What is Diabetes?
The energy that we use to live and function comes primarily from the glucose, or sugar, in the food that we eat. The pancreas produces a hormone called insulin, which is responsible for converting that glucose into energy. Diabetes is a serious disease that happens when the body stops converting glucose into useable energy, because the pancreas stops producing insulin, or produces it in insufficient amounts.
Glucose doesn’t just come from sugary foods like candy or soda, or even just from fruits and juices. Breads and cereals, dairy products, and vegetables are all sources of glucose that healthy people are able to convert into energy. But people with diabetes cannot get energy from the glucose in these foods, either. The sugar from food stays built up in the blood instead of being converted into energy, which causes high blood glucose levels, or hyperglycemia.
Hyperglycemia can lead to both short term and long term health issues, including blindness, kidney failure, heart disease, and even amputations. It’s a deadly disease that kills tens of thousands of people each year—it is the seventh leading cause of death in the United States—and plays a contributing or underlying part in the deaths of hundreds of thousands more. Rates of diabetes are currently on the rise all over the world.
There are two kinds of diabetes, type 1 and type 2, and the rates of both forms are currently on the rise all over the world. While type 1 is far less common, and type 2 generally affects adults, both forms are being diagnosed increasingly frequently in children and adolescents.
Though diabetes is serious, and when left untreated, can cause massive and glaring health problems, it is sometimes called “the silent killer” because symptoms can be mild or nonexistant for so long that they go entirely unnoticed until severe health complications occur.
People with diabetes sometimes develop symptoms like extreme hunger or thirst, or drastic and unexplained weight gain or weight loss. Sometimes diabetic people urinate excessively, or feel exhausted all the time. Some people experience changes in their vision or numbness and tingling in the hands or feet—these are serious symptoms that need to be checked out urgently before they lead to blindness or amputation.
If you think you have diabetes, it’s critical to visit a doctor for a diagnosis. They will do lab work to determine whether your blood sugar is high enough to diagnose diabetes. There are several kinds of tests, and a doctor may perform one or several of them, in addition to analyzing your symptoms, before they come to a diagnosis.
The fasting plasma glucose test (FPG) checks your blood sugar after fasting, or having nothing to eat or drink but water, for at least 8 hours. It’s good to do this test in the morning, before you eat breakfast. Your doctor might also perform an oral glucose tolerance test (the OGTT), from which they can determine how your body processes glucose. They’ll test your blood glucose before, and then two hours after, you drink a special sugary drink, and see whether or not your body is processing the glucose into energy. You can also take the A1C test to measure your average blood glucose levels over the course of a two or three months, or take a random plasma glucose test at any time if you have severe symptoms.
Type 1 Diabetes
Type 1 diabetes is the least common form of diabetes, estimated to represent only 5% of all people with diabetes. It used to be known as juvenile diabetes, because it is usually diagnosed in children and adolescents.
Type 1 diabetes differs from type 2 diabetes because it is an autoimmune disease. The immune system of someone with this form of diabetes attacks and destroys the cells in the pancreas that make insulin. As a result, the body doesn’t produce any insulin at all, and people with type 1 diabetes need to take insulin manually, or they will die. Some people take injections daily, while others wear an insulin pump that is constantly attached to their body.
Though diabetes is frequently associated with high blood sugar, or hyperglycemia, low blood sugar is also a risk factor of diabetes, especially with type 1, because you need to calculate exactly how much insulin to take based on activity and food consumption. Taking too much insulin, or exercising too much, can cause your blood sugar to drop, leading to weakness, dizziness, or even more dangerous problems like fainting.
Scientists currently aren’t sure what exactly causes type 1 diabetes, but we are aware of some risk factors and strong correlations, with family history being the strongest indicator. Many people with this form of diabetes have a family history of type 1 diabetes. There may be other triggers, like viral infections or environmental factors, which may be participating in the recent rise of type 1 diabetes, though this link is not yet clear.
Type 2 Diabetes
Type 2 diabetes is by far the most common form of diabetes. It is currently on the rise across the world, with an increasing number of cases being diagnosed even in teenagers and small children, despite the fact that people are typically diagnosed with type 2 diabetes at a later age, and are especially at risk after age 45.
Unlike type 1 diabetes, the pancreas of people with type 2 diabetes does make insulin, but they either don’t make enough of it or the body is not able to use what it does produce well enough. This is called insulin resistance, and the pancreas often produces extra insulin at first to make up for the condition, but in the case of diabetes, is unable to produce enough to keep blood sugar normal. Some people with type 2 diabetes take insulin injections, but in general, there is a much wider range of treatment options than there is for type 1. Many people simply need to lose weight, exercise more, or change their diets. Others take pills that decrease blood sugar levels or help stimulate insulin production.
Like type 1, type 2 diabetes is a chronic, long-term disease. There are some genetic risk factors like family history, but unlike type 1, type 2 diabetes I partly preventable and largely manageable, and often even reversible, just by catching a condition called prediabetes before it develops into full-blown diabetes.
Pre-diabetes is a condition where the blood sugar is higher than normal or healthy, but it is not quite high enough yet to be considered diabetes. For this reason, pre-diabetes is sometimes considered a “pre-diagnosis” of diabetes, and should be taken as a giant warning flag to change your diet and lifestyle. Prediabetes isn’t itself a disease or clinical condition, but rather a medical gray area during which you are at a much higher risk of developing type 2 diabetes, which is a disease.
Prediabetes is incredibly common, affecting nearly 1 in every 3 or 84 million American adults. But it’s also extremely underdiagnosed. It is estimated that 90% of Americans who are prediabetic aren’t even aware that they have the condition. Prediabetes is no less dangerous for the lack of awareness, as it develops into diabetes in a huge percentage of people with the condition within ten years.
Of those who do know that they are affected by prediabetes, nearly half do absolutely nothing to change their risk level. This is a shame, because prediabetes is a reversible condition (unlike diabetes) when certain minor lifestyle and dietary changes are made.
Diabetes that is developed during pregnancy is known as gestational diabetes, and is relatively common towards the middle of pregnancy, between the 24th and 28th weeks. You can be diagnosed with gestational diabetes even if you’ve never had a history of diabetes before, and it doesn’t mean that you’ll still have diabetes after you give birth. Gestational diabetes can typically be controlled with diet and exercise, but sometimes pregnant women do need to take insulin to control the condition.
Though it might be common and easy enough to manage, it’s important to get a handle on gestational diabetes right away. Uncontrolled gestational diabetes can lead to serious health problems for both moms and babies. Diabetic women are at a greater risk of needing C-sections to deliver, in part because babies with high blood sugar are often very large, which can lead to recovery complications and delays for the mother.
Gestational diabetes is also related to blood pressure issues, like preeclampsia and hypoglycemia. Preeclampsia is a high blood pressure condition that can lead to premature births, strokes, or seizures during labor, and can be fatal. Hypoglycemia, or low blood pressure, can also be deadly, and can be developed by infants right after birth if blood sugar is not immediately controlled for.
Are You At Risk?
Aside from your lifestyle, there are certain factors that can put you in greater danger of developing diabetes, and it’s important to be aware of these, to help your doctor get a greater picture of your overall risk. Having someone with diabetes in your family—either type 1 or type 2 – has been shown to put you at increased risk of developing the disease. Different ethnic and racial backgrounds also carry elevated risk: Americans with African, Asian, Latin/Hispanic, Pacific Islander, or indigenous heritage are all at greater statistical risk of developing diabetes.
Older people are also at a greater risk of developing type 2 diabetes, and people are often diagnosed after the age of 45. If you are middle age or older, have a family history of diabetes, or a personal history of gestational diabetes, it’s important to monitor your risk, and keep a close eye on your blood glucose levels and symptoms, so that you can prevent prediabetes before it happens, or reverse it before it develops into the real disease.
There isn’t much to do to prevent your risk of type 1 diabetes, but type 2 diabetes is largely preventable. Though there are factors like age and family background that put you at risk, it is often the combination of these unchangeable risk factors with diet and lifestyle that causes type 2 diabetes to develop. That’s good news, because it means that just by managing your lifestyle, you can prevent type 2 diabetes.
One of the first things a doctor will recommend you do to prevent diabetes is lose weight. Overweight and obese people are at higher risk of developing diabetes, because extra weight makes your body more resistant to insulin. Losing just 5 or 10 percent of your body weight might be all you need to reduce your risk, which means just losing ten or twenty pounds if you weigh 200 pounds already.
Exercise is great as a weight loss aid, but it also reduces your risk of diabetes even if you maintain the same weight. Multiple studies across the world have demonstrated a profound link between exercise and diabetes risk reduction, with some study groups reducing their risk by as much as 80 percent just by exercising a few hours a week. Exercising for 30 minutes a day is a solid goal for diabetes prevention, and you can start out smaller than this if you don’t currently exercise. Do whatever it is that you love to do—it doesn’t have to be the treadmill. Even just walking to and from work or school can help boost your health and reduce your risk.
Because diabetes involves the body’s failure to properly process sugar, what you eat plays a huge role in preventing or developing diabetes. Avoid a high-fat, high-sugar diet, and steer clear of processed foods. Eat less calories overall, and try to consume the calories you do eat in smaller portions throughout the day, rather than in big servings all at once, to help your body moderate your glucose intake.
It’s more fun to focus on what to eat, than what not to eat, so here’s some recommendations. Go for fresh, whole foods as much as possible (this will also help you avoid processed foods), like fruits, vegetables, and whole grains. Fiber is your friend, so go for whole grains rather than refined grains where possible. And if you like vinaigrette salad dressings, you’re in luck: one Arizona State University study found that eating about 2 tablespoons of vinegar before a high-carb meal helped keep blood sugar levels low in people with prediabetes or type 2 diabetes. So if you’re going to eat something high in carbohydrates like pasta, try eating a salad first to lower your risk.
It’s no secret that alcohol and cigarettes are health hazards, and this holds no less true where diabetes is concerned. Quitting smoking and moderating your alcohol intake will both help you prevent diabetes.
Myths & Facts
You would think that a disease so common would be well-understood, but many myths about diabetes still persist. Let’s clear some of them up now.
Myth: Diabetes is just “a touch of sugar”. It’s not a big deal.
Fact: Diabetes kills one person every six seconds, and kills more people across the world than HIV, tuberculosis, and malaria combined. With one death every six seconds, diabetes is now a bigger killer than HIV, tuberculosis and malaria combined. It is a leading cause of blindness, kidney failure, amputations, and nervous system damage.
Diabetes is estimated to cost the global economy nearly $400 billion every year, which represents more than 10 percent of the world’s total healthcare expenses. No matter how cute nicknames like “a touch of sugar” might be, diabetes in any form is a deadly disease and should be taken seriously.
Myth: Overweight people always develop type 2 diabetes.
Fact: Though obesity does increase your risk of developing type 2 diabetes, there are so many other factors that come into play. Most overweight people never develop diabetes, and many people with type 2 diabetes are only slightly overweight or at a completely normal weight. Losing weight can be an important tool in reducing your risk of developing diabetes, or managing it once it develops, but focusing only on weight can lead you to neglect other risk factors like diet, lifestyle, and family history.
Myth: Diabetes is caused by eating sugar
Fact: The myths and facts behind this sugar myth are similar to the myths and facts associated with overweight people and diabetes. There is a correlation between diabetes and high-calorie, high-sugar diets, but there’s no evidence that sugar causes diabetes. Diets that are high in sugar can cause weight gain, which can in turn increase your risk of diabetes, but type 2 diabetes is generally caused by a combination of weight, diet, lifestyle, and genetics, not by diet alone.
Myth: Diabetics can only eat special “diabetes food”
Fact: Diabetics just need to eat healthy food – just like anyone else should! In fact, a perfectly healthy diet for a diabetic person looks similar or identical to a perfectly healthy diet for anyone else without diabetes. People with diabetes should eat lots of fruits, vegetables, and whole grains, and steer clear of fats, sugars, and red meats. Cook for yourself whenever possible to control your diet, and maintain moderate portion sizes of everything that you do eat.
Though there is a market for special “diabetic” foods, they are expensive and can do more harm than good if you’re not careful, or they’re not quite right for your specific condition.
Myth: If you have diabetes, you can’t eat high-carb foods like pasta or bread
Fact: Everything in moderation! Diabetics can still eat bread, cereal, and pasta, and other starchy foods like rice and potatoes. But it’s important to watch your portion sizes to moderate your carbohydrate intake. There is no one-size-fits-all carbohydrate portion size, and every individual has different health needs. Your doctor or nutritionist can help you figure out the right amount of carbohydrates for yourself. Get a head start on figuring this out, so you can start eating the foods you enjoy without fear!
Myth: If you have diabetes, you can’t eat dessert.
Fact: Nobody should be eating loads of candy or cake anyway, and people with diabetes are no different. Desserts are fine in moderation, especially when combined with exercise and an otherwise-healthy diet. It’s true that diabetics do need to be extra careful about their blood glucose levels and sugar consumption. But awareness is key here, and diabetics can eat desserts when they are conscious of their portions and their insulin intake.
Myth: If you need to use insulin with type 2 diabetes, it’s because you’re not taking care of yourself properly.
Fact: Because type 2 diabetes is a progressive disease that often has no symptoms for quite a long time, many people aren’t diagnosed until type 2 diabetes has already become a major problem. Many people are able to manage their type 2 diabetes with diet and exercise alone, but for others, insulin and with other oral medications are necessary to keep blood sugar at safe and healthy levels.
The pancreas of a person with diabetes produces less and less insulin over time, and eventually many people need to take supplimentary insulin and medication in addition to their regular healthcare routine. It’s important to understand that using insulin to regulate your blood glucose is a good thing, because it means that you’re taking care of your body, and reducing your risk of other complications like stroke and heart disease.
Myth: Fruit is health food, so diabetics can eat as much fruit as they want.
Fact: It’s absolutely true that fruit is healthy, and full of vitamins and minerals. Like everyone else, diabetics should fill their diets with nutrient- and fiber-rich fruits and vegetables. But fruits, especially, are rich in sugars, or carbohydrates, so they do raise blood sugar more than other foods.
As with all diets, your doctor and nutritionist can help you come up with a meal plan that includes the kinds and amounts of fruits (and other carbohydrates) that are appropriate for your medical condition.
Diabetes in Australia
Diabetes is currently an epidemic in Australia, and shows no sign of stopping any time soon. Current research shows that 1.7 million Australians are currently living with diabetes, with 280 new cases developing every day, or more than 100,000 annually. That’s the equivalent of one new diabetic every five minutes. There are more than 1.7 million Australians currently paying the price of diabetes, too. The total health care cost of diabetes in Australia is estimated to be nearly $15 billion annually, and there is generally a family member or caretaker who also has to “live with” the disease, effectively doubling the number of affected people.
Diabetes is sweeping Australia with blindness and sight problems, with 3 out of 5 Australian diabetics estimated to experience poor eyesight, and another 72,000 people living with diabetic retinopathy, a diabetic condition that damages the retina of the eyes, and is a leading cause of blindness. In fact, diabetes is currently the leading cause of preventable blindness in Australia.
Diabetic Australians aren’t just losing their sight, they’re also losing their arms, legs, fingers, and toes. Every year, doctors in Australia perform more than 4,400 diabetes-related amputations. Many of these are the result of ulcers and wounds, which represent 10,000 hospital admissions per year. These unfortunate amputations are the best-case scenario when the disease progresses this far, because thousands more people die from such injuries.
All forms of diabetes –type 1, type 2, and gestational diabetes – are on on the rise in Australia, and diagnoses are increasing at a faster rate than other chronic diseases like cancer and cardiovascular disease.
The rise of diabetes is not specific to Australia – the global rate of diabetes has risen by nearly half in the last 20 years, and continues to rise. Though diabetes has been increasingly prevalent in rich countries, parallel to the rise in obesity, poorer developing nations have begun picking up the slack, and prominent rises have been seen in countries like China, Saudi Arabia, and Mexico. Nearly all of these new cases are type 2 diabetes, which is often linked to obesity.
This study reported a worldwide rise, driven by the United States, where the rate of diabetes has increased by 71 percent since 1990. Saudi Arabia was next, with a 60 percent rise, and China and Mexico saw a 56 percent and 52 percent rise, respectively. Importantly, the percent increase of rate is not the same as the number of cases. Diabetes currently affects a similar number of people in the United States and China, for example.
These numbers, unfortunately, show no signs of slowing. The WHO estimates that this global epidemic of diabetes will continue to rise even if obesity levels do not. They predict that the total number of people living with diabetes will rise to 366 million in 2030, and warn that this may even be an underestimate, as sedentary lifestyles become increasingly common, and access to cheap processed food abounds.
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