Diabetes

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Diabetes is a chronic condition in which the body produces too little insulin or can't use available insulin efficiently. Insulin is a hormone vital to helping the body use digested food for growth and energy.

An estimated 23.6 million Americans (approximately eight percent of the population) have diabetes, and about 1.6 million more aged 20 or older were diagnosed with the disorder in 2007, according to the American Diabetes Association. Untreated, diabetes can cause long-term complications that affect almost every part of the body, making it the sixth leading cause of death in the United States.

You are at higher risk for developing type 2 diabetes if you are overweight, don't exercise and are over 30, or if you have close relatives with diabetes, especially type 2 diabetes. Higher-risk ethnic groups include African American, Latino/Hispanic, Native American, Alaska Native, Asian or Pacific Islander American heritage. s. Native Americans and Alaska Natives are at more than twice the risk of Caucasians for developing type 2diabetes.

Although diabetes is a potentially life-threatening condition, people with well-managed diabetes can expect to live healthy lives.

How Diabetes Develops

Much of the food we eat is broken down by digestive juices into a simple sugar called glucose, which is the body's main source of energy. Glucose passes into the bloodstream and, from there, into cells, which use it for energy.

However, most cells require the hormone insulin to "unlock" them so glucose can enter. Insulin is normally produced by beta cells in the pancreas (a large gland behind the stomach). In healthy people, the process of eating signals the pancreas to produce the right amount of insulin to enable the glucose from the food to get into cells. If this process fails or doesn't work properly, diabetes develops.

In people with diabetes, the pancreas produces little or no insulin, or the body's cells do not respond to the insulin that is produced. As a result, glucose builds up in the blood, overflows into the urine and passes out of the body. Thus, the body loses its main source of fuel even though the blood contains large amounts of glucose.

Types of Diabetes

There are several types of diabetes:

• In type 1 (insulin-dependent) diabetes, the pancreas makes little or no insulin because the insulin-producing beta cells have been destroyed. Type 1 diabetes is less common than type 2 diabetes, accounting for about five to 10 percent of diabetes cases. Formerly known as "juvenile diabetes," type 1 typically develops during childhood or young adulthood but can appear at any age.

  Type 1 diabetes is classified as an autoimmune disease—a condition that results when the immune system turns against a specific part or system of the body. In diabetes, the immune system attacks and destroys the insulin-producing beta cells in the pancreas. At present, scientists do not know exactly what causes the body's immune system to attack the beta cells, but they believe that both genetic and environmental factors are involved.

• In type 2 (noninsulin-dependent) diabetes, the pancreas makes insulin but the body does not respond to it properly (insulin resistance). In time, the pancreas can fail to produce enough of its own insulin and requires insulin replacement. Type 2 diabetes most often occurs in overweight or obese adults after the age of 30, but may also develop in children. Factors that contribute to insulin resistance and type 2 diabetes are genetics, obesity, physical inactivity and advancing age.

  Type 2 diabetes is on the rise in the United States, and rates are expected to continue increasing for several reasons, according to the CDC. The increasing prevalence of obesity among Americans is a major contributor to the rise in type 2 diabetes. According to the National Health and Nutrition Examination Survey 2001-2004, about two-thirds of Americans are overweight, and almost one-third are obese. And the number of obese children in the United States is growing. Another reason is related to the relatively low levels of physical activity among American adults. (About 50 percent of American adults don't get enough physical activity.)

  Other factors contributing to the rise of type 2 diabetes include:

  • The increasing age of the population

  • The fast growth rate of certain ethnic populations at high risk for developing the condition, including Latino and Hispanic Americans

• A third type of diabetes, gestational diabetes, is one of the most common problems of pregnancy. Left uncontrolled, it can be dangerous for both baby and mother.

  During normal pregnancy, hormones produced by the placenta increase the mothers' resistance to insulin. Gestational diabetes results when the insulin resistance exceeds the body's capacity to make additional insulin to overcome it. This resistance usually disappears when the pregnancy ends, but women who have had gestational diabetes have a greater risk of developing type 2 diabetes later in life. All pregnant women are routinely screened for gestational diabetes between their 24th and 28th weeks.

• A new term, "pre-diabetes," describes an increasingly common condition in which blood glucose levels are higher than normal, but not high enough for a diagnosis of diabetes. About 57 million people in the United States have prediabetes.

  Those with prediabetes have impaired fasting glucose (between 100 and 126 mg/dL after an overnight fast), or they have impaired glucose tolerance as indicated by one or more simple tests used to measure glucose levels. The ADA reports that in one study, about 11 percent of people with prediabetes developed type 2 diabetes each year during the average three years of follow-up. Other research shows that most people with this condition go on to develop type 2 diabetes within 10 years unless they make modest changes in their diet and level of physical activity.

  Some long-term damaging effects to the body, particularly the heart and circulatory system, may start during the prediabetes phase of the disease.

Women and Diabetes: Special Concerns

In the United States, 11.5 million (10.2 percent) women age 20 and older have diabetes. Women with diabetes develop heart disease more often than other women, and their heart disease is more severe. Women under age 50 with diabetes are more vulnerable to heart attacks and strokes than those without diabetes because the disease seems to cancel the protective effects of estrogen on a woman's heart prior to menopause. Women with diabetes are also at even greater risk for developing heart disease after menopause.

According to the cholesterol management guidelines issued in May 2001 by the National Cholesterol Education Program, National Heart, Lung, and Blood Institute (NHLBI) and updated in 2004, diabetes poses as great a risk for having a heart attack in 10 years as heart disease itself and should be managed as aggressively as heart disease. A survey showed that most people with diabetes don't know that heart disease and stroke are the major causes of death of people with diabetes. In fact, approximately two-thirds of people with diabetes die from cardiovascular disease, and they die younger than women without diabetes.

Women with diabetes have lower levels of high-density lipoproteins (HDL) cholesterol (the good cholesterol) and higher levels of triglycerides, or fats, in the blood. Elevated low-density lipoproteins (LDL) cholesterol is a major cause of coronary heart disease and should be treated aggressively. Although LDL cholesterol (the type of cholesterol that contributes to plaque buildup in your arteries) levels are not higher in women with diabetes, studies find that reducing LDL levels to less than 100 mg/dL can help prevent heart attacks and strokes in women with diabetes.

High cholesterol is typically treated with specially designed diets low in saturated fat, weight loss, exercise and, if necessary, medication.

For more information on the new guidelines, visit www.nhlbi.nih.gov/guidelines/cholesterol/index.htm.

Other health issues of concern to women with diabetes include:

• High blood pressure. The goal for blood pressure among those with diabetes is less than 130/80 mm Hg, according to the American Diabetes Association.

• Urinary tract and vaginal infections. Urinary tract infections and vaginal yeast infections are more common in women with diabetes. The fungi and bacteria that cause these infections thrive in a high-sugar environment, and the body's immune system can't fight them as effectively when blood glucose levels are too high.

• Menstrual problems. Irregular menstrual periods are common in women with diabetes, especially if their blood sugar isn't well controlled. Blood sugar levels may rise, and insulin needs may increase before a woman's period and fall once it begins.

• Adverse reactions to hormonal birth control methods. Contraceptives containing hormones (such as birth control pills), IUDs that contain progesterone, and long-lasting progestin implants and injections may alter blood glucose levels. Birth control pills may increase insulin resistance in some women with diabetes. Women with type 2 diabetes may find it harder to manage their blood glucose while taking birth control pills. Although rare in healthy individuals, the risk of complications from birth control pills, such as high blood pressure and stroke, are greater for women with diabetes. However, the American Diabetes Association says most birth control methods are safe for women with diabetes—talk to your health care professional about any potential risks.

Management is Key to Living Well with Diabetes

Although diabetes is a chronic and potentially life-threatening condition, it can be effectively controlled and managed once it has been accurately diagnosed. The goal of diabetes management, according to the American Association of Clinical Endocrinologists, is to prevent short-term and long-term complications from developing.

Without proper management, individuals with either type 1 or type 2 diabetes can develop serious or deadly complications from high glucose levels including blindness, kidney disease and nerve damage, as well as vascular disease that can lead to amputations, heart disease and strokes. Uncontrolled diabetes can complicate pregnancy; birth defects also are more common in babies born to women with uncontrolled diabetes.

For women with type 1 diabetes, controlling blood sugar levels may mean three to four (and sometimes more) shots of insulin a day, adjusting insulin doses to food and exercise, testing blood glucose up to eight times a day depending on their health care providers' recommendations and adhering to a planned diet.

Type 2 diabetes may be controlled initially by a planned diet, exercise and daily monitoring of glucose levels. Frequently, oral drugs that lower blood glucose levels or insulin injections need to be added to this regimen.

Treating diabetes comprehensively—that is, managing not only blood glucose, but also blood pressure and cholesterol—is crucial to helping prevent heart attacks and stroke. The good news is that women with diabetes who maintain lower blood glucose, blood pressure and cholesterol levels can lower their risk of cardiovascular disease. To reduce your risk, follow the "ABC" approach recommended by the National Diabetes Education Program, National Institute of Health and the American Diabetes Association. The ABCs are easy to remember:

• A stands for the A1C, or hemoglobin A1C test, which measures average blood glucose over the previous two to three months.

• B is for blood pressure.

• C is for cholesterol.

Diabetes treatment guidelines issued by the American College of Physicians (ACP) and published in the April 2003 issue of the Annals of Internal Medicine emphasize the importance of aggressive blood pressure control in lowering the risk for heart disease, stroke and early death in type 2 diabetes patients. Until these guidelines were released, the focus in diabetes care has been on tightly controlling blood sugar, but new evidence suggests that both blood sugar and blood pressure are very important in managing the disease.

The ACP recommends that patients with diabetes and high blood pressure strive for blood pressure levels of less than 130/80 mm Hg, and that thiazide diuretics and angiotensin-converting enzyme (ACE) inhibitors be used as first-line agents to control blood pressure in most patients with diabetes.