Diabetes is a chronic (long-lasting) health condition that affects how your body turns food into energy. In a healthy body, food is broken down into sugar, or glucose, and releases into your bloodstream. As the blood sugar rises, it signals the pancreas to release insulin. Insulin acts like a key to direct the muscle and fat cells to take in the glucose. The glucose is used for energy, or stored as fat for long-term storage.
With diabetes, your body either does not make enough insulin, or cannot use it as well as it should. When this occurs, too much sugar stays in your bloodstream. Over this time, this can lead to very serious health problems, including but not limited to, heart disease, blindness and kidney disease.
Statistically, more than 37 million adults in the US have diabetes; 20% of them don’t even know they have it. In the last 20 years, the number of adults diagnosed with diabetes has more than doubled. Diabetes is the seventh leading cause of death in the US, and is the leading cause of kidney failure, lower-limb amputations, and adult blindness.
While there are three types of diabetes, type II diabetes is our greatest concern within the population of Medicare-beneficiaries. Approximately 90-95% of people with diabetes have type II diabetes. It is progressive, developing over many years and is most often the result of lifestyle. It is usually diagnosed in adulthood, but is becoming more and more common in children, teens and young adults. Type II diabetes can be prevented, or delayed with healthy lifestyle such as weight loss, a healthy diet, and remaining physically active.
What do the numbers mean?
Glucose - a glucose level is part of routine lab testing, included in a Comprehensive Metabolic Panel. In a healthy adult, a fasting blood glucose level should report between 70 and 100 mg/dL. A fasting blood glucose level from 100 to 125 mg/dL would indicate prediabetes and above 125 mg/dL would indicate diabetes.
Hemoglobin A1c - the A1c level reflects your average blood glucose levels over approximately 3 months; it is reported as a percentage. A1c target levels can vary with different factors, but as a general rule if your A1c levels are between 5.7% and 6.5% you are considered to be prediabetic. An A1c above 6.5% is considered to be in the diabetic range. The goal for most adults with diabetes is to keep the A1c below 7%.
There are no clear symptoms of prediabetes. Having routine exams and taking an active part in understanding your test results and risks will empower you to make lifestyle changes necessary to prevent or delay the progression to type II diabetes. Having prediabetes does not mean you will develop type II diabetes, but it is a clear opportunity to make small changes that can make a huge impact on delaying or prevention of the disease. Diabetes symptoms can take years to develop, and some people have no symptoms at all. The following are considered to be diabetes symptoms and you should discuss with your care coordinator or doctor if you are experiencing any of these:
frequent urination, often at night
excessive thirst
weight loss without trying to lose weight
extreme hunger
blurred vision
numbness or tingling of the hands or feet
lethargy or fatigue
very dry skin
sores that heal slowly
more infections than usual
Diabetes and the Cardiovascular System:
Cardiovascular disease is the leading cause of death in those with a diagnosis of diabetes, 2/3 of these are in those with type II diabetes. Additionally, people who have diabetes are two times more likely to have heart disease or suffer a stroke than people without diabetes. Excess blood sugar decreased the elasticity of blood vessels causing them to narrow and impede blood flow. This can lead to a reduced supply of blood and oxygen, increasing the risk of high blood pressure and damage to the large and small blood vessels.
Macrovascular disease is disease of any large blood vessel in the body, including the coronary arteries, aorta and sizeable arteries in the brain and limbs. Complications from macrovascular disease include heart attack, stroke and peripheral artery disease.
Microvascular disease is disease of the walls and inner lining of tiny vessels which branch off from the larger coronary arteries. Complications from macrovascular disease include neuropathy (nerve numbness or weakness), retinopathy (visual changes which lead to blindness), and nephropathy (deterioration of kidney function).
Diabetes and the Kidneys:
The kidneys are quite complex, having millions of tiny blood vessels that help to filter wastes from our blood and remove them from the body in urine. We cannot live without our kidneys. Having diabetes, as we have seen above, can affect the blood vessels and the filtering system starts to deteriorate. With the damage of the blood vessels, the kidneys will start leaking valuable protein into the urine, called microalbuminuria. Kidney disease is progressive; the kidneys slowly lose their ability to filter allowing waste products to enter the bloodstream, which can be toxic. Without good control of diabetes, the kidneys will begin to fail, leading to end-stage renal disease; the kidneys will need to be replaced by transplant or blood will have to be filtered by machine, through hemodialysis for the remainder of one’s life.
Diabetes can affect every part of the body. In addition to the things discussed above, persons with diabetes can experience skin complications, increased yeast and bacterial infections, elevated blood pressure, gum infections and cavities, fatty liver, thyroid dysfunction, sexual dysfunction, as well as anxiety and depression. There have also been links to diabetes and hearing loss, noting that hearing loss is twice as common in people with diabetes. It has also been determined that people with prediabetes have a 30% higher rate of hearing loss, when compared to those with normal blood glucose levels.
People don’t always take diabetes seriously; it is often perceived as a personal failure. While type II diabetes is often a result of lifestyle, diabetes is very serious and can alter one’s quality of life tremendously. You can make the changes necessary to improve your outcome. As Theodore Roosevelt once said, “Get action. Do things; be sane; don't fritter away your time; create, act, take a place wherever you are and be somebody; get action.” While I am certain he did not have health and wellness on his mind with this quote, it seems fitting. Don’t let denial put your health at risk. You can shift from a place of worry and vulnerability to hope and optimism, if only you accept the facts, and are open to change.
Resources:
NIH study shows how insulin stimulates fat cells to take in glucose
ADA - Diabetes Complications, Cardiovascular Disease
Patient Resources:
CDC Diabetes TV - Your Health with Joan Lunden and CDC
CDC Diabetes TV - Imagine YOU Preventing Type 2, National Diabetes Prevention Program
Medicare Diabetes Prevention Program (MDPP)
Novo Nordisk - Cornerstones4Care
Cornerstones4Care - Eating Healthy
Cornerstones4Care - Staying on Track