Diabetes: A Silent Killer
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Diabetes: A Silent Killer

November 14, 2017 | Naila Goldenberg

Diabetes is one of most common chronic diseases of the developed world. It is so common, that we have World Diabetes Day on November 14th each year, that was introduced by WHO and November is considered a Diabetes Month in the USA. (http://www.who.int/mediacentre/factsheets/fs312/en/). About 10% of US population has it now and up to 25% may get it by 2050 if nothing will change.

When I talk to a newly diagnosed diabetic patient, I advise thinking of it as hair. You may have straight or curly hair, but in any case, you need to take care of it. If you do not- you end up with a mess. If you take care of it- it will be very manageable.

So, what is Diabetes? Who gets Diabetes and what to do to prevent it?

 Diabetes is a condition when the body cannot keep blood glucose at a normal level and it stays at higher than 126 mg/dl fasting or >180 mg/dl after meals (normal level is 70-100 mg/d 3.3-5.5 nmol/L fasting and >140 mg/dl after meals). Rarely diabetes starts abruptly. Usually, it goes through the stage of Prediabetes, even though it may be undiagnosed and in some cases-very brief.

Types of Diabetes

There are several types of Diabetes. The most common is type 2 when people have Insulin, but it does not work well (insulin resistance) and therefore blood glucose goes up.

Type 1 diabetes is when pancreatic cells that produce Insulin damaged by autoimmune antibodies and production of Insulin is ceased.

Type 3c diabetes is when there is physical damage to the pancreas from inflammation/trauma/surgery or such, that leads to low or no insulin secretion.

There are other types/causes of diabetes, like Monogenic Diabetes, when one single gene mutation causes diabetes, those cases are very rare.

All Diabetes types have a genetic predisposition, some are more and some are less. We think that type 2 Diabetes is mostly genetic. You see that best at family reunions, where grandpa Harry, uncle Joe, aunt Marie and cousin Charlie all have diabetes. Growing in this family puts strong pressure and sense of inevitability. However, a majority of risks come from our habits that were learned to grow in our family unit: what we eat, how we exercise, how much stress were have etc.

Over the last 20 years, management of type 2 diabetes became easier with the approval of new classes of medications. Diet and exercise are still main staples of Diabetes management and prevention. In the old study Diabetes Prevention Program, patients with prediabetes who lost about 7% of their weight, exercised 5 days a week for 30 mins was able to reduce the risk of progression to diabetes by 58 percent. About 5 percent of the lifestyle intervention group developed diabetes each year during the study period, compared with 11 percent of those in the placebo group. https://www.niddk.nih.gov/about-niddk/research-areas/diabetes/diabetes-prevention-program-dpp/Pages/default.aspx

More recent studies show that we can prevent type 2 diabetes by losing weight through diet/surgery or weight loss medications and staying fit with different activities.

 

What about type 1 diabetes? it definitely has genetic markers, but usually requires "second hit"-viral infection, significant emotional stress or simply unknown. Type 1 diabetes is harder to control and requires more diligence, more "hair care" if you go with that analogy and with that- less "bad hair days". With new technology, that allows continuous glucose monitoring and continuous insulin delivery per pump or better Insulins in general, it is becoming easier. Type 1 diabetes is full-time work on its own, but with a system in place and proper education about insulins and exploration of your body's reaction to food/stress/exercise, it is possible to live a full life and avoid complications or "hair tangles". Several studies are ongoing that study anti-diabetes vaccines and other ways to prevent diabetes type 1. 

As we celebrate Diabetes Day and Diabetes Month, I want to honor all the people who have to deal with diabetes every moment of their lived and give hope to them and their relatives, that it can be the preventable or at least manageable condition.

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