Ask the Doctor – Facts About Diabetes

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According to the American Diabetes Association, 29.1 million Americans were estimated to have either Type I or Type II diabetes in 2012, of which 21 million cases were diagnosed. About 86 million American adults had pre-diabetes.

What is diabetes?
Diabetes (also known as diabetes mellitus) is a progressive medical condition in which the pancreas, a large gland behind the stomach, produces insufficient insulin, the hormone responsible for the regulation of blood glucose (sugar). The condition essentially limits the ability of the body to turn carbohydrates from food into energy.

What is the difference between Type I and Type II diabetes and pre-diabetes?
Type I diabetes, also known as juvenile diabetes, is a highly aggressive disease that shows up earlier in life than other forms of diabetes. Onset is usually sudden, and treatment always requires insulin because of destruction of the pancreas by the autoimmune system. Type II diabetes manifests later in life and progresses at a much slower rate than Type I diabetes. Incidence is more related to obesity and hereditary.

Pre-diabetes is a medical condition in which the pancreas becomes resistant to the production of insulin. It is commonly a result of weight gain. Diagnosis occurs when a blood test shows a fasting glucose value between 100 and 125 mg/dl. Pre-diabetes can progress to Type II diabetes, a medical condition in which the fasting blood glucose level is consistently above 125 mg/dl if left untreated.

What are common symptoms of Type I and Type II diabetes, and pre-diabetes?
Most people with pre-diabetes do not have any symptoms. Initial symptoms of Type II diabetes may include frequent urination, thirst, extreme fatigue and blurry vision. Type I diabetes has more aggressive symptoms at diagnosis.

What are common treatments for the different types of diabetes?
People with Type I diabetes must receive insulin to compensate for their body’s inability to produce it. Insulin can be administered through daily injections or by a special pump worn on the outside of the body that injects insulin through the skin of the abdomen. Type I diabetics must monitor blood glucose readings throughout the day and limit the consumption of foods that cause blood sugar levels to rise quickly, such as cake and cookies. Exercise can help regulate blood glucose levels by improving the body’s response to the insulin treatment.

For individuals with pre-diabetes and Type II diabetes, treatment usually focuses on measures that promote weight loss. Jogging and swimming are two activities that can help control blood glucose levels and weight. Recommended dietary changes include high-fiber foods, low-fat foods, and limited refined carbohydrates. In some cases, diet and exercise alone can bring blood glucose levels back to normal. If they do not, a physician may recommend a diabetes medication such as metformin or insulin injections. A physician may also combine different types of diabetes medications to help the body increase its secretion of insulin.

What are the long-term consequences of failing to control diabetes?
Uncontrolled diabetes can impact almost every organ in the body, including the heart and blood vessels, eyes, kidneys, nerves, gums, and teeth. People with diabetes are more likely to have heart problems and strokes, as well as an increased susceptibility to blood vessel or nerve damage. In some circumstances, the nerve damage is severe enough to lead to amputations of the feet and legs. Prolonged exposure to elevated blood glucose levels can lead to kidney failure and may also result in visual problems, such as glaucoma, cataracts, and diabetic retinopathy.

p-15-ask-the-doctor-photoWhat lifestyle changes are helpful in managing blood glucose levels?
Patients are usually advised to increase their physical activity, eat healthier, and lose weight.

Delia M. Stefan, M.D., is an endocrinologist with Phelps Medical Associates/Northwell Health.

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