Almost everyone knows someone who has diabetes. An estimated 16 million people in the United States have diabetes -which is a serious lifelong condition. About one-third of these 16 million people have not been diagnosed. Each year, about 800,000 people are diagnosed with diabetes. (NIDDK) Figure 1 -- Prevalence of diabetes in men and women in the U.S. population age 20 years or older, based on the National Health and Nutrition Examination Survey. Diabetes includes previously diagnosed and undiagnosed diabetes defined by fasting plasma glucose greater than or equal to 126 mg / d L. (age-std = age-standardized) What is Diabetes?

Diabetes is a disorder of metabolism-the way our bodies use digested food for growth and energy. Most of the food we eat is broken down into glucose, the form of sugar in the blood. Glucose is the main source of fuel for the body. After digestion, glucose passes into the bloodstream, where it is used by cells for growth and energy.

For glucose to get into cells, insulin must be present. Insulin is a hormone produced by the pancreas, a large gland behind the stomach... Insulin is produced in the pancreas, an organ that sits behind your stomach. When we eat, the pancreas is automatically supposed to produce the right amount of insulin to move glucose from blood into our cells. In people who have diabetes, the pancreas either produces little or no insulin, or the cells do not respond in the right way to the insulin that is produced. Glucose builds up in the blood, overflows into the urine, and passes out of the body.

Therefore, the body loses its main source of fuel even though the blood contains large amounts of glucose. Compare the human body to a car. To start a car, you must turn the key to move the gas to the engine. Similarly, the glucose in your bloodstream cannot go into the cells by itself. The pancreas releases a substance called insulin into the blood, which serves as the helper, or the "key" that lets the glucose into the cells for use as energy. When glucose enters your cells, the level of glucose in your bloodstream decreases.

Without insulin, glucose cannot get into the body's cells for use as energy. This increases the levels of glucose in your blood. Too much glucose in the blood is called "high blood sugar" or diabetes. (NIDDK). Insulin is the 'key' that allows your cells to take glucose from your bloodstream and use it as energy. What are the types of diabetes?

Type 1 Diabetes: Type 1 diabetes is an autoimmune disease. An autoimmune disease results when the body's system for fighting infection (the immune system) turns against a part of the body. With diabetes, the immune system attacks the insulin-producing beta cells in the pancreas and destroys them. The pancreas then produces little or no insulin. Someone with type 1 diabetes needs to take insulin daily to live. Still today, scientists do not know exactly what causes the body's immune system to attack the beta cells, but they believe that both genetic factors and environmental factors, possibly viruses, are involved.

Type 1 diabetes accounts for about 5-10% of diagnosed diabetes in the United States. Type 1 diabetes develops most often in children and young adults, but the disorder can appear at any age. Symptoms of type 1 diabetes usually develops over a short period, although beta cells destruction can begin years earlier. Symptoms include increased thirst and urination, constant hunger, weight loss, blurred vision, and extreme fatigue. If not diagnosed and treated with insulin, a person can lapse into an life-threatening diabetic coma, also known as diabetic. (NIDDK) Type 2 Diabetes The most common form of diabetes is type 2 diabetes.

About 90-95% of people with diabetes have type 2. This form of diabetes usually develops in adults age 40 and older and is most common in adults over age 55. About 80% of people with type 2 diabetes are overweight. Type 2 diabetes is often part of a metabolic syndrome that includes obesity, elevated blood pressure, and high levels of blood lipids.

Unfortunately, as more children become overweight, type 2 diabetes is becoming more common in young people. When type 2 diabetes is diagnosed, the pancreas is usually producing enough insulin, but, for unknown reasons, the body cannot use the insulin effectively, a condition called insulin resistance. After several years, insulin production decreases. The result is the same as for type 1 diabetes-glucose builds up in the blood and the body cannot make efficient use of its main source of fuel. The symptoms of type 2 diabetes develop gradually.

They are not as sudden in onset as in type 1 diabetes. Some people have no symptoms. But some may include fatigue or nausea, frequent urination, unusual thirst, weight loss, blurred vision, frequent infections, and slow healing of wounds or sores. (Cleveland Clinic) Gestational Diabetes Gestational diabetes develops only during pregnancy. Like type 2 diabetes, it occurs more often in African American, American Indians, Hispanic Americans, and people with a family history of diabetes. Though it usually disappears after delivery, the mother is at increased risk of getting type 2 diabetes later in life.

(Cleveland Clinic) What are the scope and impact of diabetes? Diabetes is widely recognized as one of the leading causes of death and disability in the United States. According to death certificate data, diabetes contributed to the deaths of more than 193,140 people in 1996. Diabetes is associated with long-term complications that affect almost every part of the body.

The disease often leads to blindness, heart and blood vessel disease, strokes, kidney failure, amputations, and nerve damage. Uncontrolled diabetes can complicate pregnancy, and birth defects are more common in babies born to women with diabetes. Diabetes cost the U. S nearly $98 billion in 1997. Indirect costs, including time lost from work along with disability payments and premature death totaled about $54 billion; direct medical costs for diabetes care, including treatment supplies, medical care and patients hospitalizations totaled $44 billion. (NIDDK) What are the risk factors for diabetes? Although the causes of diabetes are unknown, the following risk of factors may increase your chance of developing diabetes: Family history.

If a parent of sibling in your family has diabetes your risk of developing diabetes is increased. Race or ethnic background. The risk of diabetes is increased in Hispanics, African-Americans, Native Americans, and Asians. Being overweight.

If you are 20 percent or more over your optimal body weight, you increase the risk of developing diabetes. Hypertension (High Blood Pressure) Abnormal blood cholesterol or triglyceride levels. HDL or "good" cholesterol level under 35 mg / dl and / or a triglyceride level over 250 mg / dl. Age. Your risk of developing diabetes increases progressively as you get older. Use of certain drugs: Blood pressure medications, such as thiazines.

Steroid medications, such as or decd ron. Hydantoin medications, such as Dilantin. Medications for transplant recipients, such as cyclosporine. Alcohol, smoking, history of gestational diabetes, autoimmune disease.

It is important to note that sugar itself does not cause diabetes. Eating a lot of sugar can lead to tooth decay, but it does not cause diabetes. (Cleveland Clinic) How is diabetes diagnosed? The preferred method of diagnosing diabetes is the fasting plasma glucose test (FPG) because it is easy to administer, convenient for patients and less expensive than other tests, according to the American Diabetes Association. The FPG measures your blood glucose level after you have not eaten anything for 10-12 hours. Normal fasting blood glucose is between 70 and 115 mg / dl for people who do not have diabetes.

The standard diagnosis of diabetes is made when two blood tests show that your fasting blood glucose level is greater than or equal to 126 mg / dl. The casual plasma glucose test is another method of diagnosing diabetes in which blood glucose is tested without regard to the time since the person's last meal. A glucose level greater than 200 mg / dl may indicate diabetes, especially if the test is repeated at a later time and indicates results. The oral glucose tolerance test is another method used to detect diabetes, but is not recommended or routinely done except during pregnancy. (Cleveland Clinic) You hold the Keys to managing your diabetes by: Planning what you eat and following a balanced meal plan. Exercising regularly Taking medication, if prescribed, and closely following the guidelines on how and when to take it.

Monitoring your blood glucose and blood pressure levels at home. Keeping your appointments with your health-care providers and having laboratory tests completed as ordered by your doctor. What you do at home every day affects your blood glucose more than what your doctor can do every few months during your checkups. (NIDDK)

Bibliography

NIDDK. web (November 1998) The Cleveland Clinic.
web (November 2000).