Diabetes stats in the United States are alarming: 38 million are afflicted—that’s 15% of adult Americans—costing the health care system a crushing $413 billion annually. It’s the eighth–leading killer in the country, claiming 400,000 lives in 2022. If trends persist, the numbers of diabetics will triple by 2060.
There are two kinds of diabetes, type 1 and type 2. Both are chronic and caused by excess sugar (glucose) in the blood. A healthy pancreas secretes insulin, the regulatory hormone that lowers glucose. Type 2 is by far the most common form of the disease, affecting 95% of all adult diabetics, and it is linked to obesity. It’s not clear why, but excess body fat causes cells to respond poorly to insulin. The pancreas works harder to produce more of the hormone but can’t keep up. Sugar levels climb, resulting in diabetes.
Type 1 is an auto-immune disease: The body mistakes insulin-producing cells in the pancreas as harmful and destroys them. These patients require insulin pumps or injections. Nearly all young people with diabetes have type 1, but recent studies predict a drastic 700% rise in type 2 cases over the next 40 years among sufferers under the age of 20. A quarter of a million young people may develop diabetes due to escalating rates of childhood obesity.
The symptoms from both forms of the disease include thirst, frequent urination, fatigue or blurred vision. Don’t be fooled into thinking that type 2 diabetes is a milder form than its counterpart. The complications are the same and can be just as devastating: nerve damage, blindness, foot ulcers and kidney disease. Stroke and heart disease kill two-thirds of adult diabetics in the U.S.
More than 40% of American adults struggle with obesity and are at risk for type 2 diabetes. Other common causes are inactivity and poor eating habits (too much starch, sugar and fat), along with stress, poor sleep patterns and aging (45 years or older). Genetics can also be a factor; if both parents are diabetic, there’s a high likelihood their children will be too. Black people, Hispanics and Indigenous Americans suffer a high incidence of diabetes.
You’re screened for diabetes at annual checkups with a simple fasting blood test. A glucose of less than 100 is normal; 126 or higher means you have the disease. If your result is between 100 and 126, you’re considered prediabetic, a condition affecting more than a third of American adults. Prediabetes will likely progress to full-blown diabetes without some simple lifestyle changes.
Treatment of Type 2 diabetes starts with weight reduction, exercise (at least 30 minutes of walking five times a week) and a healthy diet (eating lean meats and non-starchy veggies, avoiding sugary drinks). Medication may be needed: Oral metformin helps cells absorb insulin, and injectables like Ozempic or Victoza lower sugar and promote weight loss. Insulin injections are a last resort. Your medical provider may want you to monitor your sugar at home to prove that your new healthy habits are helping. Some patients use a glucose meter that reads a finger-stick blood sample; many prefer a continuous glucose monitor (a sensor placed under the skin that measures your glucose 24 hours a day).
Regular visits to your eye doctor are a must, and consulting a nutritionist helps—both are covered by insurance. Dental exams twice yearly are important, too, because high sugar leads to tooth decay. Dutchess County offers low cost diabetic services and a free six-week course designed for people living with the disease or those taking care of them.
Diabetes prevention is similar to treatment: Maintain a normal body weight, stay active, manage stress, and eat a diet rich in proteins and greens. Commit to annual checkups and see your doctor if you have symptoms or are at risk for the disease. Remember, one fifth of Americans don’t realize they have diabetes.
Mary Jenkins recently retired after nearly 40 years as a family practice physician in New York state.