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Diabetes

Part One - Introduction

Diabetes is a disease and series of complications that arise from the inability to adequately control levels of sugar (glucose) in the bloodstream. Some 15-20 million Americans suffer from diabetes mellitus and its host of short and long term effects. Worldwide over 150 million patients suffer from diabetes, a rate five times higher than predicted a decade ago. Rates of diabetes are increasing rapidly with the disease now approaching heart disease and cancer as a leading cause of premature death or life long disability. Nearly one million new cases of diabetes are diagnosed each year in America although a substantial number of people have the disease and donít know it. Over 200,000 Americans die from diabetic complications each year. Diabetes is the leading cause of kidney disease and blindness. It is estimated that diabetes costs Americans approximately 100 billion dollars each year in direct medical costs and indirect costs related to disability and time off work.

Type I diabetes (Insulin Dependent Diabetes Mellitus or IDDM) is the situation where the patient does not produce their own insulin required for the uptake and processing of sugar by the bodyís cells. Type I used to be called "Juvenile" onset diabetes and is believed to be caused by an autoimmune reaction that destroys the Islet cells in the pancreas responsible for insulin production. Type I can also be caused by physical injury to the pancreas such as acute or chronic pancreatitis, certain genetic disorders, and infection. While Type I is the more dangerous form of diabetes it represents less than 8% of total cases. At present Type I patients require daily insulin injections or the use of the implantable insulin pump.

Type II diabetes (Non-insulin Dependent Diabetes Mellitus or NIDDM) is a disease where the cells in the body become resistant to the actions of insulin and/or the pancreas produces too little insulin. Type II used to be called "Adult" onset diabetes although recent research demonstrates that people are developing this more common form of diabetes at younger and younger ages. Type II diabetes is closely associated with obesity, advancing age, inactivity, and genetic makeup. Type II diabetes accounts for 90-95% of all cases of diabetes and often runs in families. Certain ethnicities such as Latin Americans and African Americans have very high rates of Type II diabetes. This may be due to dietary factors and/or genetic factors. The astonishing increase in diabetes seen in America today is largely a function of the increased number of obese adults and adolescents coupled with a lack of regular exercise. Apparently, when the bodyís cells are exposed to excessive amounts of dietary calories they respond by down regulating or otherwise adjusting insulin receptor sites.

Gestational diabetes is a condition effecting approximately 3- 5% of pregnancies. Lack of glucose control usually returns following delivery although women who develop gestational diabetes are at greater risk to go on to develop Type II later in life.

Initial Symptoms- Patients can go years (especially with Type II) without noticing any symptoms that might lead to a diagnosis. Routine blood screenings (fasting blood sugar) at annual check-ups can allow early identification and timely treatment of diabetes. Symptoms can include intense thirst, dry mouth, frequent urination, fatigue, weight loss, and blurred vision. Wounds that wonít heal may be another sign of diabetes. A fasting blood sugar in excess of 126 indicates that diabetes may be present. Fasting blood sugar has largely replaced the more traditional method of testing called "glucose tolerance".

Recently, the American Diabetes Association and the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) identified what is now called "pre-diabetes". This condition precedes the onset of Type II diabetes but damage to the heart and other systems can occur even during this "incubation" phase. A normal score on the fasting glucose test is less than 110. Between 100 and 126 is the area now termed pre-diabetes. A score over 126 indicates that Type II diabetes may have already developed. The good news is that patients who are identified as pre-diabetic may receive treatment and adjust life style as to avoid the progression of the disease. If you are wondering whether or not you are in such a category you can learn more and take a quiz at: Are you at risk from pre-diabetes?

Type I diabetes typically has a sudden onset. A patients first clue of Type I diabetes may be a potentially lethal condition of hyperglycemia known as ketoacidosis (DKA) that is characterized by nausea, vomiting, abdominal pain, confusion, and "fruity" breath. DKA leads to what is called "diabetic coma". Upon admission to an emergency room, Type I DKA symptoms may be confused with acute alcohol intoxication because the patientsí fruity breath smells like fruit brandy and they are generally confused and unresponsive.

The best long term measure of how much excess glucose is circulating in the blood stream (and causing havoc) is a test called an Hb1Ac. This test should be repeated every 90 days or so to measure the effectiveness of treatment. A level of 5 or below is great. Levels above 6 or 7 are problematic and levels over 9 or 10 can mean serious trouble.

In order to reduce the rates of serious complications, it is critical to diagnose diabetes early and then maintain a strict regime of glucose control. Recent studies demonstrate that long term complications can be reduced by 40-60% when a strict program of medicine, diet, and exercise are followed. Strict glucose control is insured by frequent testing of blood glucose (3-6 X/day) and making the necessary adjustments to meals and medicine. The smoking of tobacco is to be avoided if complications are to be minimized.

It is important to state clearly that patients suffering from diabetes can be largely in control of the course of their illness if they are well informed and follow medical advice including proper nutrition and diet, medications, and a program of exercise.



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