Diabetes Awareness Month
Young Ju, Ph.D.
November is Diabetes Awareness Month, and this article is intended to increase your awareness of the health risks posed by Diabetes Mellitus, aka diabetes. Diabetes is a chronic, metabolic disease characterized by elevated blood glucose (or blood sugar). Approximately 37.3 million Americans (or 11.3% of the population) have diabetes; about 26.4 million of them are aged 65 years or older. Besides background information, there are tips for managing diabetic conditions.
Diabetes (1,2,3,4)
Macronutrients, such as carbohydrates, proteins, and fats, are energy sources for the body. In healthy individuals, most carbohydrates and certain proteins and fats are converted to glucose which enters the bloodstream. With the help of insulin, circulating blood glucose (as an energy source) is taken up by the cells in tissues. Insulin is a hormone made in the pancreas after eating and released into the blood. Circulating insulin binds to insulin receptors which are located on the surface of insulin-sensitive cells. Insulin-sensitive cells include fat cells, muscle cells, brain cells, liver cells, and immune cells, etc. Once insulin binds to its receptor, it causes cascading reactions such as activating glucose transporters, translocating those transporters to the cell surface, and allowing glucose into the cells from the blood.
Our body has very efficient ways of regulating blood glucose levels between certain ranges (70-120 mg/dL). Excess amounts of blood glucose are converted to glycogen and stored in the liver and muscles. When needed, stored glycogen is converted to glucose and used as an energy source. Excess amounts of blood glucose can be also converted to fat and stored in fat tissues. A person with diabetes may produce no or low insulin from the pancreas. Therefore, insulin may not bind to its receptors and cannot help take up enough glucose from the blood into the cells. This is called insulin resistance, and the result is a high blood-glucose level.
If you have any three of the following conditions, you may have insulin resistance:
Waist size equal to or greater than 40 inches for men and 35 inches for women
Triglycerides in blood greater than 150 mg/dL
HDL-cholesterol (good cholesterol) less than 40 mg/dL for men and less than 50 mg/dL for women
Blood pressure greater than 130/85 mm Hg
Fasting blood glucose greater than 100 mg/dL
Types of Diabetes (1, 2)
Type 1 Diabetes (T1D) is thought to be caused by an autoimmune reaction–meaning that the body attacks itself–that stops the body from making insulin. About 5-10% of people with diabetes have T1D which can occur at any age, but it’s most often diagnosed in children, teens, or young adults.
Type 2 Diabetes (T2D) is diagnosed when insulin production is reduced and is often accompanied by insulin resistance. About 90-95% of people with diabetes have T2D. Usually, it appears in adults, but it can occur at any age.
Gestational Diabetes develops during pregnancy in women who did not have diabetes prior to the pregnancy. Hormones produced by the uterus to help fetal growth and development could affect insulin sensitivity. Approximately 2-10% of pregnancies in the US are affected by gestational diabetes. It usually goes away after the baby is born, but both the mother’s and baby’s risk for developing T2D later could be increased.
Prediabetes is a stage where blood glucose levels are higher than normal range but not high enough to be T2D. It’s estimated that about 96 million American adults are prediabetic. Without lifestyle changes, people with prediabetes are very likely to progress to T2D. The following CDC link offers a prediabetes risk test: https://www.cdc.gov/prediabetes/takethetest/.
Signs and Symptoms (1, 2)
Diabetes symptoms vary depending on blood glucose level, insulin level, and insulin sensitivity. Early symptoms of diabetes, especially T2D, can be subtle or not noticeable. Common symptoms include:
Excessive thirst
Increased urination
Fatigue
Sudden weight change
Blurred vision
Slow-healing sores or frequent infections
Tingling hands and feet
Red, swollen, or tender gums
If untreated, over time, these symptoms could lead to disabling and life-threatening complications, including heart disease, kidney damage (nephropathy), nerve damage (neuropathy), and eye damage (retinopathy) etc.
Risk Factors (1,2,3)
T1D: Although the exact cause of T1D is unknown, family history, viral infection, or the presence of autoimmune conditions may increase risk of developing T1D.
T2D: Being prediabetic, overweight or obese, physically inactive, or having a family history, or certain ethnicity, such as Native American, Hispanic, Black, or Asian, which are associated with higher risk of developing T2D.
Gestational Diabetes: Your family history, gestational diabetes during a previous pregnancy, or overweight before pregnancy are associated with higher risk.
Screening & Diagnosis (1,2,3,4)
There are several easy and accurate diagnostic tools–two commonly used tests are described below.
Glycated Hemoglobin (A1c) test: The A1c measures the percentage of blood glucose attached to hemoglobin. Hemoglobin is the oxygen-carrying protein in red blood cells. In the bloodstream, glucose binds to hemoglobin, and stays in bound form while red blood cells are alive (3-4 months). The bound form is called glycated hemoglobin. This test result indicates average blood glucose level for the past 3-4 months.
Diabetic: ≥6.5%
Prediabetic: 5.7 – 6.4%
Normal: < 5.7%
Fasting Blood Glucose test measures blood glucose level after overnight fasting.
Diabetic: ≥126 mg/dL
Prediabetic: 100-125 mg/dL
Normal: <100 mg/dL
Hypoglycemic: <70 mg/dL– low blood glucose which can occur in diabetic patients treated with insulin or oral medications.
In addition to these tests, if T1D is suspected, autoantibody test and/or urine test can be used.
Treatments (1,2,3,4)
Some people with T2D can manage their blood glucose levels by making healthy lifestyle choices. Many people with T2D may need diabetic medicines or other approaches as well.
Oral medications: There are many classes of oral medications targeting various processes of glucose metabolism to:
Stimulate the pancreas to produce and release more insulin
Inhibit the conversion of stored glycogen to glucose
Block the action of stomach enzymes or intestinal enzymes that metabolize carbohydrates to glucose
Increase glucose uptake to tissues by increasing number and/or sensitivity of insulin receptors
Insulin: Insulin injections may be used for T1D patients and T2D patients whose pancreas no longer produces insulin. It’s also possible to use a combination of insulin and oral medications.
Surgery: A pancreas transplant may be an option for T1D patients. Bariatric surgery may be an option for T2D patients with a Body Mass Index ≥35.
Prevention and Management (1,2,3)
This National Diabetes Prevention Program at CDC offers lifestyle-change programs which you can review here: (https://www.cdc.gov/diabetes/prevention/index.html). In general, it is important to:
Monitor and manage blood glucose levels
Choose healthy eating options
Be physically active
Take medicines on time
Lose weight (if necessary) and maintain healthy weight
Manage stress
Avoid tobacco use
Work with your doctor
This November, besides enjoying your turkey and being grateful to be tennis players, take some time to review your risk for diabetes, a serious metabolic disease that not only negatively affects individuals, but also the health care system and the economy of the US. The good news is that it can be prevented and even reversed by following a treatment and management plan. Also, early detection is really critical to management and prevention. Talk to your health care providers who can help you and also refer you to other experts for related health problems.
References
World Health Organization. Diabetes. https://www.who.int/health-topics/diabetes#tab=tab_1
Centers for Disease Control and Prevention. Diabetes. https://www.cdc.gov/diabetes/index.html
National Institute of Diabetes and Digestive and Kidney Diseases. Diabetes. https://www.niddk.nih.gov/health-information/diabetes
National Library of Medicine. Diabetes. https://www.ncbi.nlm.nih.gov/books/NBK551501/
This information is provided for your reference and you use at your own risk; you should rely on your medical professional for medical advice.