Written by Thomas J. Hanson, M.D., F.A.C.P.
Endocrinology, Metabolism, and Diabetes

Diabetes mellitus is an extraordinary illness having two varieties: Type 1 and Type 2.

Type 1 diabetes features a pure insulin hormone deficiency, which frequently occurs earlier in life with a dramatic onset like ketoacidosis --a serious medical condition resulting from uncontrolled diabetes. Ketoacidosis occurs when the body uses fat as an energy source and ketones build up in the blood. Ketoacidosis starts slowly and builds up. Ketoacidosis is a medical emergency and requires immediate medical treatment.. 

Type 2 diabetes is much more gradual in onset and very common, afflicting almost 9 percent of those older than age 20 and 18.3 percent of those older than 60.

These currently  account for more than 20 million cases and are expected to double in the next couple of decades.  Alarm and concern has been expressed because diabetes already accounts for 15 percent of all hospital admissions, 20 percent of all hospital days, and 60 percent of all non-traumatic amputations. It is the leading cause of new cases of blindness (ages 20-74), and the most frequent disease to cause kidney failure requiring dialysis and/or transplantation   It is easily the sixth-leading cause of death by disease in America.  The costs were $132 billion in 2002.

How have we developed such a dangerous situation in these times of great knowledge?  The answer may lie in our genetic make-up.  

Our environment is filled with labor-saving devices and stuffed with high-density caloric foods.  Our ancestors were hunters and gatherers, using ancient conservator genes to protect themselves from starvation during times of famine.  Such genes may account for why some folks have so much trouble with weight gain, leading to 60 percent of the population being overweight.

This means 120 million people are more susceptible to insulin resistant syndrome.  These victims have excessive abdominal (visceral) adiposity.  The fat in the blood has a tendency to have raised triglycerides plus lowered good cholesterol (dyslipidemia), while the blood pressure is usually higher than normal.  Uric acid (gout) problems are associated, as are problems with excessive blood clotting plus some forms of cancer (e.g., breast and colon).  The entire situation puts strain on the beta cells that make insulin, the hormone that controls blood sugar, causing abnormalities that are just short of a formal diagnosis of diabetes by definition.

It is from this very fertile “soil” that type 2 diabetes emerges in a slow and silent fashion.  Often it has been present for many years before victims appreciate its presence.   Predictors of its coming include:

• advanced age
• ethnic risk groups (Latino, Asian, African-American, and American Indians)
• polycystic ovarian syndrome
• gestational diabetes (babies weighing more than 9 pounds),
• nonalcoholic fatty liver
• positive family history for  type 2 diabetes
• Obesity/weight gain

The magnitude of the metabolic derangement is overwhelming, setting the body on a collision course with multiple complications.  Vascular problems have two levels of involvement including microvascular disease of the eye and kidney plus larger vessel atherosclerosis causing heart attacks, strokes, and amputations of especially lower extremities.  Neurological damage occurs in both internal nerves (stomach, colon, bladder and sexual function) as well as in peripheral (extremity) nerves that control sensations, movement, balance, temperature, etc.

There is hope for better care of these types of diseases.  Doctors and other interested parties have formed organizations like the American Association of Clinical Endocrinologists, American Diabetes Association, etc., to focus attention on these illnesses. 

Government agencies include National Institutes of Health (NIDDK), Centers of Disease Control, etc., have helped disseminate the latest information and offer guidance.  Pharmaceutical companies have continued to work diligently to develop even better drugs. 

Perhaps of even greater importance are the efforts expended by hospitals, physicians, physician assistants, nurse practitioners, certified diabetic educators, dietitians, nurses, etc., all of whom are working as a “diabetic team” to deliver the most appropriate level of care needed.  The main ingredient necessary to complete this equation is an informed public, willing to join in the fight for diabetes prevention and treatment to save their very own limbs and lives.