November is American Diabetes Awareness month and a great opportunity to assess how aware we are of diabetes and its impact on our population and economy. It has personally affected my life, both as a medical provider and as a mom.
The Centers for Disease Control (CDC) estimates that, as of 2020, over 10% of the US population (more than 34 million people) have diagnosed diabetes. In addition, another 88 million people (almost 35% of the US adult population) have what is termed “prediabetes” and are at risk for developing the disease. Despite these startling statistics and huge impact on healthcare and workforce economic dollars, as well as the treatable nature of this disease, many remain unaware of what diabetes truly is.
Probably the biggest myth is assuming that a person’s sugar intake is the cause of the disease and that overindulging in sugar or sugary foods can lead people to have diabetes.
The reality is that diabetes is a genetic predisposition that leads to decreased insulin production in the islet cells of the pancreas and can (in the case of type II, or “adult onset” diabetes) involve abnormalities of the insulin receptors on cells. These changes lead to increased “sugar” (glucose) in the blood stream and this increased blood sugar is likely what contributes to changes in the body that results in the complications of diabetes.
What is insulin?
To get technical, insulin is the “key” that attaches to receptors on the cells in the body to allow glucose (blood sugar) to enter and act as energy/fuel for the cell. Insulin receptors are the “locks” that must be opened by insulin to allow glucose into the cell. If there aren’t enough “keys” (insufficient production of insulin by the pancreas) or if the “locks” are broken (insulin resistance) you have diabetes (or prediabetes) and are at increased risk for all the complications associated with diabetes. Ultimately, it is your genes, those traits inherited from your parents and grandparents, that predispose you to these changes in insulin production and insulin receptor sensitivity BUT you can control the IMPACT of these changes.
My son was 17 years old when he was diagnosed with diabetes with a random blood sugar of 352 (normal 80-120) and Hemoglobin A1c of 11 (normal <6). Looking back at the pictures of him from ages 14 to 17, he HAD gained weight as he “ate like a teenager” and got less exercise (due to increased interest in computer games!). Does this change in his diet and activity level (and subsequent change in his appearance/body habits) mean that he DESERVED a lifelong disease? Of course not!! He was just given the unfortunate genetic mix from his father and I that predisposed him to diabetes.
The truth is, at some point, he was going to develop diabetes through absolutely no fault of his own. We discovered later that he likely has Type II, or “adult onset”, diabetes and has done VERY well with addition of medicines (injections and oral medicine) and adjusting his diet and exercise (A1C now 5.7!).
What my son’s story reiterates is that even if you are handed a less than ideal mix of genes you can impact the outcome through your lifestyle choices.
If you have the genetic predisposition to develop diabetes (as it appears about 1/3 of the population may!), you can postpone or prevent complications by taking steps to improve your health. Evidence shows that several factors influence the progression of diabetes complications. First and foremost (and hence the close association in everyone’s mind) is sugar. Keeping blood sugar levels (measured in laboratory testing by a value called Hemoglobin A1C) in a normal range with use of medications and monitoring diet and activity levels, has been shown to substantially decrease the risk of complications from diabetes. In addition to use of medications and monitoring dietary intake (ex eating an apple instead of a piece of apple pie, decreasing saturated fat intake and potentially eating less salt), avoiding smoking, keeping weight in a good range and increasing physical activity all helps to decrease the risk of complications from diabetes. Control of diabetes can allow people to lead full, productive lives without increased concern for heart attacks, strokes, dialysis, amputation, or blindness.
Early awareness of the potential to develop diabetes can allow you to take the necessary steps to make changes in your lifestyle and prevent or postpone development of overt diabetes or its complications.
This article is meant to provide general information only. It’s not professional medical or legal advice, or a substitute for that advice.
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