Diabetes Is Dangerous and Often Silent

Armen Hareyan's picture
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Symptoms of Diabetes

The American Diabetes Association estimates there are 17 million Americans with diabetes: nearly 6 percent of the U.S. population. More troubling is the fact that half of them don't know they have it.

Diabetes is a terribly destructive disease. It silently destroys circulation to the heart, brain, kidneys, legs, eyes and skin, increasing the risk of heart attack, stroke and kidney failure. More than 60 percent of non-traumatic amputations are due to diabetes and it is the leading cause of blindness in the adults 20 to 74.

About 90 percent to 95 percent of those with diabetes have type 2, which typically takes decades to cause symptoms. Many people have heard the "classic" symptoms of diabetes: increased thirst, increased urination, hunger and weakness, but these are symptoms of type 1 diabetes which is most commonly seen in children and which is a very different disease from type 2. Because most diabetics have no symptoms, it is important to understand what to look for.

Type 1 diabetes, formerly called insulin-dependent or juvenile diabetes, typically starts in childhood. Type 1 diabetes results from the immune system attacking and destroying the pancreas cells that produce insulin which controls blood sugar levels. Although type 1 diabetes is genetically based, it is not inherited from parents as other traits would be.

Symptoms of type 1 diabetes are increased thirst, fatigue, weight loss, increased urination, hunger and blurred vision. Left untreated, type 1 diabetes causes the blood sugar to rise and produce acids which can cause nausea and vomiting, abdominal pain, loss of consciousness and even death. Type 1 diabetes is treated with insulin injections, as it does not respond to pills. Type 1 diabetics must be rigorous in their diet and insulin treatment to avoid hypoglycemia or low blood sugar, which can result in coma and death.

While type 1 is not a hereditary illness, type 2 diabetes is more common in those who have family members with a history of the disease. People with a parent or sibling with type 2 diabetes have a 40 percent chance of developing it themselves.

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Unlike type 1 diabetics, type 2 diabetics actually make enough insulin, but their bodies don't produce it at the right time and cannot effectively use the insulin to control blood sugar levels. Normally, the pancreas responds to eating by producing a surge in insulin. Early in type 2 diabetes, the normal surge in insulin does not occur and blood sugars rise too high after eating. This is called post-prandial hyperglycemia. After a few hours, the blood sugar returns to normal. After some years, the body's natural ability to get the blood sugar back down to normal is lost.

Type 2 diabetes usually does not cause symptoms. Eventually it increases the chance of yeast infections and slows healing of wounds, particularly on the feet. Very high blood sugars can cause sluggishness, blurred vision and occasionally double vision.

Because symptoms occur late, doctors look for diabetes before it causes damage. Doctors no longer test urine to look for diabetes because by the time sugar shows up in the urine the diabetes often is advanced. Typically a blood sugar is checked after an 8- to 12-hour fast when it should be less than 110. Unfortunately, diabetes begins to damage the system in the early stage when fasting blood sugar is normal but it is too high after eating. Often diabetes has been present for 10 years by the time the fasting sugar becomes abnormal.

Type 2 diabetes is caused by being overweight, not specifically by consuming too much sugar. Early humans had to store extra calories for times of famine. Some believe the gene that allows us to store extra calories may be the reason for the increased incidence of diabetes in modern America, where more than half the population is overweight. Type 2 diabetes is occurring more often in adolescents because of the increase in obesity. This is a serious problem. Without normalizing blood sugars, these teenage diabetics are at increased risk of complications in their 40s. The good news is that just as being overweight causes diabetes, losing and maintaining normal weight can stop diabetes and prevent the related complications.

Everyone over age 40 should have a fasting blood glucose about once a year. Overweight people and those with a family history of diabetes should probably be tested earlier than age 40. The goal in treating diabetes is to prevent complications. Many doctors now are looking at the blood sugar after eating to detect diabetes earlier, particularly in cases where diabetes runs in the family.

Everyone should try to maintain a normal weight through proper diet and exercise, but it's particularly important for those with a family history of type 2 diabetes. Those at risk should ask their doctors about screening tests for diabetes including whether testing for elevated blood sugar after eating would be appropriate.

For more information go to the American Diabetes Association Web site at http://www.diabetes.org/ or The National Institute of Diabetes, Digestive and Kidney Diseases at http://www.niddk.nih.gov/ online.

Information about type 1 and type 2 diabetes, as well as diabetic-related blindness and kidney diseases also can be found on the Penn State Milton S. Hershey Medical Center Web site at http://www.hmc.psu.edu/healthinfo/d/index.htm online.

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