Diabetes – by Melissa Hicks M.D. of MAHEC Family Health Center
Diabetes has gotten lots more press lately, as it relates to health in general, and the increasing issue of other health related developments, such as obesity. For the purpose of this writing, Diabetes or Diabetes Mellitus will refer to the “Adult onset” or commonly known “Type II” Diabetes, usually diagnosed in adulthood (also more and more young adult/teens, too).
There is a “type I” Diabetes Mellitus that occurs earlier in life, also previously known as “Insulin Dependent”, or “Juvenile onset”.This article will not address that entity.
The definition of Diabetes, and its signs (physical findings), and symptoms, (things we feel) are broad, and the presumed causes are multiple. Genetics (inherited states) clearly play a role in Diabetes, as well as lifestyle issues, exposure to certain medications or chemicals, and the presence of other heath problems. Commonly the Diabetes of adulthood (or older adolescence, also) is characterized as “Insulin Resistant”, meaning the body (and its pancreas) still make insulin, but the cells do not use that insulin correctly or efficiently. Therefore the pancreas makes MORE insulin, to try to compensate. When the body cannot increase its insulin enough to overcome the resistance at the muscle, liver and other cell level, actual diabetes occurs.
Insulin is needed to help the body use glucose for energy. If the glucose (sugar) in the system is higher than the insulin can handle, Diabetes is the end result. There is an even more complex explanation to this process, but the gist is this: there is both too much insulin and too much glucose, but the interaction between the two in the body is flawed. Unfortunately, Insulin is a “pro-growth” chemical, so the body often responds to the increased insulin by increased appetite, and increased fat production. This just compounds the problem. (not fair, is it?) So, in general terms, Adults with new onset Diabetes are experiencing too much glucose, AND too much insulin, but the body is not able to match those up efficiently. Now, to be even more confusing, there are some adults who develop an insulin deficiency quickly, so don’t fit the “mold” of adult onset (TypeII) Diabetes (DM). The most common presentation however, is of an overweight adult with decreased activity, a family history of Diabetes, (or a personal history of Diabetes in Pregnancy (known as Gestational Diabetes), beginning to show signs or symptoms related to Diabetes.
The signs and symptoms of Diabetes Mellitus can be obvious or subtle. The first signs may be “classic”, like increased thirst (polydipsia) and increased urination (polyuria); or may be fatigue, weight change (often loss or sometimes gain), increased triglycerides (fats ) in a blood test. Weight gain and fatigue can be fairly common in adults, so these signs could be perceived as “normal” aging, or normal with a busy lifestyle. Because Diabetes affects small (micro) and large (macro) blood vessels, sometimes the first signs are changes in the end organs supplied by these blood vessels, such as
the eyes (vision or exam changes),
the heart (a heart attack, or preliminary symptoms, like angina),
the kidneys, and/or
the sensation of the skin of the feet, legs and hands (known as Neuropathy).
Women in particular may have increased YEAST infections, and
most people will notice some decreased healing, of even some minor cuts or injuries.
Many persons may have actually had diabetes (DM) for 4-7 years by the time they are actually diagnosed, due to the subtle symptoms, unawareness of risk, or perhaps even denial; not to mention possible problems with access to medical care.
The risk factors to keep in mind include:
~ Family History
~ personal History of Gestational Diabetes
~ sedentary lifestyle
~ certain racial and ethnic backgrounds: Native Americans, African Americans, and then Hispanics, are the top 3 risk groups
~ other illness such as heart disease, elevated lipids, may be part of the Syndrome X of hereditary illness that includes Diabetes
~ certain medications affect insulin and glucose metabolism- Steroids, in particular, and some psychiatric medications may, also. (remember some herb/natural compounds have steroid-like effects!)
~ unfortunately, socioeconomics play a part, with the lower SE status seemingly equivalent to less healthy diets and increased obesity (and again sometimes less access to early/consistent medical care)
What can a person do to avoid developing diabetes, or to avoid some of the worse outcomes such as dialysis, loss of toes, feet or legs, heart attack, blindness, etc.? Eat well, maintain a healthy weight, exercise, know your risks, and if you are at risk; be tested early instead of late, as blood glucose (sugar) control CAN decrease the risk of BAD things with Diabetes.
Melissa Hicks, MD Family Physician
MAHEC Family Health Center