In 2012, 29.1 million Americans, or 9.3 percent of the population, had diabetes, and 1.4 million Americans are diagnosed with diabetes every year, according to the American Diabetes Association. Of those with diabetes, the diagnosis and risk factors are, many times, a result of lifestyle choices that can be reduced or eliminated. Read on to learn more about the myths, facts, treatments, studies and what families need to know about diabetes today.
What is diabetes and what are the different types?
Diabetes mellitus is a disorder of fuel handling, with the main abnormality being an inability to control blood glucose levels. There are two main types and many other less common types that are specific to particular diseases:
- Type 1 diabetes results from the body’s immune system attacking the cells in the pancreas that make insulin, so people simply can’t make enough insulin.
- Type 2 diabetes is a condition where the body needs more insulin than it can make. We call that “insulin resistance,” and it’s usually associated with being overweight, but can even happen in thin people. We don’t know why the pancreas can’t simply make more insulin as needed.
- The main difference between these major types is that for Type 1 diabetes, there is no ability to make insulin, whereas for Type 2, there is some insulin but not enough.
The other kinds of diabetes differ from these main two, but they arise with a specific reason for loss of metabolic control. Examples include diabetes brought on by pregnancy (called gestational diabetes), diabetes because of disease in the pancreas (such as cystic fibrosis, pancreatitis or pancreatic cancer) and even diabetes due to the use of glucocorticoid medications.
What are some common myths about diabetes?
Myth: Diabetes is not a serious disease.
Truth: There’re significant short-term and long-term health problems associated with diabetes. Some people with diabetes have emergencies related to high or low blood glucose levels, and there is a disease called ketoacidosis that can be life threatening. The long-term health problems include specific diabetes-related problems like eye disease, kidney disease and nerve dysfunction, and magnify the risk of common problems like heart disease and stroke. Together, these problems make diabetes a cause of disability and early mortality.
Myth: Everyone who is overweight will develop type 2 diabetes.
Truth: While being overweight can predispose people to diabetes, diabetes affects only a minority of overweight people. However, current estimates are that there are three times as many overweight people with “prediabetes” (abnormally elevated glucose but not reaching levels high enough to call it diabetes) as there are with diabetes. These people are at risk of developing diabetes and should consider some sort of prevention treatment. You can calculate your diabetes risk using an online calculator at the ADA website (diabetes.org), and they also have some resources for learning more about how to prevent diabetes.
Myth: Eating too much sugar causes diabetes.
Truth: There is no direct link between sugar intake and diabetes risk. However, there’s a link between excess overall calorie intake and being overweight with insulin resistance, so there’s a link between overeating and diabetes. If the overeating includes sugar, it can seem as though sugar intake was linked to diabetes risk.
Myth: People with diabetes should not eat starchy foods (carbs).
Truth: Food consists of some combination of fat, protein and carbohydrates. Carbohydrates are the most immediate cause of elevations in blood glucose, and different kinds of carbohydrates can raise sugars more strongly than others. Having said that, carbohydrates are a normal and necessary part of a healthy diet. The diet management that’s part of controlling diabetes includes attention to the amount and types of carbohydrate you’re eating, but it’s normal for people with diabetes to continue to have carbohydrates in their diets. Dessert foods, which tends to be high in carbs and calories, can be successfully incorporated into a diabetes diet by balancing the overall calorie amounts and taking into account the type and amount of carbohydrate that these foods deliver.
What are the symptoms of diabetes?
Common diabetes symptoms are extra thirst and extra urination, sometimes accompanied by unintended weight loss. These are due to very high blood sugar levels. People with new type 1 diabetes can sometimes have ketoacidosis, which has symptoms from high blood sugar, but they may have an unusually rapid rate of breathing or a “Juicy Fruit” odor to the breath. If you recognize these in a friend or family member, seek medical attention right away. Type 2 diabetes can first show up with the common symptoms previously discussed, but most commonly is found through routine testing and identifying an elevated blood sugar level. Sugar levels can be clearly above normal but be associated with minor symptoms or no symptoms at all.
What is the treatment process for the different types of diabetes?
For all types of diabetes, diet management is a mainstay of glucose control. For people who are overweight, the diet management may include calorie reduction to help with weight loss. Exercise is an important component of overall health, and may also help with weight loss. In terms of medications, type 1 diabetes requires insulin treatment. People with type 2 diabetes may be able to manage their diabetes with diet and exercise alone, or with one or more oral medication, but also may require insulin. The treatment requirements for people with the less common types of diabetes differ according to the type. For example, if someone needed to have their pancreas removed, they would not be able to make their own insulin and would need treatment with insulin.
Are there studies being performed for new treatments and advancements?
There are always new advances in treatments and devices to help with the management of diabetes; the past 20 years have seen remarkable advances in new diabetes medicines and insulin delivery devices. Sometimes studies are part of a program to bring a new medication to market, and sometimes studies are evaluating new ways to use existing treatments. Here at IU, we have ongoing studies of diabetes prevention using diet and exercise, diabetes prevention using medications, diabetes treatment at early and later stages of diabetes with medications, and also treatment of depression as a part of diabetes management. We have teams of investigators focused on diabetes prevention, type 1 diabetes, type 2 diabetes and pancreatitis-related diabetes. As part of the national community of diabetes researchers, we have connections to help people find studies that fit each person and can work with interested individuals to find studies of interest to them.
Where can people seek treatment and studies in Indiana?
Treatment for diabetes is often managed by primary care or family doctors, and if someone is concerned about their diabetes symptoms or diabetes risk, their first stop should be their regular primary care doctor. If you have symptoms suggesting you might have a diabetes emergency, visit the nearest emergency room. Diabetes specialists are called endocrinologists, and each major hospital system has endocrinologists available to help with diabetes care. At IU Health, our website includes information on our team of diabetes specialists (iuhealth.org/diabetes-endocrinology). There are lots of ways for people to look for studies to learn more about. Here at Indiana University, there’s information about all our research studies through the university’s research website (indianactsi.org). The Diabetes Research Center has studies underway in diabetes treatment and prevention, and people can learn more about those through cdmd.indiana.edu and medicine.iupui.edu/dtrc. Or, people may prefer to simply call us to discuss their questions at (317) 274-7679.
Dr. Kieren Mather specializes in endocrinology, diabetes and metabolism at IU Health.
