Nearly 30 million Americans are affected by diabetes – more than one million in Georgia alone. Diabetes is one of the most common chronic illnesses in Georgia and across the Southeast, and is the seventh highest cause of death among Georgians. Despite its prevalence, many cases of diabetes are preventable, and even those who have already been diagnosed can still enjoy a happy, healthy and productive life.
What is diabetes?
Diabetes is a metabolic disorder that prevents the body from making or efficiently using insulin. Insulin is a hormone that helps cells absorb glucose, a sugar that provides our bodies with necessary energy. Without insulin, glucose builds up in the blood. High blood sugar – called hyperglycemia – can cause blurred vision, headaches, slow healing and even organ damage or coma if not treated.
Type 1 diabetes occurs most often in children and young adults and comprises only a small percentage of all diabetes cases. In Type 1 diabetes, the body doesn't produce insulin. Type 2 diabetes, by contrast, can occur at any age and is much more prevalent. In this form of the disease, the body cannot adequately use the insulin that it produces. Most cases are diagnosed in people ages 40 to 64, but Type 2 diabetes is on the rise in children as well. Other forms of diabetes include latent autoimmune diabetes in adults (LADA), sometimes called Type 1.5, and gestational diabetes, which occurs during pregnancy and typically resolves when the pregnancy ends. Type 2 diabetes accounts for 90 to 95 percent of diagnosed diabetes in adults.
Symptoms and Complications
Of the nearly 30 million Americans with diabetes, as many as eight million aren't even aware that they have the condition. The earliest signs of diabetes, such as blurred vision and fatigue, can be easy to miss or explained away as a natural part of aging. Other common symptoms include increased thirst, frequent urination, unexplained weight loss, and numbness or tingling in the feet. Less commonly, diabetes may present with frequent bacterial or yeast infections, recurring sores or boils, or periodontal disease.
If diabetes progresses undetected or is poorly managed, these symptoms can worsen or develop into even more serious conditions, such as:
Diabetic peripheral neuropathy (nerve damage). This condition may first present as tingling and numbness in the extremities. It can lead to loss of sensation, most commonly in the feet, and can lead to amputation. "Approximately 73,000 patients undergo amputations each year due to diabetes," says Dr. Twiggy Harris with Kaiser Permanente.
Glaucoma and cataracts. Unmanaged high blood sugar can be a contributing factor in these eye problems, as well as diabetic retinopathy, a condition of the blood vessels in the retina that can lead to vision loss. "[Diabetes] is the leading cause of blindness in ages 20 to 74," says Dr. Dawn Smiley-Byrd, endocrinologist and associate professor of medicine at Emory University. Dr. Smiley-Byrd explains that in a 24-hour time period, anywhere from 48 to 55 people with diabetes will go blind, and that 28.5 percent of adults with diabetes have diabetic retinopathy.
Kidney damage. Diabetes can lead to kidney damage and eventual kidney failure, requiring dialysis.
Cardiovascular disease. While all diabetes-related conditions should be taken seriously, another threat looms. Dr. Jamie Noll, Certified Diabetes Educator and author of "The 95% Vegan Diet," reveals, "Most people with Type 2 diabetes [...] don't die from kidney failure." Instead, she says the real culprit is cardiovascular disease. Brooks Kent, licensed dietitian and Certified Diabetes Educator with WellStar, agrees. Kent describes heart disease as the number one complication of diabetes and stresses the need for managing blood pressure and cholesterol along with blood sugar.
Treatment and Recovery
Treatment for Type 2 diabetes is comprehensive and can change over time based on the current health of the individual, always with the goal of long-term management of blood sugar levels. Oral medications are the most common treatment. Metformin, which has been on the market for over 45 years, is the top prescribed oral agent for diabetics and often pre-diabetics as well. Metformin is an effective tool for managing blood sugar, and it can aid with weight loss and help prevent heart attacks and strokes. Unlike many of the newer oral agents, metformin is very affordable, only pennies a day, and is consistently the most reliable oral treatment for diabetes.
Insulin injections are another common treatment for diabetes. Insulin may be used for long-term blood sugar management or for more immediate management of symptoms. When a person with diabetes is admitted to the hospital for diabetic complications such as a build-up of sugar in the body, they are at risk for illness and organ damage. In cases like that, or if their A1c number is too high, Kent says insulin may be necessary for breaking the glucose toxicity. Insulin can be discontinued once blood sugar is back within a healthy range, and diabetes can then be managed through a combination of diet, exercise and possibly oral medications.
Better eating habits and regular exercise are both an important part of diabetes management. The sooner after diagnosis that dietary and exercise habits are improved, the better for long-term health and minimizing the need for other treatments. A mix of strength training and aerobic exercises provides an ideal balance, and a daily brisk walk can be the first step toward improved health.
Even with excellent diet and exercise habits, however, people with diabetes may still find an increased need for medications or insulin as they age. Over time, the pancreas produces less and less insulin. As a result, a person with diabetes is likely reach a point where insulin becomes a necessity. "Patients should not look at the need to intensify therapy as a personal failure," Dr. Noll stresses, but rather should see it as part of lifelong diabetes management. While insulin is often viewed as a worst case scenario treatment, it's actually one of the easiest treatments to control.
The most important aspect of diabetes treatment is regular monitoring. Blood sugar checks before and two hours after meals are necessary for identifying the causes of elevated blood sugar levels and adjusting medication accordingly. Regular visits with an endocrinologist, including A1c checks at least twice a year, should be prioritized. Because people with diabetes are at risk for depression, finding good emotional support is a must. Daily checks for wounds or other changes to the feet and skin should also be a part of regular diabetes management and are an important part of preventing diabetic complications.
While Type 2 diabetes can be managed through a combination of lifestyle changes and good medical care, those at risk for diabetes should focus on prevention. Certain risk factors like age, race or ethnicity and family history can't be changed, but many other risk factors can. Dietary changes and regular exercise significantly lower the risk of developing diabetes.
"According to the Diabetes Prevention Program (DPP) study, just losing seven percent of body weight along with exercise can reduce the chances of getting Type 2 diabetes by 58 percent," says Dr. Noll. DPP participants who lost seven to 10 percent of their body weight continued to show a lower rate of diabetes throughout their lives.
Another important part of prevention is regular screening. People who are overweight, have a family history of diabetes, have had gestational diabetes during pregnancy, or who belong to a higher risk racial/ethnic group (Black, Hispanic, Filipino, Native American or Asian-American) should consider diabetic screening every one to three years and make sure their doctors are aware of their risk factors.
"Get screened, especially if you have risk factors," Dr. Smiley-Byrd says, because though diabetes is preventable and treatable, it is still a chronic illness. "It's serious," Kent says. "It is a serious condition, and should be taken seriously and controlled."
Now that you have the information you need about this condition, you can take steps to ensure your own health for a life that's just the right amount of sweet.
Twiggy Harris, MD, Kaiser Permanente – www.kaiserpermanente.org
Brooks Kent, MS, RDN, LD, CDE, WellStar Diabetes Educator – www.wellstar.org
Dawn Smiley-Byrd, MD, Emory University School of Medicine – www.med.emory.edu
Andrew Muir, MD, Children's Healthcare of Atlanta and Emory University – www.choa.org
Jamie Noll, PharmD, LD, CDE – www.95percentvegan.com