian Americans and Pacific Islanders are at particularly high risk for type 2 diabetes. Gestational diabetes develops in 2% to 5% of all pregnancies but usually disappears when a pregnancy is over. Gestational diabetes occurs more frequently in African Americans, Hispanic/Latino Americans, American Indians, and people with a family history of diabetes than in other groups. Obesity is also associated with higher risk. Women who have had gestational diabetes are at increased risk for later developing type 2 diabetes. In some studies, nearly 40% of women with a history of gestational diabetes developed diabetes in the future. Other specific types of diabetes result from specific genetic syndromes, surgery, drugs, malnutrition, infections, and other illnesses. Such types of diabetes may account for 1% to 2% of all diagnosed cases of diabetes.

 

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What is the treatment for diabetes? Management strategies should be planned along with a qualified health care team. The following information on treatments for diabetes is from the National Diabetes Fact Sheet: National estimates and general information on diabetes in the United States (Centers for Disease Control and Prevention. Atlanta, GA: US Department of Health and Human Services, 1997): Diabetes knowledge, treatment, and prevention strategies advance daily. Treatment is aimed at keeping blood glucose near normal levels at all times. Training in self-management is integral to the treatment of diabetes. Treatment must be individualized and must address medical, psychosocial, and lifestyle issues. Treatment of type 1 diabetes: Lack of insulin production by the pancreas makes type 1 diabetes particularly difficult to control. Treatment requires a strict regimen that typically includes a carefully calculated diet, planned physical activity, home blood glucose testing several times a day, and multiple daily insulin injections. Can diabetes be prevented? A number of studies have shown that regular physical activity can significantly reduce the risk of developing type 2 diabetes. It also appears to be associated with obesity. Researchers are making progress in identifying the exact genetics and "triggers" that predispose some individuals to develop type 1 diabetes, but prevention, as well as a cure, remains elusive. Is there a cure for diabetes? In response to the growing health burden of diabetes mellitus (diabetes), the diabetes community has three choices: prevent diabetes; cure diabetes; and take better care of people with diabetes to prevent devastating complications. All three approaches are actively being pursued by the US Department of Health and Human Services. Both the National Institutes of Health (NIH) and the Centers for Disease Control and Prevention (CDC) are involved in prevention activities. The NIH is involved in research to cure both type 1 and type 2 diabetes, especially type 1. CDC focuses most of its programs on being sure that the proven science is put into daily practice for people with diabetes. The basic idea is that if all the important research and science are not made meaningful in the daily lives of people with diabetes, then the research is, in essence, wasted. Several approaches to "cure" diabetes are being pursued: • Pancreas transplantation • Islet cell transplantation (islet cells produce insulin) •  Artificial pancreas development • Genetic manipulation (fat or muscle cells that don’t normally make insulin have a human insulin gene inserted — then these "pseudo" islet cells are transplanted into people with type 1 diabetes). Each of these approaches still has a lot of challenges, such as preventing immune rejection; finding an adequate number of insulin cells; keeping cells alive; and others. But progress is being made in all areas. Treating diabetes In order to survive, people with type 1 diabetes must have insulin delivered by injections or a pump. Many people with type 2 diabetes can control their blood glucose by following a careful diet and exercise program, losing excess weight, and taking oral medication. Many people with diabetes also need to take medications to control their cholesterol and blood pressure. Among adults with diagnosed diabetes, about 11% take both insulin and oral medications, 22% take insulin only, 49% take oral medications only, and 17% do not take either insulin or oral medications. Percent of adults with diagnosed diabetes treated by insulin and oral medications — United States, 1997-1999   Source: 1997-1999 National Health Interview Survey   Preventing diabetes Research studies in the United States and abroad have found that lifestyle changes can prevent or delay the onset of type 2 diabetes among high-risk adults. These studies included people with IGT and other high-risk characteristics for developing diabetes. Lifestyle interventions included diet and moderate-intensity physical activity (such as walking for 2 1/2 hours each week). For both sexes and all age and racial and ethnic groups, the development of diabetes was reduced 40% to 60% during these studies that lasted 3 to 6 years. Studies have also shown that medications have been successful in preventing diabetes in some population groups. In the Diabetes Prevention Program, a large prevention study of people at high risk for diabetes, people treated with the drug metformin reduced their risk of developing diabetes by 31%. Treatment with metformin was most effective among younger, heavier people (those 25-40 years of age who were 50 to 80 pounds overweight) and less effective among older people and people who were not as overweight. There are no known methods to prevent type 1 diabetes. Several clinical trials are currently in progress.

 

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Preventing diabetes complications Glucose control • Research studies in the United States and abroad have found that improved glycemic control benefits people with either type 1 or type 2 diabetes. In general, for every 1% reduction in results of A1C blood tests, the risk of developing microvascular diabetic complications (eye, kidney, and nerve disease) is reduced by 40%. Blood pressure control • Blood pressure control can reduce cardiovascular disease (heart disease and stroke) by approximately 33% to 50% and can reduce microvascular disease (eye, kidney, and nerve disease) by approximately 33%. • In general, for every 10 millimeters of mercury (mm Hg) reduction in systolic blood pressure, the risk for any complication related to diabetes is reduced by 12%. Control of blood lipids • Improved control of cholesterol and lipids (for example, HDL, LDL, and triglycerides) can reduce cardiovascular complications by 20% to 50%. Preventive care practices for eyes, kidneys, and feet • Detecting and treating diabetic eye disease with laser therapy can reduce the development of severe vision loss by an estimated 50% to 60%. • Comprehensive foot care programs can reduce amputation rates by 45% to 85%. Detecting and treating early diabetic kidney disease can reduce the development of kidney failure by 30% to 70%. Complications of diabetes Heart disease • Heart disease is the leading cause of diabetes-related deaths. Adults with diabetes have heart disease death rates about 2 to 4 times higher than adults without diabetes. Stroke • The risk for stroke is 2 to 4 times higher among people with diabetes. High blood pressure • About 73% of adults with diabetes have blood pressure greater than or equal to 130/80 mm Hg or use prescription medications for hypertension. Blindness • Diabetes is the leading cause of new cases of blindness among adults aged 20-74 years old. • Diabetic retinopathy causes from 12,000 to 24,000 new cases of blindness each year. Kidney disease • Diabetes is the leading cause of treated end-stage renal disease, accounting for 43% of new cases. • In 1999, 38,160 people with diabetes began treatment for end-stage renal disease. • In 1999, a total of 114,478 people with diabetes underwent dialysis or kidney transplantation. Nervous system disease • About 60% to 70% of people with diabetes have mild to severe forms of nervous system damage. The results of such damage include impaired sensation or pain in the feet or hands, slowed digestion of food in the stomach, carpal tunnel syndrome, and other nerve problems. • Severe forms of diabetic nerve disease are a major contributing cause of lower-extremity amputations. Amputations • More than 60% of nontraumatic lower-limb amputations in the United States occur among people with diabetes. • From 1997 to 1999, about 82,000 nontraumatic lower-limb amputations were performed each year among people with diabetes. Dental disease • Periodontal or gum diseases are more common among people with diabetes than among people without diabetes. Among young adults, those with diabetes are often at twice the risk of those without diabetes. • Almost one third of people with diabetes have severe periodontal diseases with loss of attachment of the gums to the teeth measuring 5 millimeters or more. Complications of pregnancy • Poorly controlled diabetes before conception and during the first trimester of pregnancy can cause major birth defects in 5% to 10% of pregnancies and spontaneous abortions in 15% to 20% of pregnancies. • Poorly controlled diabetes during the second and third trimesters of pregnancy can result in excessively large babies, posing a risk to the mother and the child. Other complications • Uncontrolled diabetes often leads to biochemical imbalances that can cause acute life-threatening events, such as diabetic ketoacidosis and hyperosmolar (nonketotic) coma. • People with diabetes are more susceptible to many other illnesses and, once they acquire these illnesses, often have worse prognoses than people without diabetes. For example, they are more likely to die with pneumonia or influenza than people who do not have diabetes.

 

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Get routine care to avoid problems See your health care team at least twice a year to find and treat problems early. Follow this plan: Two times each year get: • A1c check - check more often iif over 7 years old • Dental exams to prevent gum disease and loss of teeth. Tell your dentist you have diabetes. At each visit get a: • Blood pressure check - if over 130/80, ask what steps to take to reach your goal • Weight check • Foot check Once each year get a: • Cholesterol check - if LDL over 100, ask what steps to take to reach your goal • Dilated eye exam to check for eye problems • Complete foot exam to check on foot health • Urine and blood tests to check for kidney problems • Flu shot At least once get a: • Pneumonia shot Cost of diabetes in the United States Total (direct and indirect): $98 billion Direct medical costs: $44 billion Indirect costs: $54 billion (disability, work loss, premature mortality)

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