November is National Diabetes Awareness Month

I hope we find all of you in good health and good spirits. November is National Diabetes Awareness Month. Looking back at the late 80’s, students were trained to interpret a case history to determine what disease entities we should look for based on a patient’s race and age. For example, it you were middle aged and of Hispanic or American Indian descent, we would be concerned with diabetes, if you were of African American descent, we would be concerned with hypertension and glaucoma and so on. While this is not funny, consider it a medical form of racial profiling but it was clinically significant. Case histories are still important but the thinking has changed.

While attending a continuing education course in 2001, with speakers from the National Institute of Health and the Center for Disease Control, the room was shocked with the results of the study. In 1960, diabetes and hypertension were on the bottom of the top twenty things that would likely kill an American. In 2000, diabetes and hypertension moved up to the top five things that would kill an American and globally. If current trends continue, one in three adults will be diabetic by 2050. Most of Type 2 diabetes can be attributed to obesity, age, sedentary lifestyles and the American diet. Many health experts are calling diabetes and obesity a pandemic.

Diabetes mellitus often goes undiagnosed because symptoms go unnoticed despite the complications it may cause such as visual impairment, blindness, hypertension, renal failure, heart disease and stroke. In fact about forty percent of people don’t know they are diabetic. Often undiagnosed diabetes is discovered during an eye exam. Diabetic retinopathy is responsible for about twelve percent of new blindness cases each year. However keeping blood glucose levels at normal can decrease the risk of diabetic retinopathy by seventy six percent. The three most common classifications of diabetes are Type 1, Type 2 and Pre-Diabetes.

Type 1 diabetes occurs when the body’s immune system attacks and destroys the beta-cells in the pancreas that produce insulin. It is most common in children and young adults but can occur at any age. Currently about ten percent of diabetics are Type 1. It can be caused by genetic, environmental factors and unknown factors and we have no way of preventing it.

Type 2 diabetes is the most common form of diabetes and occurs when the body doesn’t produce enough insulin or cannot use the insulin effectively. Currently, about 90 percent of diabetes cases in American are Type 2 and it is more common in adults than in children. Shockingly more children are being diagnosed with diabetes in high risk ethnic groups than before. Those children are between the ages of ten and nineteen years old, are obese, and have a strong family history of diabetes.

Pre-Diabetes are individuals whose blood glucose levels do not meet the definition of diabetes but still have an increased risk of developing type 2 diabetes, heart disease and stroke. Typically their glycosylated hemoglobin (HbA1c is one of the test to determine diabetes) is between 5.7 and 6.4 percent.

So what can you do to prevent Type 2 Diabetes? Well the Diabetes Prevention Program study revealed that weight loss through moderate diet changes and physical activities can delay and possibly prevent type 2 diabetes.

Does early detection and treatment help? Yes, it can reduce risk of complications associated with the diabetes. As a rule of thumb, every percentage point reduction in A1c test reduces the risk of a microvascular complication (think of it as circulation issues, poor circulation leads to tissue damage & tissue death) by forty percent. Also control of high blood pressure (hypertension) reduces risk of cardiovascular disease and microvascular complications. As a rule of thumb, for every 10 mm Hg reduction in systolic blood pressure, the risk of complications related to diabetes is reduced by 12 percent. The ideal normal blood pressure is about 120/80 (systolic/diastolic).

In my years of practice, I cannot over emphasize the importance of exercise, diet, regular appointments, monitoring, and medications. It is always difficult to tell a patient that they are losing their vision from complications of diabetes. It is depressing watching patients, family, and friends suffering from the complications of diabetes. However, many times you, the patient can make a difference with your health care team. Studies show that early detection and appropriate treatment reduces severe vision loss. Thus the importance of a regular physicals, follow up visits, lab work, and an annual eye examination are important factors for detection. If you are diabetic, than lifestyle (i.e. exercise, diet, etc…) changes, medications, and regular monitoring are important steps for leading a quality life and maintaining your precious vision. As with any medical article, this is a small bit of information on diabetes. For more knowledge, please consult your doctors.