Diabetes Awareness – You can't control your genes, but you can control your lifestyle choices

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 mother.

The Centers for Disease Control (CDC) estimates that as of 2020, over 10% of the US population (more than 34 million people) have been diagnosed with 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. The CDC also shares “During the COVID-19 pandemic, diabetes emerged as an underlying condition that increases the chance of severe illness. Nearly 4 in 10 adults who died from COVID-19 in the United States also had diabetes.”  

Despite these startling statistics and huge impact on healthcare and workforce economic dollars, , 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 Underlying Cause for Diabetes is Genetics

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.

Breaking down Type I vs Type II Diabetes

Type I is also known as juvenile onset diabetes and Type II is formerly known as adult-onset diabetes” because of significant increase in the number of adolescents who have been diagnosed with this form of the disease. Young people, like my son, who are diagnosed in their teens must begin thinking about the consequences of their actions and are taking medication daily well before most of their peers. 

In Type II diabetes there is less production of insulin from the pancreas but there is also resistance to insulin in the cells of the body. To use an analogy, it means there are less “keys” (insulin) as well as “broken locks” (dysfunctional insulin receptors that normally use insulin to allow glucose/blood sugar into cells to be used as fuel). In Type I diabetes the pancreas stops producing insulin altogether. No insulin means difficulty with getting glucose into cells for energy. Lack of energy source results in death.

Although there is likely a spectrum of diabetes between the entire loss of insulin with Type I and the insulin resistance in Type II, Type I diabetes is an ever-present life-threatening emergency. Although going one day without insulin is unlikely to lead to death, people with Type I diabetes still must think about their illness every day. There is no vacation, no “I don’t want to think about it today,”, no “cheat days.” For them, every single day brings the calculation of how much insulin is needed for food taken in and exercise performed. Few of us can conceive of such an overwhelming, time-consuming process, and it is truly for a lifetime as many times Type I diabetes is detected in early childhood.

The most important thing to be aware of regarding Type I diabetes is that it means monitoring of blood sugar and multiple doses of insulin daily.

Insulin is life sustaining. Although there are many types of insulin available now, there is no other treatment for this disease such as an oral substitute or surgical intervention.

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.

Insulin is an injectable medication (must be given by a needle or tube inserted under the skin) and it must be refrigerated when stored. Insulin was first harvested from animals for use in humans in the early 1920s (the discoverers of the process went on to win the Nobel Prize in 1923). In the 1970s human insulin was manufactured from recombinant DNA and since that time there has been development of a variety of insulins, both long and short acting (as well as combinations of the two) that more closely mimic the way in which insulin is produced and released in the human body. Combined with advances such as insulin pumps (which automatically release specified amounts of insulin through a tube into the body) and continuous blood glucose monitors (which check blood sugar levels without need for repetitive finger sticks to obtain blood), the ease of treatment has improved. 

Maintaining a Healthy Lifestyle is the Best Way to Manage Diabetes  

I have found that the biggest takeaway in Diabetes Awareness is understanding that both types – Type I and Type II - are a biological process that affects up to a third of the US population.

This also means understanding the risk factors that lead to development of this disease and that portions of people with diabetes require their medicine (insulin) to live. Finally, this means that, regardless of type, all persons with diabetes must think about balancing diet, exercise, and medicine to avoid the complications of poorly controlled blood sugar levels for the remainder of their lives.

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.

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 one third of the population may!), you can postpone or prevent complications by taking steps to improve your health. Though the CDC shares that diabetes in young people is on the rise, evidence also 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 (for example, eating an apple instead of a piece of apple pie, decreasing saturated fat intake, and potentially eating less salt), lifestyle changes like avoiding smoking, keeping weight in a good range, and increasing physical activity all help 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. 

For more information, please visit the American Diabetes Association website. Their screening test is a good first step to assess the risk for you and your loved ones.

 

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#1244909687 11/23 (Exp 11/25)