Diabetes 101

Diabetes is a chronic disorder in which the body cannot properly metabolize sugar. When you are healthy, your pancreas produces a hormone called insulin to help the cells utilize sugar for growth and energy. If the body is unable to produce insulin or cannot utilize existing insulin, the levels of sugar in the blood rises dramatically and dangerously in the body. In the short run high blood sugar levels can lead to a fatal diabetic coma. In the lung run, the elevated blood sugars are associated with damage to blood vessels in vital organs. Damaged blood vessels in the eye can rupture leading to often irreversible blindness. Diabetes hardens the capillaries of the kidneys leading to kidney failure and blocks blood vessels in the heart leading to high blood pressure and precipitating heart attacks. Although diabetes is caused by hormonal problems, physicians frequently view diabetes as a problem affecting veins and arteries because of its devastating effect on the entire circulatory system.

Defining Diabetes
There are two major types of diabetes. Type I occurs when the pancreas abruptly stops producing insulin. Often called juvenile diabetes, it usually appears before the age of twenty. It starts suddenly with symptoms of constant thirst, stomach pain, nausea, vomiting, weight loss (despite an increased appetite), and extreme fatigue. Type I diabetics always require daily insulin injections to survive. At present scientists do not know what causes Type I diabetes to develop. They believe that both genetic factors, infections and the body’s own immune system may be involved. Type I accounts for less than ten percent of diabetes in the US.

Heredity plays a much larger role in Type II diabetes. Also known as mature onset diabetes, it usually appears after age forty and represents nearly ninety percent of known diabetes cases. Susceptibility to Type II diabetes runs in families. Symptoms such as excessive thirst, frequent urination, and blurred vision develop so slowly that many people are unaware that they have a problem and it can be years before diabetes is diagnosed. All to often, high blood sugar level silently damage the body for years, and the first sign of a problem is irreversible kidney failure or a heart attack.

Some Type II diabetics are unable to produce enough insulin; wheras others are unable to use existing insulin. Not infrequently, Type II diabetics have normal or even high insulin levels, but can't use it properly—a condition known as insulin resistance. Type II diabetics usually begin treatment with exercise, diet and oral medications to help the body to produce insulin or help the cells using existing insulin. The disease continues to progress over the years and eventually about half of Type II diabetics require daily insulin injections.

What Causes Type II Diabetes?
Excess Weight
Carrying more than 10 pounds in people with a susceptability to diabetes is more than a beauty issue—much more. Excess weight decreases sensitivity of the body to insulin. In some cases, this means the blood sugars will rise sharply. Not infrequently, just losing as little as ten pounds can reverse the presence of diabetes and restore normal blood sugars. In other cases excessive weight forces the pancreas to work overtime to produce enough insulin for the needs of the body. Moreover, since insulin stimulates storage of fat, the high insulin levels floating in the body actually contribute to weight gain, signaling an even greater need for insulin production. The rise in obesity in this country has been accompanied by a sharp leap in the incidence in Type II diabetes. Even more troubling, doctors are now seeing Type II diabetes in overweight school age children—decades earlier than in the past. Since diabetes is a progressive disease, experts are very concerned that the complications of diabetes now seen in diabetics over 50, will now begin to appear in young adults.

Family History
Diabetes tends to run in families, but the pattern of inheritance is difficult to predict. Research indicates that if one member of the immediate family is diabetic, then the other family members are to five times more likely to develop diabetes. Studies of identical twins demonstrated that when one twin develops Type II diabetes, there is a 75% chance that the second twin will develop it as well.

Our cultural heritage can increase risk of diabetes. African Americans and Hispanic Americans have rates of diabetes three times higher than the national average, while up 50% of Native Americans are diabetic. Overall, it is estimated that 1 in 4 people in the United States have the genetic tendency for diabetes.

Sedentary Lifestyle
Lack of exercise not only promotes weight gain, it apparently decreases the body’s ability to lower blood sugar. During physical activity the muscles require energy, pulling the sugar from the blood. Exercise also creates greater muscle mass, which increases the body’s ability to use sugar. Interestingly, men—who have a naturally higher muscle mass than women—account for only 15% of Type II diabetes. It is felt that their increased muscle mass is a protective element against developing the disorder—even in families at risk.

Diet and Nutrition
Foods high in simple carbohydrates (e.g., sugar, pasta, rice, and potatoes) should carry a warning label for people at risk for diabetes. These carbohydrates rapidly stimulate insulin production and in a diet that is high in these nutrients, forces the pancreas to work overtime and eventually shut down. Interestingly vegetarian diets (which are generally favored by cardiologists for reversing heart disease) may be a poor choice for a people with a susceptibility for diabetes. The average vegetarian diet contains about 350 grams of carbohydrates a day. By contrast, the maximum daily intake recommended for diabetics is 120 grams of carbohydrates. Whatever benefits a high carbohydrate/low fat diet could offer for reduction of heart disease, are overwhelmed by the strain on the pancreas struggling to meet the needs of a high carbohydrate load for the 1 out 4 Americans at increased risk for diabetes.

This concern is supported by a study published in the Journal of the American Medical Association. The research compared the rate of heart disease in diabetic and non-diabetic men and women. From 1971 to 1993, death rates for non-diabetic men fell 36%, but dropped only 13% for men with diabetes. For women the numbers were even more sobering. While death from heart disease for women without diabetes declined almost 30% , they actually rose more than 20% for diabetic women. Some experts suggested that the low fat/high carb diets of the time were at least partly responsible for an actual increase in the death rate from heart disease for women with diabetes.

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