According to the latest government statistics, diabetes affects almost 26 million people or 8.3% of the U.S. population. Unfortunately, more than a quarter of diabetics are undiagnosed. Even if you don’t have diabetes, take note: 35% of adults 20 years or older have prediabetes, a condition that leads to diabetes and is largely preventable with dietary & lifestyle changes.
With November marking the observance of American Diabetes Month, now is a good time to better understand this disease and what you can do to lower your risk of developing Type 2 diabetes.
There’s another good reason why now is a good time to understand diabetes – the cost of health care is a key issue in this month’s presidential election. A person diagnosed with diabetes pays 2.3 times more for medical care than a non-diabetic person. In 2007, the total costs of diagnosed diabetes were $174 billion. Reducing the incidence of prediabetes and diabetes is crucial if we want to manage health care costs in the next few decades.
What follows is a three-part series which reviews the factors that increase your risk for developing diabetes and prediabetes. Next, the dietary and lifestyle behaviors you can adopt to reduce your chance of developing diabetes are identified. Then, the nutritional supplements that play a role in the treatment of diabetes are reviewed.
What is Diabetes?
A hallmark of diabetes is elevated blood glucose levels as a result of the body not producing enough insulin, not properly using insulin or both.
When we eat foods, our body breaks down most carbohydrates into a simple sugar called glucose. Glucose is the fuel that our muscles, fat and liver cells use as energy. In order for the glucose to be used or taken up by cells, insulin is required.
In a healthy functioning body, the rise in glucose signals the pancreas to produce and release insulin. This feedback mechanism is tightly regulated by the body so that normal blood glucose levels are below 100 mg/dL.
In the most common type of diabetes (Type 2), the body’s cells become resistant to insulin. This means that more and more insulin is required to encourage glucose to enter cells. Over time, the insulin-making cells get exhausted and start to fail. When this occurs, blood glucose levels rise. Untreated, elevated blood sugar levels can cause harm to the cardiovascular system, eyes, kidneys and nerves.
What is Type 1 Diabetes?
Type 1 diabetes used to be called juvenile-onset diabetes because the vast majority of cases occur in children and young adults.
This form of the disease is also referred to as insulin-dependent diabetes mellitus (IDDM) because Type 1 diabetics rely on insulin delivered either by injection or a pump. Only 5-10% of all diabetics are Type 1.
While the exact cause of Type 1 diabetes is unclear, researchers believe that immune cells attack the pancreas. The result is that the body makes little or no insulin.
Presently, a cure for Type 1 diabetes is not available but research is investigating several approaches including pancreas transplantation, islet cell transplantation (the cells that produce insulin), artificial pancreas development and genetic manipulation (a human insulin gene inserted into fat or muscle cells that don’t normally produce insulin).
What is Type 2 Diabetes?
Type 2 diabetes used to be called adult-onset diabetes because the vast majority of patients were adults. But, this term is outdated because Type 2 is becoming more common in children and adolescents. In fact, the rate of diabetes has increased dramatically to about 1 in every 400 children and adolescents. About 90% to 95% of diabetics are Type 2.
Type 2 diabetes is also referred to as non-insulin dependent diabetes mellitus (NIDDM) as these patients don’t typically require insulin injections to lower blood sugar. Diet, insulin and oral medications can be used to lower blood glucose levels.
Type 2 diabetes and the symptoms associated with the disease develop slowly. As a result, many people don’t realize they have the disease. Type 2 diabetes occurs when the body’s cells become insensitive to insulin. Obesity and physical inactivity are major contributors to this form of diabetes.
In response to carbohydrates that are ingested and broken down into glucose, the body secretes insulin. The Western diet, which features simple carbohydrates (e.g., sweetened beverages, white bread, cereal, bagels, pasta, white rice, chips, cookies, candy) forces the pancreas to pump more insulin so that cells can use glucose. Over time, more insulin is required while cells are increasingly unable to use glucose. The result is that excess glucose stays in the blood stream, elevating blood sugar levels.
By making modifications to diet and lifestyle, Type 2 diabetes can often be reversed and even prevented.
What is Gestational Diabetes?
Gestational diabetes is when a pregnant woman develops insulin resistance during her pregnancy. The placenta releases hormones that help the fetus grow. But, these hormones also block the action of insulin. As a result, more and more insulin is needed. Glucose builds up in the blood as the mother’s body has a more difficult time using insulin.
The rate of gestational diabetes is from 2% to 10% of pregnancies. The risk is higher in obese women and occurs more frequently in African American, Hispanic/Latino, American Indian women. Women with gestational diabetes have a 35% to 60% chance of developing the disease in the next 10 to 20 years.
What is Prediabetes?
Prediabetes, as the name implies, is a condition that precedes Type 2 diabetes. A hallmark of this condition is elevated blood sugar levels. Without making changes to diet or lifestyle, a person with prediabetes is much more likely to develop Type 2 diabetes than someone without elevated blood sugar levels.
How is Diabetes Determined?
Diabetes can be determined by three simple blood tests: fasting plasma glucose test (FPGT), oral glucose tolerance test (OGTT) and A1C.
FPGT. With this test, blood glucose levels are measured after a fast. A normal blood sugar level should be 100 mg/dL. An abnormal reading (greater than 100 mg/dL) is considered impaired fasting glucose or IFG.
OGTT. This test is usually administered to pregnant women to test for gestational diabetes. After a fasting blood glucose level is determined, the woman is instructed to drink a sweet liquid. Glucose readings are monitored over a period of time. A normal reading is 140 mg/dL. An abnormal reading (greater than 140 mg/dL) is considered impaired glucose tolerance or IGT.
A1C. This test measures average blood glucose control over the past 2 to 3 months. Hemoglobin is a protein found in red blood cells that carries oxygen. In the blood cells, hemoglobin “hooks” up with glucose (a process called glycation). About 5% of all hemoglobin attaches to glucose. In a person with diabetes, extra glucose enters red blood cells, and as a result, a higher amount of glucose is glycated. The A1C measures blood sugar control over the past 120 days or the lifespan of a red blood cell. A normal A1C is 5.7%. A reading over 5.7% but less than 6.5% is considered prediabetic; over 6.5% is considered diabetic.
Excess Sugars = Accelerated Aging
Here’s another reason why you should be concerned with consuming excess sugar – it promotes fine lines and wrinkles! When glucose and fructose link amino acids in collagen and elastin (proteins that support the dermis) they produce advanced glycation end products or “AGEs” that literally age you. AGEs cause the protein fibers to become stiff and more brittle so they break. Meaning your skin will sag and start to look old!
Symptoms of Diabetes
In a Type 1 diabetic, the symptoms associated with diabetes can emerge very quickly. For a person with Type 2 diabetes, the symptoms may appear gradually and therefore are less noticeable.
A person with diabetes may exhibit some (or none) of the following symptoms:
- Frequent urination (an attempt by the body to remove excess sugar)
- Excessive thirst (due to increased urine output)
- Unexplained weight loss (Type 1) or weight gain (Type 2)
- Extreme hunger
- Sudden vision changes
- Tingling or numbness in the hands or feet
- Feeling tired
- Very dry skin
- Sores that are slow to heal
- More infections than usual
Risk Factors for Diabetes
The risk for developing Type 1 diabetes is not well understood although this type of diabetes occurs more often in Caucasians than in other ethnic groups. A combination of factors including autoimmune, genetic and environmental may play a role in the development of Type 1 diabetes.
While some of the risks associated with developing Type 2 diabetes are within your control others are not. In some cases, increased risk is associated with a combination of genetics (predisposition) and environmental factors (diet & lifestyle).
Some risk factors for developing Type 2 diabetes include the following:
- Impaired glucose tolerance (IGT) and/or impaired fasting glucose (IFG)
- Racial & ethnic groups (African Americans, Mexican Americans, American Indians, Native Hawaiians, Pacific Islanders, Asian Americans)
- Family history of diabetes
- Women who have had gestational diabetes
- Age over 45 years
- Sedentary lifestyle
- Low HDL or “good” cholesterol levels (35 or lower)
- High blood pressure
- High triglycerides (250 or higher)
- Alcohol (more than one drink a day for women; two drinks a day for men)
- Severe psoriasis
To determine your risk of developing Type 2 diabetes, take this short quiz from the American Diabetes Association.
Complications of Diabetes
Diabetes is the seventh leading cause of death in the United States and a major cause of heart disease and stroke. Diabetes can cause serious health complications if blood sugar levels over time are not managed well.
Some of the complications associated with diabetes include the following:
Cardiovascular Disease. Diabetes causes the blood vessels to narrow and harden, a process called atherosclerosis. As a result, the risk for heart disease and stroke is 2 to 4 times higher among people with diabetes. Almost 70% of diabetics age 20 years or older have high blood pressure and use prescription medications for hypertension. Maintaining blood sugar, cholesterol and blood pressure levels lowers your risk for having a heart attack or stroke.
Retinopathy (eyes). Diabetic retinopathy refers to disorders of the retina caused by diabetes. This light sensitive tissue can become damaged by changes in the blood vessels in the back of the eye. Advanced stages of diabetic retinopathy can cause vision loss. Roughly a third of diabetics over age 40 have diabetic retinopathy. Incidence of retinopathy is influenced by blood sugar control, blood pressure levels, length of time with diabetes and genetics.
Nephropathy (kidneys). Diabetes can cause kidney disease by damaging parts of the kidneys that filter out wastes. Keeping blood sugar levels and blood pressure under control lowers the chance of diabetics getting kidney disease.
Neuropathy (nervous system). People with diabetes can develop nerve damage over time throughout their body. Symptoms may be absent or include pain, tingling, numbness, or loss of feeling in the hands, feet and legs. About 60% to 70% of diabetics have mild to more severe forms of nervous system damage.
Not surprisingly, the medical issues associated with diabetes are costly and stressful. But, many of these complications can be avoided or reduced greatly by making changes to diet and lifestyle. Nutritional supplements, like fish oil, also support a healthy diet. For more information, be sure to read our two companion articles, Preventing Diabetes through Diet & Exercise and Nutritional Supplements and Diabetes.
David H. Rahm, M.D. is the founder and medical director of The Wellness Center, a medical clinic located in Long Beach, CA. Dr. Rahm is also president and medical director of VitaMedica. Dr. Rahm is one of a select group of conventional medical doctors who have education and expertise in functional medicine and nutritional science. Over the past 20 years, Dr. Rahm has published articles in the plastic surgery literature and educated physicians about the importance of good peri-operative nutrition.