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Published: Monday, 4/26/2010

Diabetes: Why you get it, will you get it?

DR. MARK WATKINS
SPECIAL TO THE BLADE

This is one of a series of columns about health issues written by staff members of ProMedica and Mercy Health Partners.

It can lead to blindness, kidney failure, and heart disease. It can also be delayed or, in many cases, completely avoided.

According to the Centers for Disease Control and Prevention, more than 23 million Americans have diabetes. To better understand the causes, symptoms, prevention, and treatment of this disease, let me start with the basics.

What is diabetes?

Diabetes is a disease characterized by high blood sugar. A more scientific word for sugar is “glucose.” The cause of this high blood glucose is what differentiates type 1 diabetes from type 2 diabetes.

But they are similar in root cause: the body's ongoing struggle with insulin.

As you eat, your body breaks down food. Sugars and starches are broken down into glucose. Glucose is transported into your cells (where it becomes fuel) by insulin, a hormone produced by the pancreas. Think of insulin as a delivery truck.

Type 1 diabetes — previously called juvenile diabetes — is characterized by the body's inability to make insulin (in other words, all the delivery trucks are broken down and there are no mechanics available). In type 1 diabetics, the immune system destroys beta cells — the body's only producer of insulin. Type 1 diabetes is typically diagnosed in children and young adults, and insulin treatments help type 1 diabetics manage their condition.

Type 2 diabetes — previously called adult-onset diabetes — is characterized by the body's inadequate production of insulin. In type 2 diabetics, the body either doesn't make enough insulin or the cells simply don't use it (they refuse to accept the truck's delivery). Type 2 diabetes accounts for 90 to 95 percent of all cases of diabetes in the United States, and exercise and a healthy diet help type 2 diabetics manager their condition.

In both cases, a lack of insulin causes glucose to build up in the bloodstream. Why is this bad? Too much glucose in your bloodstream is called hyperglycemia, and its effects on blood vessels can be devastating in two ways:

• Damage to large blood vessels — responsible for heart disease and stroke.

• Damage to small blood vessels — responsible for kidney damage, nerve damage, and eye disease.

How do I know if I have diabetes?

Symptoms of diabetes don't often indicate extreme danger, which is why so many cases of diabetes go undiagnosed. Symptoms are often attributed to tiredness or stress. Symptoms of type 1 and type 2 diabetes include:

• Extreme fatigue, irritability, and weight loss

• Frequent urination

• Unusual thirst and hunger

Additionally, symptoms of type 2 diabetes include:

• Blurred vision

• Frequent infections

• Numbness in hands and feet

It's also important to note that some type 2 diabetics may experience no symptoms at all.

If you experience any of these symptoms, see your physician immediately. A simple blood test will determine if you have diabetes.

How is diabetes treated?

Because they don't produce any insulin, type 1 diabetics require insulin treatments.

Oral medications are available for those who produce some insulin, which includes most type 2 diabetics. Oral medications help control blood glucose levels, but are usually a supplement to dietary and lifestyle changes.

Diet and lifestyle changes are a huge part of type 2 diabetes treatment. The good news is that you can eat a wide variety of foods that are healthy for everyone — including fruits, vegetables, meats, grains, and dairy. The guiding principle is to watch the carbs. Carbohydrates have the most influence on blood glucose levels, so your intake needs to be monitored carefully.

After diagnosis

When you have been diagnosed with diabetes — or maybe when you're only at risk — it's important to immediately begin managing your condition.

Besides the prescribed treatments I've previously addressed, there are programs to help diabetics manage their condition. ProMedica Health System's diabetes education program is accredited by the American Diabetes Association (ADA), and employs registered dietitians who are also certified diabetic educators.

“Every patient is unique and treated on a case-by-case basis,” says Terri Kowalski, director of ProMedica's Diabetes and Wound Care Center. “We don't want to limit our patients; we want to give them new strategies and new activities to get their blood sugars down. We want our patients to live happy, healthy, and fun lives.”

This comprehensive program features private sessions with a diabetes educator and program dietitian. To enroll or sign up for classes, please call 419-291-6767.

In addition, the Pharmacy Counter features a free, walk-in diabetes introductory session, Diabetes 101, at the 2655 West Central Ave. location at 9:30 p.m. each Wednesday (419-473-1493), and at the pharmacy at 1511 South Byrne Rd. at 9:30 a.m. each Thursday (419-382-3475). This free program covers the importance of blood glucose testing and preventing and living with complications of diabetes.

“When patients are diagnosed, they often don't understand exactly how this disease works,” says Brian Coehrs, director of pharmacy operations for the Pharmacy Counter.

“So we spend a lot of time discussing how diabetes occurs, how lifestyle choices have gotten you to this point, and how you can use lifestyle choices to improve your condition.”

Prevention: Who is at risk?

To prevent diabetes, we must consider its causes. Because type 1 diabetes occurs naturally in the body, there currently is no known prevention. We don't know why some people can't produce insulin, but research and studies are constantly being conducted to better understand this disease.

Type 2 diabetes, however, can result from a high-fat diet, high alcohol intake, high blood pressure, obesity, and lack of adequate physical activity. Additionally, those over the age of 45 are at a higher risk, and genetics and race may be a factor: African-Americans, Native Americans, Hispanic-Americans, and Japanese-Americans have a greater risk of developing type 2 diabetes.

But because we can't control our genes, age, or race, we must focus on what we can control. Type 2 diabetes prevention is a simple, reliable concept: eat right and exercise.

For more information, or if you think you may have diabetes, please see your primary care physician. To assess your risk of developing diabetes, visit diabetes.org.

Mark Watkins, DO, is a board-eligible physician and pediatric endocrinologist at the Endocrine and Diabetes Care Center in Toledo. He is a member of ProMedica Physician Group.



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