Diabetes

What's the Problem?

Most of the food we eat is turned into glucose (sugar) for our bodies to use for energy. Insulin helps glucose into our body cells. When you have diabetes, your body either doesn't make enough insulin or can't use its own insulin very well. The most common, types of diabetes include type 2, type 1, and gestational (occurs during pregnancy). Type 2 affects 90-95% of people with diabetes and usually appears after age 40. Type 1 affects 5-10% of those with diabetes and most often appears in childhood or teen years. People with type 1 diabetes need insulin to survive. Gestational diabetes affects 2.5-4% of pregnant women. People with diabetes may have some or none of the following symptoms: frequent urination, excessive thirst, unexplained weight loss, extreme hunger, blurry vision, tingling or numbness in hands or feet, recurring fatigue, very dry skin, slow-healing sores, or more infections than usual.

If not well managed, diabetes can seriously impact a person's quality of life. Complications, many of which are preventable, include the following: heart disease, stroke, blindness, kidney failure, foot or leg amputations, nerve damage, and complications of pregnancy. Diabetes contributed to 209,664 deaths in the United States in 1999 and is the sixth leading cause of death.

Who's at Risk?

About 17 million people in the United States, or 6.2% of the population, have diabetes. About one-third of these don't know they have it. Risk factors for type 1 diabetes include autoimmune disease, genetic predisposition, and environmental factors. Pre-diabetes is a new term for a condition that people get before they are diagnosed with diabetes. People who develop diabetes don't go from normal blood glucose numbers directly to type 2 diabetes. Almost all go through a phase called impaired glucose tolerance or impaired fasting glucose, conditions in which the blood glucose level is elevated but is not high enough to be classified as diabetes. Type 2 diabetes is more likely to develop in people who are older, are obese, have a family history of diabetes, have a prior history of gestational diabetes (5-10% of women with gestational diabetes are found to have type 2 diabetes after pregnancy), are physically inactive, and belong to a certain racial or ethnic group. African-Americans, Hispanic/Latino Americans, American Indians, Alaska Natives, and some Asian-Americans and Pacific Islanders are at particularly high risk for type 2 diabetes. Type 2 diabetes was previously called adult-onset diabetes but is increasingly being diagnosed in children and adolescents.

Can It Be Prevented?

Research studies in the United States and abroad have found that lifestyle changes can prevent or delay the onset of type 2 diabetes among high-risk adults. Currently, there are no known methods to prevent type 1 diabetes. However, several clinical trials are currently in progress.

People with diabetes must develop a life-long commitment to regular medical care and diabetes self-management. Treatment for diabetes is aimed at keeping blood glucose near normal levels at all times. To do that, people with diabetes must balance three important things: what they eat and drink, how much physical activity they do, and what diabetes medicines they take (if their doctor has prescribed diabetes pills or insulin). People with diabetes often learn to check their blood glucose levels at home with a glucometer as part of diabetes self-management. In addition, controlling blood pressure is very important for people with high blood pressure and diabetes.

Treatment must be individualized and address medical, emotional, cultural, and lifestyle issues. Potential barriers to treatment and preventive services include lack of financial resources, linguistic barriers, limited access to transportation, lack of physical activity because of unsafe neighborhoods, and lack of healthy food choices. Communities can overcome some of these barriers by using community health workers (other titles include: promotores de salud, lay health advisors, outreach workers, and peer educators) to serve as bridges between community members and health care systems. Community health workers communicate and model healthy lifestyle choices in culturally and linguistically appropriate ways.

The Bottom Line

• Symptoms of diabetes may include: frequent urination, excessive thirst, unexplained weight loss, extreme hunger, blurry vision, tingling or numbness in hands or feet, recurring fatigue, very dry skin, slow-healing sores, or more infections than usual.
• If you have any of the symptoms of diabetes OR have any of the risk factors for diabetes, you should see a doctor.
• People with diabetes can prevent or delay many problems such as eye disease, kidney disease, heart disease, nerve damage, and serious foot problems by keeping their blood glucose levels close to normal.

Case Examples

Problem

While fishing, Juan notices he has to urinate a lot and he's always thirsty. He's also hungrier than usual and even though he is eating more than usual, he has recently lost 15 pounds. His eyes feel blurry and his feet feel numb. Juan knows his mother experienced similar symptoms before she was diagnosed with diabetes. He remembers his uncle going blind and having to have one of his feet amputated from diabetes before he died of the disease. Juan knows many people in his community who have diabetes. It scares him, and he realizes he needs to see his doctor. His family physician performs blood tests and learns that Juan has diabetes. Juan begins to work with his doctor to keep track of glucose levels, maintain a healthy diet, and get regular exercise.

Prevention

Keesha is a teacher with 2 young children. During her last pregnancy she was diagnosed with gestational diabetes. The diabetes educator told her that gestational diabetes increases her risk for developing impaired glucose tolerance, a condition that often leads to type 2 diabetes. The diabetes educator also told her she could reduce her risk if she stayed physically active and maintained a healthy weight. Keesha, struggling to keep up with the demands of her busy life, found it hard to achieve those goals. She continued to gain weight over the years and never established a program of regular physical activity that she could maintain. Ten years later, Keesha's doctor discovered she had impaired glucose tolerance during her annual physical exam, which means she has pre-diabetes. Her doctor told her she was at risk for developing type 2 diabetes and advised her to lose weight. Keesha began walking 30 minutes five days a week. She also lowered her fat intake and started eating more vegetables and fruit. At her next annual physical she had lost 7 pounds and her glucose was well within the normal range

Spanish Version of Diabetes [PDF – 164K]