Ask the Doctor

Diabetes

Q. Why am I hearing so much about diabetes these days? And what is the difference between Type 1 and Type 2?

A. You are probably hearing and reading a lot about diabetes at this time of the year because November is national diabetes awareness month, and the American Diabetes Association does an excellent job getting the message out.

And it's an important message. Diabetes is a serious disease and is the 5th leading cause of death in this country. Most people are surprised to learn that more than 200,000 Americans will die this year as a result of diabetes or its complications - more than from AIDS and breast cancer combined. In addition, untreated or poorly managed diabetes can lead to serious health problems that affect quality of life.

Let's start with a definition of diabetes. Diabetes is a disease in which the body either does not produce insulin (Type 1), or is not able to properly use insulin (Type 2). Insulin is a hormone produced by the pancreas that is needed to convert sugar, starches and other food into energy needed for daily life. Type 1 diabetes accounts for 5% to 10% of all diabetes in the United States. Type 2 diabetes accounts for 90% to 95% of cases.

The cause of diabetes continues to be a mystery, although both genetics and environmental factors such as obesity and lack of exercise appear to play roles. If you have a family history of diabetes, and/or if you are of a Hispanic, Native American or African American background, you may be at a higher risk for the disease. The incidence of Type 2 diabetes increases with age; people aged 65 years and older make up 40% of the cases.

Symptoms of diabetes include excessive thirst, the need for frequent urination, unexplained weight loss, and fatigue. Having one or more of these symptoms, however, does not mean you have diabetes. Diagnosis requires a blood test, which your doctor can order.

The numbers of new cases of diabetes are increasing at an epidemic rate, which is another reason why awareness is so important. According to the American Diabetes Association, there are currently 20.8 million people in the United States, or 7% of the population, who have diabetes. Of this group, an estimated 6.2 million people (or nearly one-third), are unaware that they have the disease, in other words, they are undiagnosed and therefore not receiving treatment or learning how to manage the disease. This is an alarming statistic, as the damage that untreated diabetes can cause is serious.

There are four major complications from diabetes: 1. Heart Disease: Cardiovascular disease is accelerated by diabetes, with a significant increased risk for heart attack and stroke. In addition to good diabetes management, patients should control their blood pressure (about 70% of diabetics may acquire hypertension during their lifetime), should not smoke, and have good cholesterol-control through their primary care physician/cardiologist.

2. Eye Disease: Disease affecting the retina (retinopathy) can lead to partial or complete blindness if not managed early in diabetic disease. It is estimated that 5.5 million adult patients with diabetes have this problem. Yearly eye examinations for retinopathy, cataracts and glaucoma are essential to preventing this complication.

3. Kidney disease (nephropathy) is a leading cause of end-stage diabetes, requiring dialysis, with 28,000 new cases of dialysis-dependence per year. Again, good blood sugar control and monitoring of kidney function through the blood and urine can decrease the risk of having this complication.

4. Foot and Leg Disease: Frequent examination of the legs and feet by a physician should be part of diabetic care. Vascular and neurologic damage (neuropathy) to the extremities is not an uncommon problem for individuals with diabetes. More than 60% of the non-traumatic amputations to the lower limbs in the United States occur among people with diabetes. Care of the lower extremities, particularly the feet, is very important. Foot ulcers develop in about 15% of patient with diabetes. The primary problem usually begins with neuropathy (which includes the loss of sensation in the feet and legs), and develops over the years ascending from the toes up the legs. Due to the decreased sensation caused by neuropathy, patients may be unaware of cuts, infections or early, small skin ulcers. Treatment of these ulcers may involve control of infection with antibiotics, debridement, pressure relief and possibly other therapies. Wound care centers (such as the one at South County Hospital), are an integral part of keeping diabetic patients healthy.

The management of diabetes and blood sugar control can be complicated. It may consist of diet and weight control alone, or may additionally involve oral medication and/or insulin therapy. Your doctor will be able to guide you through this. In addition, most individuals with diabetes benefit from attending diabetes management classes. South County Hospital offers a number of ongoing classes and support groups for individuals with diabetes and their family members. For information, call 788-1259.