Diabetes - You Can Take Control

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Neal Shanblatt, M.D., Internist at Saint John's Health Center.

About 5 million people in the U.S. have diabetes and don't know it, so it's important to get tested. The good news is that most people with diabetes have Type 2 and do not require insulin injections. Healthy eating, exercise, and losing weight may be enough to control the problem. When these treatments are not sufficient, several types of oral medications are effective. Insulin therapy is needed only for the most severe cases.

The two types of diabetes differ in their causes and their treatments. Normally, the pancreas makes insulin, which is required to control the blood glucose (sugar) level. Your body requires glucose as its main energy source, and its level needs to be closely controlled. Either too much or too little glucose can be dangerous.

In Type 1 diabetes, the insulin producing cells of the pancreas deteriorate because of an immune reaction. As a result, the body does not have enough insulin, and blood sugar levels get out of control. Type 1 diabetes is always treated with insulin injections.


The pancreas makes plenty of insulin in Type 2 diabetes, but the problem is insulin resistance, usually due to obesity. The body cannot efficiently use the insulin that it is producing. This can often be overcome by diet changes and weight loss. If the blood sugar is not well controlled with these lifestyle changes, diabetes pills can help correct the problem. As a last resort, insulin therapy may be needed.

Type 2 diabetes used to be called adult-onset diabetes or non-insulin dependent diabetes, because it rarely occurred in children, and it rarely required insulin. However, because childhood obesity is becoming more common, more children have been affected by this type of diabetes. For this reason, and because some patients do require insulin therapy, the old names were confusing. Therefore, the name Type 2 diabetes is now preferred.

Type 1 diabetes was formerly called juvenile diabetes or insulin dependent diabetes because it most commonly starts in childhood and always requires insulin therapy. However, it can begin in early adulthood as well.

Make sure you get tested for diabetes. Diabetes is a dangerous disease, but it is one that you and your doctor can control.

Dr. Shanblatt specializes in internal medicine at Saint John's Health Center. As an internist and primary care physician, his interests include preventive medicine, diabetes, hypertension, and cholesterol management.