Diabetes Education

What is Diabetes?
Diabetes affects almost 24 million Americans and people may be at risk and not know it

Diabetes (diabetes mellitus) is a metabolic disorder that affects 23.6 million Americans. The trouble begins when blood glucose levels become elevated. This is due to a lack of sufficient insulin production, or the body failing to recognize and use the insulin properly. Serious organ damage can result from diabetes, especially if left untreated.

With proper care from your diabetes team and yourself, this disease, unlike many other diseases, may be managed and complications can be reduced, delayed or even prevented.

What causes diabetes?

Every time you eat, your body converts food into glucose (sugar) to fuel cells for energy. In order for this process to work, insulin, a hormone produced by the pancreas, must be present to transport glucose from the blood to the cells. In people who produce little or no insulin, glucose builds up in the blood instead. When blood sugar remains too high, headache, blurry vision, dull skin, and frequent urination are sure to follow. What is truly the worrisome issue is that consistently high blood sugar results in organ damage.

There are two major types of diabetes: type 1 and type 2. Type 1 is an autoimmune disorder in which the immune system attacks and destroys insulin-producing beta cells in the pancreas. It's not clear why this cellular genocide occurs, but it's believed that abnormal antibodies, and possibly viral infections, may be involved. Type 1 accounts for 5-10% of diagnosed diabetes, occurring most commonly in children and young adults, and requires daily insulin injections. Without this intervention, the body is forced to break down fats for energy, a process that produces ketones (waste products) in the blood, which can result in diabetic ketoacidosis (DKA), a highly toxic state that can lead to a life-threatening coma.

In Type 2, the pancreas may produce adequate insulin, but for some reason the body ignores it, setting up insulin resistance. In response, the pancreas pumps out even more insulin to force glucose into the cells since the glucose in accumulating in the bloodstream, resulting in elevated blood glucose. This form of diabetes is more common, occurring in up to 90-95% of diabetics and is associated with age, family history, obesity, and certain ethnic groups. The good news is that type 2 is largely preventable — even reversible — with proper care.

While having a sweet tooth isn't necessarily a precursor to diabetes for most people, a sensible diet low in fat and refined sugar does provide resistance. According to Ruchi Mathur, MD, Assistant Professor of Medicine at the Keck School of Medicine, University of Southern California, "It's a matter of smaller portion sizes more than anything else. Some people go to extremes by avoiding starches, but it doesn't work that way." Instead, she recommends limiting simple carbohydrates such as sodas, breads and pastas made from white flour and other highly processed foods. Most people don’t realize that 1 slice of bread or ⅓ cup of cooked rice breaks down into 4 teaspoons – over one tablespoon – of sugar in the bloodstream!

Double the Trouble – Diabetes Complications

More than half those living with diabetes can eventually expect to experience neuropathy, a tingling sensation (or lack of any feeling) in the extremities brought on by insufficient blood flow. In severe cases, especially when coupled with untreated ulceration, bone infection can occur and lead to the need for amputation.

Nephropathy, or kidney disease, is another complication of diabetes that is characterized by the presence of too much albumin (protein) in the urine. Unfortunately, this usually remains undetected until too much damage has occurred, possibly renal failure. However, elevated blood pressure and triglyceride levels are often early warning signs.

According to the American Diabetes Association, 12,000 to 24,000 annual cases of blindness are reported in diabetic patients ranging 20-74 years of age, primarily due to damage to eye vessels by high blood glucose levels. Eventually, lipid infiltration and deformed blood vessels attack and destroy the retina. Approximately 76% of eye damage can be prevented with good blood sugar control.

Awareness is key to the prevention of this disease, especially since the occurrence of diabetes in children and adults is rising on an epidemic scale. Over 3 million people have diabetes now than just two years ago. The American Diabetes Association estimates that by 2025, there will be 50.2 million people with diabetes in the United States (in 2008 there are 23.6 million – 17.9 million are diagnosed and 5.7 million don’t know they have the disease). The World Health Organization estimates that by 2030, there will be 366 million people worldwide with diabetes.

Did You Know?

  • Heart disease and stroke account for about 65% of deaths in people with diabetes.
  • About 73% of adults with diabetes have high blood pressure.
  • Mexican Americans are almost twice as likely and non-Hispanic blacks are almost 50% as likely to develop diabetic retinopathy as non-Hispanic whites.
  • About 60% to 70% of people with diabetes have mild to severe forms of nervous system damage.
  • More than 60% of non-traumatic lower-limb amputations occur in people with diabetes.

In 2005, 46,739 people with diabetes began treatment for end-stage renal disease (ESRD) and in 2002, a total of 178,689 people were living on chronic dialysis or with a kidney transplant. With good blood sugar control people with diabetes can reduce damage to their kidneys by 35-56 percent.

Types of Diabetes

There are three main types of diabetes. Pre-diabetes is also a condition you may want to be aware of.

Marci Sloane, MS, RD, LD/N, CDE, is a registered and licensed dietitian/nutritionist and certified diabetes educator with a degree in Nutrition and Physiology from Teachers College at Columbia University. Marci is the author of The Diet Game: Playing for Life! More about Marci Sloane

The goal of Destination Diabetes is to be a useful and credible resource for the more than 20 million children and adults who have diabetes in the U.S. and their families. Destination Diabetes provides information on a wide range of diabetes health and wellness topics. Articles are written or reviewed by diabetes advisors who have experience in diabetes education.