Diabetes-LEWAC

Diabetes
by Glen R. Smith, M.D., Ph.D. Internal Medicine/Endocrinology
Email: hwellness@aol.com
135 Grant Street, Buffalo, New York 14213, Telephone: 881-4300, Fax: 881-5300
Office hours Monday – Friday 9 AM – 5 PM

Diabetes, is it in your genes? Or is it the environment? Before I answer both of these questions, let’s define diabetes. Diabetes is a chronic disease that is caused by the pancreas’ inability to produce enough insulin, or any insulin, or the body’s resistance to insulin. Let’s also establish this point: The body produces its own insulin. In fact, it’s the organ we call the pancreas that produces insulin.

Here’s how it works: We consume food in the form of carbohydrate, fat, protein, etc. The body processes this food and the carbohydrate is converted to glucose (sugar). This is a good thing, because we need glucose, which is fuel for our body. This fuel gives us energy to walk, talk, think – in other words, move our body parts.

Some sugar is good, more is not better. When too much sugar (glucose) gets into the system, the burden is on the pancreas to produce insulin to bring the glucose down. Many years of overworking the pancreas can deplete its insulin-making capacity, causing the pancreas to stop producing the insulin necessary to handle all of the excess sugar in the body. As a result, many people must take 1) medication and/or 2) insulin injections to put insulin back in circulation in the body.
You may say, “but I only have a little sugar.” You must take this little bit of sugar seriously. I hear patients say, “I was told that I am a borderline diabetic.” I say here and now. There is no such thing as a borderline diabetic. That’s like saying – you are a little bit pregnant. You are or you are not!! You need to understand and know your numbers and know what is normal.

Using a glucometer, you should check your blood glucose level at least 2 times a day if you are a diabetic. Your fasting blood glucose (before you eat breakfast) should range between 80 – 110. Two hours after a meal (usually evening after 5:00p.m.), your blood glucose should be around 140. You might ask, “Why is that?” I am so glad you asked. At night when you are asleep you are not eating carbohydrates. Even though you are not eating carbohydrates, your body is using some of its stored glucose to keep you alive and functional. So by the time you wake up in the morning your glucose is expected to be lower than when you are eating. On the other hand, after eating, the glucose rises according to the amount of carbohydrates you eat. Remember, most people’s largest meal is at suppertime. Normally, insulin rises as glucose rises. This is necessary to bring the elevated glucose down. Under normal conditions, by two hours after eating, the glucose should come down to 140 or less.

You should record your blood glucose and take the recorded numbers to your doctor at each visit. Every diabetic should also have what is called a hemoglobin AlC done at least every six (6) months. The goal is less than 6. This is a blood test your doctor will send you to the laboratory to get.

Now that you have a brief overview, I want to make you aware of the two main classifications of diabetes.
Diabetes has been classified into two main groups, namely: Type 1 and Type 2 diabetes. There are also other types, such as gestational diabetes which shows up during pregnancy but may not persist after delivery.

TYPE 1 DIABETES
Type 1 diabetes is responsible for about 5-10% of all diagnosed diabetes and is one of the most common chronic illnesses in children. About 30,000 new cases of Type 1 diabetes occur each year in the United States and about 40% of these persons are younger than age 20. The highest incidence of Type 1 diabetes seems to occur in white populations. The age of onset peaks around 10-14 years and seems to be peak slightly earlier in young girls. It is to be noted that some patients develop Type 1 diabetes late in life. In this type of diabetes, the individual produces only limited amounts of insulin and eventually must depend on insulin therapy to sustain life.

The cause of Type 1 diabetes is a failure of the beta cells of the pancreas to produce insulin. The specific cause of this failure is unknown, but some factors that may influence it are: viral infection; genetic susceptibility to the disease; inflammation and autoimmune problems (where the body attacks itself).

TYPE 2 DIABETES
About 90-95% of people with diabetes have Type 2. Until recently, this was seen mostly in people over 30 years of age. As a result of children and adolescents becoming more obese and getting less exercise, we are seeing a dramatic rise in Type 2 diabetes in these groups. This now accounts for about 8 – 45% of all new cases of diabetes in children.

Diabetes imposes a tremendous burden on the population and on the health care system. The prevalence of diabetes is increasing so rapidly that it is now seen as a national epidemic. There are over 19 million people in the United States with diabetes and close to one third do not know that they have it. The cost to the health care system to manage people with diabetes and its complications is estimated at close to $132 billion per year. This represents 7% of the health care budget. Many people believe that diabetes is just having “sugar.” Diabetes is far more than a problem of “sugar.” It affects almost every system in the body, causing or contributing to heart attack, stroke, high blood pressure, high cholesterol, blindness, amputation, impotence, depression, skin & stomach problems and may even play a role in Alzheimer’s disease.

Consider these important facts which underscore the seriousness of the diabetes epidemic:
Over the next 24 hours:

2,200 diabetics will be newly diagnosed;
512 diabetics will die as a result of their diabetes;
66 diabetics will go blind (diabetes is now the most common cause of blindness);
77 diabetics will be diagnosed with end-stage kidney failure;
153 diabetes-related amputations will occur (it is the most common cause of non-traumatic leg amputation).

Heart disease and stroke are two to four times more common in people with diabetes. A higher incidence of diabetes is seen in Native Americans, African Americans, Hispanics, Asians and Pacific Islanders. We are not exactly sure why this is so. However, there seems to be a relation to genetics (“runs in the family”), obesity and lower socio-economic conditions.

This article is simply an introduction to diabetes. Remember: Knowledge is power; wisdom is applying that knowledge. Take charge of your health. Ask questions. Be in partnership with your doctor. You are a major player on the health care team. Be well and be informed.