Diabetes is the leading cause of heart disease, stroke, kidney disease, blindness and amputation, yet nearly 25 percent of people with diabetes don’t even know they have it. Vicki Kraus, PhD, and coordinator of the diabetes education program at University of Iowa Hospitals and Clinics, talks about diabetes:
What is diabetes?
Diabetes, simply put, is a blood sugar that’s above normal. We diagnose it in adults by having them fast overnight and measure a blood sugar. If that blood sugar is over 125 mg per deciliter, we call that diabetes. We would measure a second time to confirm it before we give that diagnosis. Another way is to do a random blood sugar test on somebody who complains of symptoms like thirst, frequent urination, big appetite. If it’s at or above 200 mg per deciliter, we would diagnose them as having diabetes.
What are the symptoms of diabetes?
The symptoms include being thirsty, needing to urinate more frequently because of the added fluid intake because the body is trying to get rid of the extra sugar in the bloodstream. People often say their appetite increases, but in some instances—especially with onset of type 1 diabetes—they’re actually losing weight even though they’re eating large amounts of food. Other symptoms may include being tired and having skin problems, including sores that won’t heal.
How is diabetes treated?
Diabetes treatment varies depending on whether it’s type 1 or type 2 diabetes. Individuals with type 1 diabetes do not make insulin so insulin therapy is initiated as soon as the diagnosis is made. But diet and exercise enter into the treatment program and need to be balanced with the insulin therapy.
People with type 2 diabetes, depending upon where their blood sugars are when they are diagnosed, often start with lifestyle change—that is diet and exercise—along with a medication, usually Metformin, which helps insulin in their bodies work better to keep their blood sugars under control. Often, though, they will proceed to needing to have insulin therapy as their own pancreases are not able to keep up with the amount of insulin it takes to normalize their blood sugar levels.
What is type 1 diabetes and can it be prevented?
Type 1 diabetes is used as a diagnosis when we have evidence that the individual’s pancreas is not making insulin anymore. These individuals usually are young at time of onset—children. However, adults, too, can get type 1 diabetes. It’s usually an autoimmune process that destroys the beta cells of the pancreas and therefore stops their insulin production.
What is type 2 diabetes?
Type 2 diabetes, in general, occurs in adults who are genetically susceptible and/or become overweight because of too many calories in and not enough energy out (exercise). These individuals have what we call insulin resistance, where their body cells do not respond in the normal way to the insulin their pancreas makes. Diet and exercise, as well as medication, can help with improvement in sensitivity of cells. But over time, their pancreases wear out and don’t make enough insulin and insulin therapy is required. Usually it’s adults that get type 2 diabetes, but we’re seeing it in adolescents and even children because of the obesity epidemic that we’re having in our world today.
Are there steps adults can take to reduce their risks of developing type 2 diabetes?
Diet and exercise are two ways people can reduce their risk. You can’t change your family history, but you can change what you eat and what you do for exercise.
There was a trial a few years ago called the Diabetes Prevention Program that proved lifestyle changes (as in exercise and loss of weight) will decrease the risk of developing type 2 diabetes.
I always think it’s good news when you hear that these people did not have to lose large amounts of weight—it was like five to seven percent of their beginning body weight. The exercise level that they needed to prevent onset of type 2 diabetes was 150 minutes of exercise a week. That’s five days a week doing 30 minutes of aerobic or walking-type of exercise. That’s really pretty achievable by most people.
What is gestational diabetes? What causes diabetes in pregnancy?
Diabetes comes on during pregnancy because of changes that occur in the mother’s body due to the development of the fetus during the pregnancy. Hormones are secreted—particularly by the placenta—in the second half of the pregnancy that causes an insulin resistance. It’s the same situation that you have in type 2 diabetes. In some women their pancreas is unable to keep up with adequate supplies of insulin to keep their blood sugars normal.
So somewhere, usually in the 24-28 week stage of the pregnancy, we screen women by giving them some sugar water to see if they’re able to keep their blood sugars normal. For some women at that time, that level is elevated and we go on to do another test where they get more glucose but we take more blood sugar levels. Then, if they have gestational diabetes, they need to be managed with diet and exercise and maybe insulin therapy if their blood sugars do not become normal.
Once the woman with gestational diabetes has her baby, does her diabetes go away?
Usually it does go away and we check people right after they deliver, as well as about six weeks after the delivery to see if they have elevated blood sugar levels. However, it does mean that they’re at risk for developing type 2 diabetes later in their lives, so it’s really important that they learn about the fact that diet and exercise are important in terms of prevention of future onset of type 2 diabetes, If they become pregnant again, we need to screen them even earlier to detect diabetes so we can start treating it earlier in the pregnancy if necessary.
Is there a cure for diabetes?
There isn’t really a cure. I think sometimes we get people, particularly with type 2 diabetes. Type 1 obviously not because there isn’t insulin production by the pancreas—that’s a lifelong insulin replacement challenge unless they’re one of the few people who are candidates for beta-cell transplant. Type 2 individuals sometimes are able to get to the point—I don’t see it often, but it is possible—where they do lose weight, they have a regular program of exercise, and their blood sugars return to normal. It doesn’t mean that they’re cured, but they’ve been able to control their blood sugars in the normal range. If they’re able to keep up with the exercise program and maintain a more normal body weight, their blood sugars will remain normal. |
