Diabetes

No, I don’t have diabetes. My almost-and-very-soon-to-be husband doesn’t either. But, in my line of work, I come across a lot of diabetic people. Two weeks ago on Monday, I had my first back as a full-timer. I only worked the second 12 of it (the night part, yay) because I had county orientation to set up my benefits during the daytime; however, the only patients that my partner and I saw during those 12 hours were diabetics. Here in North Carolina, we are in several “belts”.

We have the Bible belt…

On the medical side, we have the stroke belt…

Stroke map.

We have the diabetes belt…

Map showing areas in the Diabetes Belt

So, maybe we don’t have the highest rates of diabetes that are found in the diabetes belt, but you can still see that we have a lot surrounding us. According to the National Diabetes Fact Sheet that was released in January of this year, more than 25 million people in the United States, both children and adults, have diabetes. That’s 8.3% of the population. Quite a chunk of change. With that statistic, every 12th patient I see has diabetes (per national rates). As of 2008, North Carolina was ranked 17th highest for prevalence of adult diabetes at 9.3%. There, we’re getting closer to one of every 10 patients I see having diabetes. That’s a lot. And that’s not good.

So what’s the problem with diabetes? What can result from this disease that everyone has heard of (you must be living under a rock if you haven’t)?

First off, there is an increased risk of heart disease and stroke. If you look at the second and third map above, do you really find it to be a coincidence that the stroke and diabetes belts somewhat coincide? Likely not. Someone with diabetes has the same risk of having a heart attack as someone who has already had one. Why? Because the system is already compromised. Another confounding factor is that diabetics often have atypical presentations when experiencing a heart attack making it more difficult to discern from something that’s “nothing” and something that’s really “something”. They are at a higher risk of hypertension, or high blood pressure, high cholesterol and peripheral vascular disease (damage that is done to the arteries and veins that supply the extremities).

They also have a much higher risk of eye problems such as cataracts, glaucoma and blindness. These all result from damage to the blood vessels in the eyes. (When oxygen-rich blood stops flowing to an area, it begins to die.)

Diabetics are known for skin issues and, particularly, foot problems. With a decreased blood supply, tissues can become necrotic (dead) and sores cannot heal as well. These people have difficulty healing from any issue, especially if it involves the skin in some way.

Something these people experience, or rather don’t, are nerve issues. This disease damages nerves and causes neuropathy. The damage that results causes pain, numbness and sometimes a lack of sensation particularly to the extremities. This also accounts for slowed digestion of food through the digestive tract.

Another issue these people face (as if they don’t have enough already) is kidney disease and, ultimately, kidney failure (also called nephropathy). As blood supply decreases to vital organs (yes, the kidneys are vital), they are unable to function at the full capacity they once did. As the kidneys are no longer able to filter toxins and remove excess fluid from the body, hemodialysis becomes necessary.

Now that you know complications, what are the types of diabetes?

First, there is type 1, or insulin-dependent diabetes mellitus (IDDM). This was also once referred to as juvenile-onset diabetes. Here, the body has destroyed the cells in the pancreas that are necessary for developing insulin. Insulin is the substance that helps to regulate the blood glucose, or sugar. As a result of the destruction of beta cells (which produce insulin), these people must rely on insulin injections to keep their blood glucose under control. Though the name “juvenile-onset” is misleading, it is generally diagnosed when the person is a child, adolescent or during the early adulthood years. According to the CDC, type 1 accounts for approximately 5% of all diagnosed diabetes cases.

So if type 1 account for only 5%, where does the other 95% come from??

Well, between 90 and 95% of the remaining diagnoses comes from type 2 diabetes, or non-insulin-dependent diabetes mellitus (NIDDM). This is also referred to as adult-onset diabetes. This type is classified as an insulin resistance. The body still makes insulin but the cells are unable to make use of it. As a result, the body can understand that it needs more insulin and tells the pancreas to make more. The pancreas makes plenty of insulin but, because the body is unable to use it, the pancreas begins to lose the ability to produce it. There are certain risk factors, some of which you can alter:

  • Old age — can’t help that. Everyone gets old. Sorry.
  • Obesity — keep hearing how “obesity is such a problem”? Well, not only are you at increased risk of diabetes but your risk of other serious health problems increases.
  • Family history — can’t help what you’re given from Mom and Dad. You can thanks them later.
  • History of gestational diabetes — we’ll touch on that in a minute.
  • Physical inactivity — so get your butt up off the couch and get moving!
  • Race and/or ethnicity: African Americans, Hispanic/Latino Americans, American Indians, Asian Americans, Native Hawaiians, Pacific Islanders — can’t help this either.

So, why should you care if you have risk factors that you can’t help, such as family history and race/ethnicity? Because there are other things you can do to help prevent the disease. These things include watching your weight (and not watching it go up) and staying active. Being proactive about disease prevention (for any disease) is a huge factor to help keep it away.

I said I would mention gestational diabetes. This is a disease of pregnancy where glucose is no longer tolerated during those 9 months. I am not very familiar with this except to know that many of these women (if not all) take insulin shots in order to regulate their blood glucose levels in order to protect their growing baby. This usually resolves after pregnancy. If not, it is generally classified as type 2.

If you look at my math, 5% + 90/95% = 95/100%. Seems like I’m leaving something off. I am. There are some other ways that people can develop diabetes. Some of these include pancreatic disease (like cancer), infections, surgery, medications and some specific genetic conditions. These make up 1 to 5% of the diagnosed diabetics. As you can see, not very common and, like type 1, you really have absolutely no control over this.

A natural question is, how is diabetes treated? I mentioned insulin as a form of treatment, specifically for type 1 diabetes and women with gestational diabetes. However, insulin alone as a treatment accounts for only 12 percent of adults on treatment. Another option is oral medication. This stuff can last a long time — much longer than is typical of the injected insulin. This option is used for type 2 diabetes. That accounts for 58% of the treatment. 58%! A combination of insulin injections and oral medication accounts for 14% while no medication of any kind accounts for 16% of all diabetic treatment. The last option entails using diet and exercise to control the disease. (This data comes from a National Health Interview Survey that looked at the percentage of adults diagnosed with diabetes receiving treatment between 2007 and 2009.)

Looking at those numbers astounds me. It shows how big of a problem type 2 diabetes really is in our country. Yet we still continue our poor dietary and exercise habits. Basically, we’re unhealthy and we choose not to do anything to help stop these disease processes.

So, stop reading this blog, get off your butt and go outside and get active…or cook something healthy…or just do something good for your body!