Learn About Diabetes

According to the International Diabetes Federation, an estimated 194 million people worldwide have diabetes.  In 1985, there were an estimated 30 million people with diabetes worldwide.  The number of people with diabetes is expected to increase to at least 333 million by 2025.  The World Health Organization estimates that by 2025, there will be more people with diabetes in the world than the entire population of the United States.

The American Diabetes Association reports that 20.8 million people in the United States have diabetes.  About 14.6 million people have been diagnosed with the disease; another 6.2 million people are unaware that they have it.

Diabetes is the sixth leading cause of death in the United States, responsible for over 224,092 deaths each year.  The number of adults diagnosed with diabetes, including women with gestational diabetes (diabetes that develops during pregnancy) has increased 61% since 1991 and is projected to more than double by 2050.  Overall, the risk for death among people with diabetes is about two times that of people without diabetes.

What is Diabetes?
Disease Stages
Hypoglycemia Unawareness
Secondary Complications
Treatments

What is Diabetes?

People with diabetes have a shortage of insulin or a decreased ability to use insulin.  Insulin is a hormone that allows glucose (sugar) to enter cells and be converted to energy.  When diabetes is not controlled, glucose and fats remain in the blood and, over time, damage vital organs.  Diabetes can cause many secondary complications which are debilitating and deadly.  People who have diabetes, but who have not been yet diagnosed with it, are particularly at risk for these secondary complications.

Diabetes results most frequently from one of two basic problems. In type 1 diabetes, the body has mistakenly destroyed its own islet cells of the pancreas, which are the cells that produce insulin in response to glucose levels in the blood.  Type 1 most often appears during childhood or adolescence.  In type 2 diabetes, the body has not destroyed its cells, but rather, cannot effectively use the insulin they are producing.  Type 2 accounts for about 90% of diabetes cases and most often appears among people older than 40.  However, it is now being found at younger ages and is even being diagnosed among children and teens.

In both types of diabetes, the body has minimal or no ability to control its blood glucose levels without adequate insulin production. Blood glucose levels rise dangerously, causing one or more of the following symptoms: Excessive thirst, Frequent urination, Hunger, Weight loss, Blurred vision, Itching, and Skin infections in addition to a variety of others.

Diabetes can lead to blindness, heart attack, stroke, kidney failure, nerve damage and amputation, among other complications.

Type 1 Diabetes

People with type 1 diabetes have no functioning islet cells. They must inject insulin in balance with a healthy diet and exercise, attempting to manually compensate for what the pancreas can no longer do.  Because a variety of external factors, such as stress, exercise and diet, impact blood glucose levels, inevitably a person will experience high or low blood sugars.

High blood sugar is known as "hyperglycemia," and low blood sugar is known as "hypoglycemia."

Type 2 Diabetes

Type 2 diabetes typically results when predisposed people become overweight and sedentary. In type 2 diabetes, a person's immune system has not attacked and destroyed their islet cells. Rather, their body has become resistant to effectively using the insulin its pancreas produces. Type 2 diabetes used to be most commonly diagnosed in adults over the age of 40 who are overweight. However, given today's sedentary lifestyles and high-fat snacks and diets, more children are being diagnosed with type 2 diabetes.

A person with type 2 diabetes may be able to minimize or eliminate the need to take oral medications or insulin injections by losing weight, eating a healthy diet and becoming more active. Type 2 diabetes is often controlled strictly by diet, oral medications that work the pancreas to produce or use insulin more effectively, and/or by losing weight and becoming more active.

Type 2 diabetes is the more prevalent form of diabetes in America. Over 16 million Americans have diabetes. Of this figure, approximately 1 million have type 1 diabetes; the remainder are type 2 diabetics. However, of the $100 billion that is spent annually to manage and treat diabetes, over half of the costs are incurred by people with type 1 diabetes. This demonstrates the substantial health threat of type 1 diabetes.

How can I tell if I have Type 1 or Type 2 diabetes?

Your doctor can tell you if you have type 1 or type 2 diabetes. However, there are some general tendencies.

Your are more likely to have type 1 diabetes if:

• You were diagnosed with diabetes before the age of 30 years;

• You were very ill when you were diagnosed;

• You have required insulin injections since the time of diagnosis.

You are more likely to have type 2 diabetes if you:

• Were diagnosed with diabetes after the age of 45;

• Didn't know that you were ill and the diabetes was discovered in conjunction with a doctor visit for other reasons;

• Don't need insulin injections (although many with type 2 diabetes do require insulin injections), and

• Are overweight.

Please keep in mind that these are generalizations and your doctor can tell you for sure which type of diabetes you have if you are unsure.

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Disease Stages

Diabetes can progress through a series of stages:

Nondiabetic - In this stage, a person may have the propensity to develop diabetes, but their metabolism has not yet been detected.

Prediabetes - Before people develop type 2 diabetes, they usually have prediabetes.  Prediabetes occurs when a person's blood glucose levels are higher than normal but not yet high enough to be diagnosed as diabetes.  This used to be referred to as impaired glucose tolerance or impaired fasting glucose tolerance.

Disease

- Diabetes may be identified as a disease when specific abnormal blood sugar levels occur.  According to the American Diabetes Association, an abnormal blood sugar level is defined as 126 mg when someone has been fasting (not eating for a long period of time) or 200 mg after meals. Sometimes, secondary complications are already present because diabetes lies undetected for so long.  For example, a person may have the early stages of eye, nerve, kidney or heart disease. 

Disease complications - After some years, secondary complications may advance.  In the worst case, they can result in amputation, blindness or kidney failure.  Loss of symptoms of low blood sugars called hypoglycemia unawareness is also possible.  This can seriously affect one's work and safety since the person may not be able to move or think clearly without realizing it.  Unconsciousness is even a possibility.

Disability - If diabetes is extremely difficult to regulate or if complications prevent someone from working or doing their daily activities, diabetes becomes a disability.

Not all people with diabetes will experience all of these stages and not all people with diabetes will progress through each of these stages in the order listed above.

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Hypoglycemia Unawareness

Eventually, people with diabetes who take insulin will experience hypoglycemia (low blood sugars) from time to time since it is nearly impossible to balance food, activity and insulin perfectly.  Frequent or severe low blood sugars are usually caused by missing meals, taking too much insulin, or exercising more than usual.  Sometimes, it is impossible to determine what caused an episode.  Usually, a person with mild hypoglycemia notices the symptoms and can treat the condition with food or drink. 

However, some people (especially those with type 1 diabetes) may no longer experience these symptoms and they are not aware that their blood sugar is dropping (this is called hypoglycemia unawareness).  Because they can not tell that their blood sugar is decreasing, these people do not know that they need to treat themselves.  If their blood sugars continue to fall, their brain may be affected.  A person that is experiencing hypoglycemia unawareness may:

• be unable to think clearly,

• become uncoordinated, and

• lose consciousness.

They will require assistance from another person in order to survive.

For people who are “unaware,” daily life is more difficult because they never know if, and when, they will experience hypoglycemia unawareness.  In an attempt to prevent it from occurring, the person may allow their blood sugar levels to run too high (which can cause secondary complications). Or, they may become fearful of daily activities, such as driving, watching their children, or being alone.  Family, friends, and coworkers are equally concerned.

If you have diabetes and experience hypoglycemia, you can tell your family, friends, and coworkers what symptoms to watch for and how they can assist you if you need help.  If they notice that you don't seem to be thinking clearly or become uncoordinated, tell them to let you know they are concerned and ask them to help you get what you need to treat yourself.  Also let them know how to help you if you become unconscious.

People with diabetes can work closely with their providers to closely monitor their diabetes management program so that their glucose levels are controlled in a safe way.  For many people with diabetes, it is very helpful to check blood glucose levels frequently and administer insulin accordingly to try to prevent episodes of both hypoglycemia (low blood sugars) or hyperglycemia (high blood sugars).

The DCCT Trials illustrated that intensive insulin management can help people with type 1 diabetes better control their blood sugar levels.  However, some people practicing intensive insulin management experience at least one episode of hypoglycemia.  If you have have experienced one episode of severe hypoglycemia or if you are unaware that your blood sugar drops, be sure to monitor your blood sugar regularly, wear a medical alert chain or bracelet, and carry a glucagon injection with you - this could help save your life.  If you experience episodes of hypoglycemia unawareness, you may want to consider having a pancreas transplant or islet transplants.  Our experience has shown that, in most cases, both pancreas and islet transplants can help resolve hypoglycemia unawareness.

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