There are two types of diabetes – type 1 and type 2 – but the one that is usually in the news because of its association with rising obesity rates in America is type 2 diabetes.
Type 1 diabetes: Previously called juvenile diabetes, type 1 is usually diagnosed in children and young adults. In this type, the body does not produce insulin, a hormone needed to convert sugar, starches and other foods into energy. Insulin, by shot or pump, must be started right away. Exercise and nutrition are also important in managing type 1 diabetes. It is caused by one’s immune system attacking and destroying insulin-producing cells in the pancreas. It is thought to be caused genetic and environmental factors.
Type 2 diabetes: This type, which may be prevented through lifestyle changes in diet, weight loss and exercise, accounts for 90 percent to 95 percent of all diabetes cases in the U.S. It occurs when an indivdual’s body doesn’t make enough insulin or use it well. This results in “insulin resistance.”
Diabetes can be diagnosed using three blood tests – fasting blood sugar test, hemoglobin A1C test and a glucose challenge test.
“Patients are often asymptomatic, but the risks associated with prediabetes and diabetes, like heart attack and stroke, are happening before the diagnosis,” said Dr. Scott Setzer, a family doctor in Lemoyne.
People with prediabetes have blood sugar levels that are higher than normal – between 100 and 125 mg/dl – but not high enough to be called diabetes, the label given when fasting blood glucose is 126 mg/dl or higher. Sometimes, early treatment of prediabetes can return blood glucose levels to normal and prevent escalation to diabetes.
When they do present, symptoms include frequent thirst, extreme hunger, frequent urination as in every two hours, weight loss, blurred vision and fatigue, said Dr. Renu Joshi, medical director of endocrinology at PinnacleHealth System in Harrisburg.
Treatment can include lifestyle change in diet, exercise and weight loss, medications and insulin.
In the past several months, a new medication for type 2 diabetes called Invokana (generically called canagliflozin) was introduced that works by making blood sugar come out in the urine, Joshi said. It holds promise, but it can cause thirst, frequent urination and yeast infections. Patients must have completely normal kidney function to be able to take it, she said.
The American Diabetes Association has set these guidelines for diabetes screening:
- Anyone with a body mass index higher than 25, regardless of age, who has additional risk factors, such as high blood pressure, a sedentary lifestyle, a history of polycystic ovary syndrome, having delivered a baby who weighed more than 9 pounds, a history of diabetes in pregnancy, high cholesterol levels, a history of heart disease, or having a close relative with diabetes.
- Anyone older than age 45 is advised to receive an initial blood sugar screening, and then, if the results are normal, to be screened every three years thereafter.