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Physician Insight Series

MN healthcare news


Scott Benson, MD

From Minnesota Healthcare News

Dr. Benson is a board-certified family medicine physician at the Apple Valley Medical Center.

What is diabetes? Diabetes, or diabetes mellitus, is a chronic metabolic disease involving high blood glucose. It occurs either when a body doesn’t produce enough insulin or when the body does not respond properly to the insulin it does produce. Insulin is a hormone the body needs to convert sugar, starches, and other food into energy. Diabetes is rapidly becoming a national epidemic. The American Diabetes Association says diabetes affects 29 million people in the U.S. alone—but only three out of four individuals have been diagnosed. There are three types of diabetes: type 1, type 2, and gestational diabetes, which occurs in some women during pregnancy.

What is the difference between type 1 and type 2 diabetes? Type 1 diabetes is sometimes called insulin-dependent or juvenile diabetes. It usually occurs in children or young adults when the body’s immune system destroys insulin-making cells that control blood glucose. Patients with type 1 diabetes need to take insulin injections their entire lives.

Type 2, or adult-onset, diabetes is the most common form and accounts for more than 90 percent of all diabetes. With type 2 diabetes, either a person’s pancreas stops producing enough insulin for the body to function properly or the cells in the body become insulin resistant. Type 2 diabetes can often be treated with lifestyle changes or medications before insulin is needed.

What is prediabetes? Prediabetes is a condition in which blood glucose levels are higher than normal but not high enough to be classified as diabetes. At this stage, cells in the body are starting to become resistant to insulin. The majority of patients who develop type 2 diabetes start out with prediabetes. Some patients with prediabetes benefit from medication, including metformin. Others respond well to medications that control cholesterol, such as statins, or those that lower blood pressure. The best option for individuals with prediabetes, however, is to make lifestyle changes in diet and exercise before the condition becomes full-blown diabetes.

What are the common symptoms of the onset of diabetes? The most common symptoms of diabetes include the following:

  • Increased thirst
  • Frequent urination
  • Extreme hunger
  • Unexplained weight loss (with type 1)
  • Ketones in the urine
  • Fatigue
  • Irritability
  • Blurred vision
  • Slow-healing sores
  • Frequent infections
  • Tingling, pain, or numbness in hands and feet (with type 2)

Some people with type 2 diabetes have very mild symptoms that may not be noticed. Pregnant women with gestational diabetes may not have any symptoms. Physicians can determine if the symptoms are signs of diabetes with one of three tests: A1C, fasting plasma glucose, or oral glucose tolerance.

The initial diagnosis of diabetes can be overwhelming. What advice do you have for people facing this news? Remember that most cases of diabetes can be well managed. Individuals who suspect they or someone they love has diabetes should seek help from a medical professional right away. Together, they can begin to make lifestyle changes that will have a positive impact on the illness. This might include a healthier diet with more fruits, vegetables, lean meats, and low-fat dairy products. It also might include 30 to 60 minutes of physical activity or exercise at least five days a week. Individuals with diabetes should also have regular check-ups so their physician can manage important diabetes indicators.

What advice might you give parents of diabetic children? Parents of children with diabetes have special issues. Managing the disease affects the entire family, and special precautions must be made for those times when the child is away from his or her parents. School teachers, for example, must be made aware of dietary restrictions and signs of distress should your child’s blood glucose level get too low. In addition, the American Diabetes Association suggests that parents develop a written care plan, such as those developed under federal disability law (a Section 504 Plan or an Individualized Education Program) to ensure their child is given the same educational opportunities as others despite his or her diabetes.

What are common treatments and medications for both types of diabetes? Individuals with type 1 diabetes almost always need insulin injections to manage their blood glucose levels. Some people with type 2 diabetes can manage their disease with lifestyle changes involving diet and exercise. Others may need medications to stimulate their pancreas, inhibit the production of glucose from their liver, or block enzymes that make the body more sensitive to insulin. Some may need insulin injections to control their diabetes. Today, there are exciting new products on the market to measure blood glucose and deliver insulin, including blood glucose meters and implantable insulin pumps. There also are effective insulin medications available that act faster and last longer than those used in the past. Metformin is a frequently prescribed medication for patients with type 2 diabetes.

Please discuss recommended diet and exercise habits for diabetics. Patients with diabetes need to watch their diet and eat healthy foods, such as fruits, vegetables, lean meats, whole grains, and low-fat dairy products. They should eat more foods with fiber and fewer with fat and salt. A physician can help to create a meal plan that fits into a person’s lifestyle. Exercise is also important. Patients with diabetes should get between 30 and 60 minutes of physical activity at least five days a week. Individuals with diabetes should also keep their blood pressure and cholesterol levels within a normal range and have them checked by a physician regularly.

What can happen to patients who do not manage their diabetes? Diabetes is serious and can lead to a number of complications, including cardiovascular problems such as ischemic heart disease, high blood pressure, stroke, and peripheral arterial disease. It also can cause kidney disease and diseases of the nervous system, such as neuropathy. People with diabetes are more likely to develop infections, slow-healing wounds, hearing loss, and gum disease. They also can develop eye problems, such as glaucoma, cataracts, and diabetic retinopathy. In extreme cases, diabetes can lead to kidney transplants, blindness, or amputation of feet and legs.

What does the future of diabetes research hold? Recent scientific developments to address diabetes include a “smart insulin” patch that imitates the body’s beta cells by sensing blood glucose levels and releasing insulin. Research is being conducted to develop new medications, to learn about rare forms of diabetes caused by gene mutations, to study the link between obesity and diabetes, and to understand how to reduce cardiovascular complications in people with type 1 diabetes. Medical device companies are conducting clinical trials on a closed loop insulin delivery system, also known as an artificial pancreas. This device links a continuous glucose monitor to an insulin pump in order to deliver insulin automatically.

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