A LOOMING EPIDEMIC
What is diabetes?
November 6, 2008
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Diabetes is a disease in which blood glucose is above normal levels. Our bodies convert food into glucose, their main source of fuel for our bodies. The pancreas makes a hormone called insulin that helps glucose get into the cells of our bodies. In people with diabetes, the pancreas either produces little or no insulin, or the cells do not respond appropriately to the insulin that is produced. As a result, glucose builds up in the blood, causing increased urination and excessive thirst. Eventually, diabetic coma can occur. Over years, sustained elevated blood sugars can lead to damage of the kidney and heart. The disease also puts people at risk for blindness and lower-extremity amputations due to poor blood circulation.
– Compiled by Marion Traynor and Peggy MacKenzie, Toronto Star Library
TYPE 1 DIABETES
Definition: Previously called insulin-dependent diabetes mellitus (IDDM) or juvenile-onset diabetes, Type 1 diabetes is an autoimmune disease in which the body makes little or no insulin.
Risk factors: Develops most often in children and young adults before age 30, although it can appear at any age. There is no known cause and no way to prevent it. The disease is not caused by consuming too much sugar.
Symptoms: These usually develop over a short period, although cell destruction can begin very early. Symptoms include increased thirst and urination, constant hunger, unexplained weight loss, blurred vision, extreme fatigue, tingling or numbness in hands or feet, very dry skin, sores that are slow to heal and an increase in the number of infections. Those affected do not necessarily show symptoms. Nausea, vomiting and stomach pains may accompany some of these symptoms in the abrupt onset of the disease. Risk factors are less well defined for Type 1 than Type 2, but researchers do know that autoimmune, genetic and environmental factors are among the causes of Type 1.
Treatments: Type 1 sufferers must take insulin daily. Lifestyle changes such as healthy eating and increased physical activity are basic therapies for the disease. Blood-glucose levels must be monitored through frequent testing.
Complications: In addition to facing the threat of early heart disease, amputation, kidney failure, nerve damage, stroke and blindness, people with Type 1 diabetes risk lapsing into a potentially fatal coma known as diabetic ketoacidosis if their blood glucose is too high and they are not treated.
TYPE 2 DIABETES
Definition: Previously called non-insulin-dependent diabetes mellitus (NIDDM) or adult-onset diabetes, Type 2 diabetes is the most commonly diagnosed form of the disease. With Type 2 diabetes, your body can't use the insulin it makes.
Risk factors: Associated with those age 40 or older, obesity, family history of diabetes, high blood pressure, abnormal cholesterol levels (such as if your HDL or "good" cholesterol levels are 35 or lower or the triglyceride level is 250 or higher), schizophrenia, polycystic ovary syndrome, acanthosis nigricans (darkened patches of skin), previous history of gestational diabetes, history of giving birth to a baby over nine pounds, physical inactivity and ethnicity (those of Aboriginal, Hispanic, Asian or African descent). Type 2, which develops more slowly than Type 1, is increasingly diagnosed in children and adolescents.
Symptoms: May include fatigue or nausea, frequent urination,
unusual thirst, weight loss, blurred vision, frequent infections, and slow healing of sores. In some cases, there are no symptoms.
Treatments: Healthy eating, physical activity, and blood-glucose testing are the basic
therapies. In addition, many people with Type 2 require oral medication, insulin, or both to control their blood-glucose levels.
Complications: High blood-glucose levels over a long period can cause blindness, heart disease, kidney problems, amputations, nerve damage and erectile dysfunction.
GESTATIONAL DIABETES
Definition: Glucose intolerance, but with its first onset during pregnancy.
Risk factors: Only affects women during pregnancy and usually disappears after. About 3.5 per cent of non-Aboriginal women and up to 18 per cent of Aboriginal women will develop gestational diabetes. Risk factors include a history of gestational diabetes, age over 35 years, obesity, a history of polycystic ovary syndrome, hirsutism, acanthosis nigricans (darkened patches of skin) and ethnicity (includes women of Aboriginal, Hispanic, South Asian, Asian or African descent).
Symptoms: The Canadian Diabetes Association's 2003 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada recommend that all women be screened between 24 and 28 weeks' gestation using a glucose tolerance test. For those with multiple risk factors, this testing should be done during the first trimester, then again during the second and third trimesters.
Treatments: Nutritional therapy is recommended to achieve "euglycemia" or blood-glucose balance. It's important to ensure appropriate weight gain, but not weight loss, and adequate nutritional intake for mother and baby. If
reductions in blood glucose do not reach the recommended
levels within two weeks after eating and exercise adjustments, then certain types of insulin can be safely used in pregnancy. A blood-glucose test is recommended within six months of childbirth. In addition to this test, women should breastfeed to
reduce the risk of diabetes in the baby. Women should be screened regularly for Type 2 diabetes.
Complications: Babies born to mothers with gestational diabetes may be "macrosomic," a medical term meaning severely obese. Macrosomic babies have a higher risk of severe breathing problems and hypoglycemia. They are also at higher risk for long-term obesity and glucose intolerance. Women with a history of gestational diabetes have a 20 to 50 per cent chance of developing Type 2 diabetes within five to 10 years.
Toronto Star