Reducing
Your Risk
The purpose of this article is to help you
determine if you may be at risk of developing type 2
diabetes, a very common disease, and what you can do
to lower your risk. By making some simple changes in
your lifestyle - such as losing weight and
increasing your level of activity - you may be able
to delay the development of type 2 diabetes or avoid
it altogether. If you do get diabetes, the
information in this article can help you reduce the
severity of the disease and avoid its many possible
life-threatening complications.
What Is Type 2 Diabetes?
Diabetes is a disorder of metabolism - the way in
which your body converts the food you eat into
energy. Most of the food you eat is broken down by
digestive juices into chemicals, including a simple
sugar called glucose. Glucose is your body's main
source of energy. After digestion, glucose passes
into your bloodstream, where it is available for
cells to take in and use or store for later use.
In order for your cells to take in glucose, a
hormone called insulin must be present in your
blood. Insulin acts as a "key" that
unlocks "doors" on cell surfaces to allow
glucose to enter the cells. Insulin is produced by
special cells (called islet cells) in an organ
called the pancreas, which is about 6 inches long
and lies behind your stomach.
In healthy people, the pancreas automatically
produces the right amount of insulin to enable
glucose to enter cells. In people who have diabetes,
cells do not respond to the effects of the insulin
that the pancreas produces. If glucose cannot get
inside cells, it builds up in the bloodstream. The
buildup of glucose in the blood — sometimes
referred to as high blood sugar or hyperglycemia
(which means "too much glucose in the
blood") — is the hallmark of diabetes.
When the glucose level in your blood goes above a
certain level, the excess glucose flows out from the
kidneys (two organs that filter wastes from the
bloodstream) into the urine. The glucose takes water
with it, which causes you to urinate frequently and
to become extremely thirsty. These two conditions
— frequent urination and unusual thirst — are
usually the first noticeable signs of diabetes.
Another symptom you may notice is weight loss, which
results from the loss of calories and water in your
urine.
Type 1 Diabetes: The Other Form
Diabetes has two forms - type 1 and type 2. Nine
out of 10 people with diabetes have type 2 diabetes.
But to give you an idea of how the two are related
— their similarities and differences — we will
briefly describe type 1 here.
Type 1 diabetes is, at least initially, much more
serious than type 2. Type 1 diabetes is sometimes
referred to as insulin-dependent diabetes. It used
to be known as juvenile diabetes because most people
develop it when they are children or teenagers. Type
2 diabetes also is known as non-insulin-dependent
diabetes. In the past, it was often referred to as
adult-onset diabetes because it usually occurs after
age 40. Unlike type 2 diabetes, there is no known
way to prevent type 1 diabetes.
You have type 1 diabetes if your pancreas cannot
make enough insulin to help glucose get inside your
cells. This type of diabetes occurs when the cells
in the pancreas that make insulin are attacked by
your body's own immune defense system, which
mistakes these insulin-producing cells for germs and
tries to destroy them. Doctors do not know exactly
what makes the immune system attack healthy tissue;
some think a virus may be the cause.
Type 1 diabetes will make you feel very sick very
quickly because you cannot survive for long without
insulin. People who have type 1 diabetes must give
themselves shots of insulin every day just to stay
alive. In addition to taking shots of insulin to
help regulate the level of glucose in their blood,
people with type 1 diabetes work very closely with
their doctor, nurses and a dietitian (a person who
is trained to provide education and counseling about
nutrition) to establish an individualized treatment
program. This program will include a meal plan
designed just for them, which they must carefully
follow to control their diabetes.
If you have type 1 diabetes, you already know a
lot about the disease. You should be following your
doctor's instructions and actively controlling your
illness to keep yourself healthy. The information in
this article may reinforce what you already know
about the importance of following an established
eating plan and fitting exercise into your daily
life. This article also will help people who do not
now have diabetes understand their risk of
developing type 2 diabetes and what they can do to
try to prevent it.
Who Has Type 2 Diabetes?
Diabetes is a very old disease — written
records of it date back to 1550 B.C. However, until
the 20th century, diabetes was fairly rare. Type 2
diabetes is now widespread in every industrialized
country in the world. More than 14 million Americans
have type 2 diabetes. Doctors think the reason this
form of diabetes is so common today is because
increasing numbers of people are eating more,
exercising less and becoming overweight. Most (but
not all) people who have type 2 diabetes are
overweight. As the population ages, more and more
people will develop type 2 diabetes, which usually
occurs after age 40.
Over thousands of years, the human body has
become very good at converting digested food into
fat and storing the fat in cells to use later for
energy. This ability to store food as fat was
helpful for our ancestors, who often went long
periods without food. When food was scarce, their
bodies could rely on the stored fat for their energy
needs.
For us, this ability to store fat can be a
serious problem. In developed countries today, food
is abundant and always available. We can choose from
a variety of foods ranging from nutritious, low-fat
fresh fruits and vegetables to high-fat,
high-calorie snacks and sweets. Many of us choose
too many of the high-fat, high-calorie foods. In
response, our body does what it has learned to do;
it efficiently stores the food away as fat. The more
efficient our body is in storing fat, the fatter we
become from the food we eat.
The Path Toward Type 2 Diabetes
As you gain weight, the extra weight causes your
cells to become resistant to the effects of insulin.
The pancreas responds by producing more and more
insulin, which eventually begins to build up in your
blood. High levels of insulin in the blood — a
condition called insulin resistance — may cause
problems such as high blood pressure and harmful
changes in the levels of different fats
(cholesterol) in your blood. Insulin resistance, the
hallmark of what doctors sometimes refer to as
"syndrome X," is the first step on the
path to type 2 diabetes.
The second step to type 2 diabetes is a condition
called impaired glucose tolerance. Impaired glucose
tolerance occurs when your pancreas becomes
exhausted and can no longer produce enough insulin
to get glucose out of your bloodstream into cells.
Glucose begins to build up in your blood. If it is
not diagnosed and not treated, this gradual rise in
glucose often leads to type 2 diabetes, high blood
pressure and heart disease — in any order and in
any combination.
While all these harmful activities are going on
inside your body, you feel perfectly fine. Type 2
diabetes is considered a silent disease because it
works its destruction over many years without
causing any noticeable symptoms. That's why half of
the people who have type 2 diabetes don't know it.
You or someone you love could have diabetes.
The good news is that you may be able to avoid
type 2 diabetes altogether. This article will help
you understand the disease, learn about your chances
of developing it, and tell you what you can do to
try to prevent it. Many people are able to avoid
diabetes by making changes in their lifestyle, such
as eating less and exercising more.
Are You at Risk?
Diabetes is not contagious. You can't catch it
from another person. But you are more likely to
develop type 2 diabetes if one of your parents or a
brother or sister has the disease. Diabetes results
from the way in which your genes interact with your
environment. Genes are the basic units of heredity
each of us inherits from our parents. Just as we all
inherit genes that make our eyes a particular color
or our hair curly or straight, we inherit genes that
do things that aren't quite so obvious. For example,
most of us have genes that help protect us from some
illnesses and other genes that make us more likely
to develop some illnesses.
Although doctors now know that genes are involved
in diabetes, they have not yet found the specific
genes, and they don't know how they work exactly.
When they do find the genes involved in type 2
diabetes, they will be able to develop a simple test
to determine whether you or anyone else has them.
Knowing that you have the genes for type 2 diabetes
is not as alarming as it seems; it does not mean you
are destined to develop diabetes.
These genes do not cause diabetes — they only
make you more likely to develop the disease than a
person who does not have them. And, even with the
genes, you will develop diabetes only under certain
circumstances. For example, if you have the genes
that make you susceptible to developing diabetes and
you are inactive and have been overweight for most
of your life, your chances of getting diabetes are
high. On the other hand, if you know you have the
diabetes-related genes but you exercise regularly
and have never been overweight, you will probably
not get diabetes. The knowledge of your
susceptibility gives you a great deal of control
over whether or not you will get the disease. You
can lower those chances greatly by losing weight if
you are overweight and increasing your level of
activity.
Symptoms
The symptoms of type 2 diabetes tend to come on
very gradually and often go unnoticed until problems
develop. See your doctor immediately if you have any
of the following symptoms:
- Frequent urination
- Unusual thirst
- Extreme hunger
- Unexplained weight loss
- Extreme fatigue
- Blurred vision
- Irritability
- Tingling or numbness in the legs, feet or
hands
- Frequent infections of the skin, gums, vagina
or bladder
- Itchy skin
- Slow healing of cuts and bruises
Screening for Diabetes
If you have any of the symptoms listed above,
talk to your doctor about being tested for diabetes.
You can prevent many of the symptoms and
complications that can result from diabetes when you
discover it at an early stage and begin treatment.
Your doctor may suggest that you participate in a
nationwide research study that is looking for ways
to help people like you avoid getting diabetes. This
study is called the Diabetes Prevention Program. Ask
your doctor how you can join. As a participant in
the study you will receive free physical
examinations and work with a team of doctors and
nurses who will help you stay in good health.
If you do not have any symptoms of type 2
diabetes, you should be tested for the disease if
you meet any of the following recommendations from
the Expert Committee on the Diagnosis and
Classification of Diabetes Mellitus. See your doctor
about screening if you:
- Are age 45 years or older (If the results are
normal, testing should be repeated at 3-year
intervals.)
- Are obese
- Have a first-degree relative with diabetes
- Belong to a high-risk ethnic group (eg,
African-American, Hispanic, Native American)
- Have given birth to a baby weighing more than
9 pounds or have been diagnosed with gestational
diabetes
- Have hypertension
- Have a high-density lipoprotein cholesterol
level of 35 mg/dL or a triglyceride level of 250
mg/dL or above
- Had impaired glucose tolerance or impaired
fasting glucose on previous testing
Making the Diagnosis
Because the primary sign of diabetes is a high
level of glucose in the blood, doctors use blood
tests to diagnose the disease. If you are diagnosed
with diabetes, you will have frequent blood tests to
determine if your treatment is effective in
maintaining your glucose level in the healthy range.
It can be difficult to precisely diagnose diabetes
because your blood glucose level can be affected by
factors such as your general state of health and
medicines you may be taking. For this reason, your
doctor will evaluate more than one blood test before
making a diagnosis.
The blood tests your doctor may recommend if he
or she suspects you have diabetes or are at risk of
getting it are explained below.
Fasting Glucose Test
A fasting plasma glucose test is a blood test
that measures your glucose level after you have gone
without eating anything for 10 to 16 hours, usually
overnight.
The results of a fasting glucose test may
indicate the following:
- A glucose level of less than 110 milligrams
per deciliter (mg/dL) is considered normal.
- If your glucose level measures 126 mg/dL or
more on two or more fasting glucose tests, your
doctor will tell you that you have diabetes.
- If your glucose level is 110 or more but less
than 126 mg/dL or if it is normal but you have
symptoms of diabetes, your doctor will recommend
another blood test — probably glycosylated
hemoglobin test or an oral glucose tolerance
test. You may have a condition called impaired
glucose tolerance.
Oral Glucose Tolerance Test
To prepare for this test you will be asked to eat
a diet rich in carbohydrates (foods such as whole
grains, dried beans and vegetables) for two or three
days and then to fast overnight (or for 10 to 16
hours) before the test.
Here is what to expect when you have an oral
glucose tolerance test:
- You will first be given a fasting glucose
test.
- You will be asked to drink a sweet-tasting
glucose liquid. Samples of your blood will be
taken five times over a period of three hours.
(You will be asked to lie or sit quietly during
this time because any amount of exercise can
lower your glucose level, which would change the
results of the test.)
The results of an oral glucose tolerance test may
indicate the following:
- If your glucose level is less than 140 mg/dL
at two hours, this is normal.
- If your glucose level measures 200 mg/dL or
more at two hours your doctor will tell you that
you have diabetes.
- If your glucose level is 140 mg/dL or more but
less than 200 mg/dL at the end of the test, you
have a condition called impaired glucose
tolerance.
- If you have impaired glucose tolerance, you
are at high risk of developing diabetes. Your
doctor will recommend losing weight if you are
overweight and exercising regularly to help
prevent or postpone symptoms of the disease. He
or she also will recommend regular testing of
your blood glucose level to make sure it stays
at a safe level.
Medicine
Many people who have type 2 diabetes can keep
their blood glucose level in a healthy range by
following their doctor's recommended eating plan, by
losing weight, and by exercising regularly. If these
measures are not effective for you, your doctor may
recommend that you also take medicine to help lower
your glucose level.
You must keep in mind, however, that taking
diabetes medicine doesn't mean that you can give up
your diet and exercise program; the medicine is
designed to work with your diet and exercise, not to
replace them. Make sure your doctor knows of any
other medicines you are taking because they may
reduce the effectiveness of your diabetes medicine.
Your treatment depends on how long you have had
diabetes, how high your blood glucose level is, what
other medicines you are taking, and your general
state of health. Following are descriptions of the
different types of medicine that are used for
treating diabetes:
Pills that lower blood glucose level:
There are now several different types of pills
available that lower glucose levels, and doctors
expect that many more glucose-lowering drugs will be
developed in the future.
If you take too much of some glucose-lowering
medicines, your blood glucose level can drop too
low. This condition — called hypoglycemia (for
"low level of glucose in the blood") —
can be serious. It can make you feel tired,
confused, shaky, hungry or sweaty.
Other possible side effects of glucose-lowering
pills include loss of appetite, upset stomach,
diarrhea, rashes or itching. Make sure you tell your
doctor immediately if you feel unusual in any way
after you start taking the medicine.
Your blood glucose level also can drop if you
take too much insulin, if you do not eat enough or
you delay or miss a meal, or if you exercise too
much. You may have this reaction shortly before you
have a meal, while you are exercising, right after
exercise, or up to 12 hours later.
Make sure you know the following signs of an
insulin reaction so you can recognize them if they
occur and act immediately. People have different
symptoms, and your own symptoms may change over
time. For this reason, it is important to be
familiar with the way you feel when your glucose
level is too low. You may feel any of the following:
- Shaky
- Sweaty
- Dizzy
- Hungry
- Irritable
- Confused
- Angry
- Tired
As soon as you feel an insulin reaction coming
on, stop what you are doing and test your glucose
level. If the level is low (below 70 mg/dL),
immediately take glucose tablets (which you should
always carry with you) or drink a small amount of a
sweet beverage (such as fruit juice) or eat a sugar
candy. If you are not able to test your glucose
level, the safest thing to do is to eat or drink
something sweet — slowly and in small quantities
— until you feel normal. If your glucose is not
low, eating will cause your glucose level to go up
only slightly. Your doctor will give you more
specific guidelines.
Sulfonylureas: Until recently, a class of
drugs called sulfonylureas were the only pills
available for treating diabetes. Sulfonylureas
stimulate your pancreas to make more insulin (the
hormone that helps glucose get inside cells). These
pills also make your tissues more sensitive to the
effects of the insulin. This, in turn, lowers your
glucose level.
Sulfonylureas sometimes stop working after a few
months or years. The pills may not work as well if
you gain weight or if your body is under stress —
such as when you have a bad infection, a heart
attack or an operation. Stress can cause your blood
glucose level to go up. If this happens, you may
have to take shots of insulin for a while until your
glucose level is under control.
Metformin hydrochloride tablets: Metformin
is a new type of diabetes pill that reduces your
glucose level by preventing the liver from producing
glucose. The drug also helps your cells take in
glucose and use it.
Acarbose: Another glucose-lowering
medicine called acarbose is a pill that you take
with the first bite of a meal. This medicine limits
the rise in glucose level that usually occurs after
you eat.
Insulin: Although your doctor is likely to
recommend pills as your first diabetes medicine, he
or she may decide to put you directly on insulin
shots. Or you may need to take both pills and
insulin. You are more likely to need insulin or a
combination of insulin and pills if your blood
glucose level is difficult to control. You may need
to try different combinations to see which works
best.
If you need insulin, ask your doctor to show you
how to give yourself shots and tell you exactly how
often you should take them. You should eat about the
same amount of food every day at approximately the
same time to maintain the delicate balance between
the level of insulin and the level of glucose in
your blood.
