EDITOR’S NOTE: This month AFMC launches a year-long series on diabetes. Look for an article at the beginning of each month that will explain a specific aspect of diabetes – diet, exercise, prevention, treatment options and much more.

The disease of our time

Almost 30 million Americans have diabetes and it is increasing so fast that public health experts call it an epidemic. Here’s why:

  • Almost 10 percent of the U.S. population has diabetes
  • About a third of people with diabetes don’t know they have it
  • About a third who know they have diabetes are not receiving treatment
  • Another 86 million Americans have prediabetes; 90 percent don’t know it
  • Diagnosed diabetes costs $245 billion a year in medical costs, lost work and wages
  • One in three Americans will develop diabetes in their lifetime

Adults with diabetes die earlier and live with disabilities longer than non-diabetics. Diabetes causes long-term damage to the body. It can damage your eyes, kidneys, nerves and blood vessels; cause heart attacks, heart disease, stroke and amputations; and cause gum problems and tooth loss.

Types of diabetes

Diabetes mellitus (types 1 and 2) causes high blood glucose (or blood sugar) because the body is unable to use blood glucose for energy. Our bodies change the food we eat into glucose. Insulin is a hormone that helps the glucose get into the cells in the body and give them energy. Without enough insulin, the glucose builds up in the blood.

Type 1 diabetes means the body does not make enough insulin. It develops when the body’s immune system destroys the cells in the pancreas that make insulin. Type 1 can develop at any age, but most type 1 patients are born with this disease and are usually diagnosed in childhood. However, some adults can develop type 1 or have it diagnosed later in life. While there is no cure and no know way to prevent it, type 1 can be treated with insulin injections and other medications. Only about 5 percent of people with diabetes in the United States have type 1.

Type 2 diabetes is far more common than type 1 and occurs when the body does not make or use insulin well. Type 2 is often referred to as a lifestyle disease, resulting from poor food choices, obesity and lack of exercise. Almost all type 2 diabetes can be prevented.  Most type 2 diabetes is diagnosed in adults. However, the growing obesity and lack of exercise among children is causing type 2 to be diagnosed in an increasing number of children. In fact, diabetes is now the third most common severe and chronic childhood disease in the United States.

Type 2 diabetes usually begins with insulin resistance. Insulin “resists” carrying glucose into the body’s cells to use for energy. As a result, the body needs more insulin to help glucose enter cells. At first, the body keeps up with the added demand by making more insulin. Over time, the pancreas doesn’t make enough insulin when blood sugar levels increase, such as after meals. Treatment for diabetes must begin when the body can no longer make enough insulin.

Prediabetes can occur when blood glucose is higher than normal but not high enough to be called diabetes. However, having prediabetes puts you at higher risk of getting type 2 diabetes.

About 4 percent of pregnant women develop gestational diabetes. Although it goes away after pregnancy, about half of women who had gestational diabetes will develop type 2 diabetes within 15 years. Also, women who give birth to babies weighing nine pounds or more are more likely to develop type 2 diabetes later in life.

Diabetes symptoms include:

  • Extreme hunger
  • Extreme thirst
  • Frequent urination
  • Unexplained weight loss
  • Fatigue or drowsiness
  • Blurry eyesight
  • Slow-healing wounds, sores or bruises
  • Dry, itchy skin
  • Tingling or numbness in the hands or feet
  • Frequent or recurring skin, gum, bladder or vaginal yeast infections

Other signs of insulin resistance (the body’s inability to properly use insulin) include darkening skin around the neck or in the armpits, high blood pressure, high cholesterol, yeast infections and, in women, skipped or absent periods.

However, some people never have any of these symptoms. The only way to know if you have diabetes or prediabetes is to have a blood test.

Health emergency

Undiagnosed diabetes can lead to a health emergency. Call your doctor or go to an emergency room if you:

  • Notice your breath smells like nail polish remover (acetone)
  • Start to tremble, feel weak and drowsy, confused or dizzy, or your vision becomes blurred
  • Feel uncoordinated
  • Lose a significant amount of weight without trying to
  • Are nauseous or vomit more than once
  • Start breathing deeper and faster
  • Have a sore, blister or wound that won’t heal
  • Have extreme thirst and urinate more than usual

If blood sugar becomes very high, a condition called diabetic ketoacidosis may develop. Symptoms may include shortness of breath, stomach pain, vomiting, dehydration, and even coma and death if left untreated.

Diagnosis

Blood tests can determine if you have diabetes.

  • A fasting blood glucose test is usually done in the morning after not eating for eight to 14 hours (called a fasting blood sugar test). If your blood glucose is 126 mg/dL or higher for more than two tests, it indicates diabetes. If the test is from 100 to 125 mg/dL it suggests prediabetes.
  • Oral glucose tolerance test involves drinking glucose dissolved in water. The amount of glucose in your blood will be measured after two hours. A level at 200 mg/dL or higher indicates diabetes.
  • Random blood glucose tests measure your blood glucose level at any time of day, regardless of when you last ate. A level at 200 mg/dL or higher indicates diabetes.
  • The A1c tests shows how well you are managing your diabetes/prediabetes over the past two to three months.

For more information about diabetes, see articles about preventing it; options for treatment and how to prevent the complications of diabetes.