Diabetes 101 -- What You Need To Know
From:
Jill Daniel
58 days 17 hours 18 minutes ago
"Diabetes, type 1 or type 2, is such a constant burden that it’s one of the few illnesses that defines a person – “I’m a diabetic.” -- Dr. Daniel Einhorn
With Diabetes on a disconcerting rise in the US, Glam sat down with Dr. Daniel Einhorn, MD, FACP, FACE, Medical Director of the Scripps Whittier Institute for Diabetes and Clinical Professor of Medicine, University of California, San Diego to get the low-down on this disease. Dr. Einhorn is also the President of Diabetes and Endocrine Associates, Trustee, American College of Endocrinology, and Vice President, American Association of Clinical Endocrinologists.
Q: What happens in the body when you have diabetes and what is the difference between Type 1 and Type 2 Diabetes?
A: In normal physiology, insulin is a hormone made by the beta cell of the pancreas whose function is to enable glucose to get into cells for energy. In diabetes, there is either absence of insulin (Type 1) or resistance to insulin (Type 2).
In Type 1 diabetes there is no insulin because the beta cells are destroyed by an autoimmune process whose trigger is unknown. People with type 1 diabetes, who make up 5-10% of all diabetics, are often lean and otherwise healthy.
Type 1 diabetes ALWAYS requires round-the-clock insulin and lots of blood sugar monitoring. You need a team of health care professionals who are interested in your overall well-being and you will usually be seen, at least initially, by an endocrinologist and by a diabetes team including a certified diabetes educator, a registered dietician, and if you’re lucky, an exercise physiologist and a psychologist. Sometimes, a certified diabetes educator plays the role of all 4.
Type 2 Diabetes, in contrast, is very affected by lifestyle. This usually happens in adults who are overweight and have a family history of diabetes, though we are seeing this in younger and younger people because of the epidemic of childhood obesity. In type 2 your body makes insulin but because you are obese, and because of your genetics, your body is resistant to insulin and you just can’t make enough of it to control the sugar. That can be helped by lifestyle changes such as weight loss and fitness, by oral medications, and sometimes insulin.
Q: What are the symptoms of each type of Diabetes?
A: Type 1 diabetes typically has an explosive onset with frequent urination, weight loss, extreme thirst, and blurred vision and often requires hospitalization at the onset. People have died during the onset of Type 1 diabetes because they weren’t expecting it, it just came out of the blue, and they didn’t get medical support in time.
Type 2 diabetes typically has many years where there are just no symptoms at all because the sugar is not high enough to make you go to the bathroom all the time or get up at night to urinate. It’s considered one of the silent diseases, like high cholesterol or high blood pressure. We have about 20 to 22 million American with diabetes and about 7 million of them are walking around with diabetes not knowing they have it. The overwhelming majority of people with diabetes never really have symptoms because their blood sugar just isn’t high enough to give symptoms. The predominant group with symptoms is the Type 1 diabetic at first onset.
Q: Should a women be screened for diabetes regularly and what is considered a normal blood sugar count?
A: Yes, make sure that as part of your regular health monitoring someone is checking your blood sugar. It’s usually a part of your yearly physical examination; there is a chemistry panel blood test which will include a blood sugar count. Just know that if you came to the doctor and were fasting for 8 hours prior, and had a blood sugar test, that blood sugar should not go up above 100. And if you came to the doctor just randomly after having eaten, that blood sugar should not be above 140. Certainly by the time you’re in your mid-thirties, you should know your blood pressure, your cholesterol count, and your blood sugar.
Q: Who is most at risk or should be most concerned about developing diabetes—and is there anything you can do to prevent it?
A: Type 1 diabetes cannot be prevented or reversed yet. It has a genetic component but only 3-5% of parents with type 1 pass it on so typically there is no known family history. If you do have a first degree relative with type 1, new tests are available to predict it and new strategies to make it an easier illness to live with.
Type 2 diabetes, in contrast, offers many opportunities for prevention. You should be concerned about type 2 diabetes if you have a family history of it, if you’re above the age of 45, if you’re overweight—and especially if you’re overweight around the abdomen and upper body. That’s the apple shape versus the pear shape; there really is something to that. And also if your doctor told you that you have a high cholesterol count or high triglycerides or if you have high blood pressure, those tend to go along with diabetes.
So, anything that makes you obese should be avoided…let’s say you’re a big fat eater, you eat a lot of bacon double cheeseburgers and you get fat, that could give you the diabetes…it’s not just about sugary foods and not eating fattening desserts—it’s anything that makes you fat that should be avoided. Being fit and lean is always number one.
Q: What is gestational diabetes?
A: Gestational diabetes is diabetes that develops while a woman is pregnant and usually goes away after delivery of the baby. Every woman who is pregnant is very carefully screened for diabetes. Pregnancy is a huge stress on the body and anything that is a huge stress can cause the body’s blood sugar to rise. Taking care of the diabetes during the pregnancy is extremely important for the health of the baby and mother and it’s also important to remember that after delivery, if you had gestational diabetes, you have about a 50% chance of developing Type 2 diabetes later, especially if they are overweight and there is a family history.
Stats show that if you’re Hispanic and you had gestational diabetes, your chance of going on to type 2 diabetes is very high. You don’t have symptoms of gestational diabetes, so generally you would have no reason to suspect that you had it. That’s why it is so critical that your OBGYN is screening you for it when you’re pregnant. It’s mandatory screening during pregnancy. Gestational diabetes can sometimes be treated with diet alone or oral agents, so it’s really like treating type 2 diabetes.
Q: Have patient regimens become easier in the treatment of diabetes?
A: Yes. For type 1, needles have become virtually painless, insulins have become easier to use, insulin pumps are very effective, and now there are continuous real-time glucose monitors that allow you to stay right on top of your glucose at all times. Treatment regimens for Type 2 diabetes are much easier than they used to be. The medicines today tend to not cause low blood sugars, do not cause weight gain, tend to be very easy to take and really have a very minimal spectrum of side effects. Especially, if you’re diagnosed early, life with Type 2 diabetes can be very, very easy. It can be as simple as taking a blood pressure pill or a pill for high cholesterol. Type 2 Diabetes can sometimes be managed that simply. So, my experience with people who have this type of diabetes today is that they are sometimes shocked at how easy it ends up being if it’s caught early. If it’s caught late and you have lots of problems with your eyes, and your kidneys, and your feet, then that is a different story. And no matter what, attention to diet and fitness remains #1.
Q: Are there any new advances in diabetes treatments?
A: Yes, there are several important new advances. The latest is a whole new class of medicines you can take. There are the hormones that are normally produced when you eat and they are defective in people with diabetes. So, one of them is an injectable and is called Byetta.
Byetta mimics a natural hormone and the beauty of it is that it can induce weight-loss in people with diabetes. It’s really cool! The disadvantage is that it does have to be given by injection a couple of times a day and that’s kind of a hassle. But if you know anything about injections today, the needles have become so great, that you can’t even feel it. You literally can not feel it. It’s not anything like when you give blood or get a blood test which uses a huge needle. Giving yourself insulin or giving yourself Byetta is completely quick and painless.
There is also an oral form which works in somewhat of a different way and it’s called Januvia. It’s a once-a-day pill which helps with your diabetes, will not give you a low blood sugar, but it is less likely to give you weight-loss. Generally, in determining someone’s medication in diabetes, like other medical issues, you have to mix and match among a few medicines to get the best control. We try to get very good control as easily as possible…we make a real effort to make the experience of a person with diabetes as normal and as effortless as possible.
Diabetes, type 1 or type 2, is such a constant burden that it’s one of the few illnesses that defines a person – “I’m a diabetic.” What’s so great about treatment today is that everything that you know that is bad about diabetes can be prevented with early and aggressive management that is within reach of most everybody.
