by Scott Maanum, MD, Family Medicine
November is Diabetes Awareness Month. I thought this would be a good time to provide some background on the disease and encourage you to take time to think about how diabetes affects you and others around you. Diabetes is a highly complex disease of metabolism that is characterized by elevated blood glucose. This can be due to the inability to make insulin or to respond to it appropriately. According to the Centers for Disease Control, over 30 million people in the United States have diabetes mellitus. The represents nearly 1 out of 10 people. Surprisingly, one fourth do not know that they have it. What is even more concerning is that over 80 million people have a condition called prediabetes, and this places them at risk of developing diabetes in the future. If these estimates are accurate, there is a very good chance that you already have diabetes or are at risk of developing it in the future.
Type 2 vs. Type 1 Diabetes
96% of individuals with diabetes have type 2 diabetes, and the remainder have type 1 diabetes. There are similarities and differences between type 1 and type 2 diabetes, and diabetes is truly unique to each individual. So how do you know if you have diabetes? It is typical for type 2 diabetes to develop slowly over time and gradually worsen. This often results in a delay in diagnosis of approximately 4-6 years from the time in which it first started. In the early stages of type 2 diabetes, there may be no symptoms. Those with early type 2 diabetes might feel normal and not seek medical attention. As the disease progresses, one may begin to notice excessive thirst or excessive urination, wounds that do not heal, vision changes, weight loss/gain, and more frequent infections. A burning sensation may be present in the fingers or toes, coupled with a loss of sensation. Occasionally, a person may have a stroke or heart attack and then come to realize that diabetes was present without previous recognition.
Contrast this with the recognition and diagnosis of type 1 diabetes. Type 1 diabetes often progresses rapidly once it starts, and this causes the individual to feel very ill over a short period of time. This often leads to hospitalization, diagnostic tests that confirm the disease, and early delivery of insulin. Without insulin, type 1 diabetes is fatal.
Risk Factors and Screening
Perhaps you are wondering, “Should I be checked for diabetes?” As a physician, I would strongly encourage anyone with the symptoms mentioned above to seek diagnostic testing. According to The American Diabetes Association, it is not recommended to screen for type 1 diabetes unless a person has a first-degree family member affected by type 1 diabetes.
It is generally recommended to start screening the general population at age 45 for type 2 diabetes and repeating this in 3-year intervals. If a person has one or more risk factors, testing should be considered at an earlier age or carried out more frequently. Risk factors include family history of diabetes, overweight, physical inactivity, previously identified prediabetes, hypertension, HDL cholesterol < 35 and/or a triglyceride level of > 250, history of gestational diabetes or delivery of a baby weighing greater than 9 pounds, polycystic ovary syndrome, and certain races (for example African-Americans, Hispanic Americans, Native Americans, Asian Americans, and Pacific Islanders). For overweight children and adolescents with additional risk factors, screening can be done every 2 years starting at age 10 or at the onset of puberty, whichever comes first.
There is often a misconception that type 1 diabetes develops in childhood and that type 2 diabetes develops in adulthood. That is simply false. The incidence of type 2 diabetes in obese children and adolescents is rising at an alarming rate. Some adults who did not have diabetes in childhood can develop autoimmune diabetes with the inability to make insulin, just like those who were diagnosed with type 1 diabetes in childhood. These adults should be identified and offered insulin early as many of the initial therapies for type 2 diabetes involve things other than insulin. This might defy some of our perceptions about “adult-onset” diabetes and make us realize that there is wide variability in how this looks and how it is treated.
Your medical provider is an excellent resource to seek answers to your questions about diabetes. Within medical facilities and in the community, there are individuals who can help with meal planning, exercise plans, mental health counseling, and medication management. Visit the American Diabetes Association (ADA) website to learn all about diabetes. There is also an easy, online risk test that takes approximately 60 seconds to complete. This is available in both English and Spanish. I encourage you to take this test and discuss it with your medical provider at your next visit.
The bitter reality of diabetes is that there are individuals who cannot afford insulin or other therapies. Individuals without access to medications and medical care are at a much higher risk of dying prematurely or suffering devastating complications from diabetes like blindness, kidney failure, or foot/leg amputation. Diabetes therapies and other aspects of care are expensive. According to the Minnesota Department of Health, the ANNUAL cost of managing diabetes in Minnesota is nearly $5 BILLION. This is almost FIVE times the expense of what it cost to build the US Bank Stadium, and we spend it EVERY year to treat and manage this disease.
Another unfortunate truth is that many face discrimination based on diabetes. They may not be given the same opportunities as those who do not have the disease. This can make some people less motivated to be tested and can delay diagnosis and treatment. From speaking with many individuals who have diabetes, I know that they can often feel their decisions about food choices and lifestyle are criticized. There can be negative perceptions that can have adverse effects on one’s physical and mental health. Many may feel like they cannot show their diabetes in public and are therefore feeling isolated from others.
What You, and Everyone, Can Do
In closing, I would like to encourage you to do the following. If you have diabetes, know that you are not alone and that you are supported. We care and we want to help. You can truly thrive with diabetes. If you do not have diabetes, consider being screened or tested. You may be one of the 80 million people in the U.S. who are at risk and you may be one of the 25% with the disease who just doesn’t know it. Most importantly, be sensitive and understanding towards your peers, co-workers, friends, and family members who have diabetes. Try to help people feel included. If we are going to change the course of this disease, it is going to be together.
Use your voice to educate others and to raise awareness. Talk with or write your legislators. For more information, you can contact House Public Information Services in Room 175, State Office Building at 651-296-2146 or the Senate Information Office, Room 231 State Capitol at 651-296-0504. Consider participating in a fund-raising campaign to raise money for diabetes research. Juvenile Diabetes Research Foundation (JDRF) has an annual walk to raise awareness and money for research and the American Diabetes Association has an annual bike ride to do the same. Consider donating money to send a child or adolescent to diabetes camp. I have volunteered at a diabetes camp for kids for 5 years, and it is a life-changing experience. Thank you for your consideration.