by Christopher Ferber, PGY-1
It is American Diabetes Month this November and that makes it the perfect time to become familiar with diabetes! I was diagnosed with diabetes almost 5 years ago and before receiving that diagnosis, I did not know very much at all about diabetes. Diabetes is a chronic illness that affects 29 million Americans across the country, over 200,000 of which are children. This disease can lead to many complications, some of which include high blood pressure, heart attack, stroke, eye problems, and kidney dysfunction. Furthermore, in a 2010 study, Diabetes was found to be the 7th leading cause of death in the United States, although that figure is likely underrepresented. As if the burden of this condition wasn’t impactful enough, it has been estimated that Diabetes costs the U.S. almost 250 billion dollars annually. Because of all this data, it is easy to see why it is important to understand Diabetes and what it means for so many Americans.
Diabetes mellitus has been separated by physicians into two categories, type I and type II. These occur in different ways but ultimately lead to a similar result. The underlying problem is that patients with diabetes are unable to process sugar effectively. We obtain sugar from the carbohydrates in our diets, and foods such as breads, starches, grains, fruits, and sweets are all good sources. Normally, the body uses a protein it manufactures called insulin to allow absorption of the sugar into our body so that we can utilize it for energy. Diabetes results because of a lack of, or resistance to, the protein insulin. In type I diabetes, immune cells in the body attack the cells in the pancreas that produce insulin, ultimately leaving the body unable to make any insulin at all. Type II diabetes is slightly more complex. Basically, in people who are overweight or obese, a resistance to insulin develops. This causes the cells in the pancreas to work harder to produce more insulin. Eventually this may result in the body being unable to produce any insulin, similar to type I. At the end of the day, patients with both types of diabetes cannot absorb the sugar from their diets effectively, which leads to high sugar levels in the bloodstream and causes damage over time.
Type I diabetes is treated by providing the body with insulin that it no longer produces. This is done through injections into the skin or with a device such as an insulin pump which continuously delivers insulin. This sounds simple enough, but insulin is a potentially dangerous medication. Too much can lead to decreased blood sugar and serious side effects such as agitation, sweating, lightheadedness and seizures. On the other hand, not enough insulin will lead to prolonged elevated sugar levels in the bloodstream that causes long term complications. Therefore, managing type I diabetes requires very careful monitoring to try and maintain sugar levels within the normal range. Type II diabetes is treated differently because the body is still able to produce some insulin in most cases. The mainstay of treatment is oral pills. There are several classes of medications used, but they all affect insulin. Metformin, likely the most common medication used, helps to make the body more sensitive to insulin, counteracting the resistance that has developed. The other medications act in different ways, some by helping the body to make more insulin, some by helping to decrease blood sugar levels and other by decreasing the amount of sugar absorbed by the gut. In severe cases of type II diabetes, insulin itself can be needed to control blood sugar levels.
Currently, it is not known what exactly causes type I diabetes. It is known that it is the body’s own immune response that causes the destruction of insulin-producing cells in the pancreas and it is thought to be possibly related to certain viral infections, but there is no known way to predict or prevent it. In contrast, type II diabetes can be prevented by maintaining a healthy lifestyle. Exercising regularly and eating a well-balanced diet can help to prevent type II diabetes and even serve to control it in patients who are already diagnosed. When it comes to children, the majority of diagnoses are with type I diabetes, but recently type II diabetes is being seen in younger and younger patients. Given that this is highly preventable, it is imperative to set good examples for children so that they can manage their weight with regular exercise and healthy eating to hopefully avoid any risk of developing this burdensome disease.
For parents of children diagnosed with diabetes, it is vital to start lifestyle modifications and to put the time in to set your child up with good habits early. Managing diabetes is no easy feat, and it can be especially difficult to try to stay on top of your child’s diabetes in addition to everything else required as a parent. Therefore, it is important to encourage children to take an active role in their diabetes care. In the case of type I diabetics, the earlier children are able to responsibly check their own blood sugars and administer their own insulin, the better. This will allow them to develop good habits that hopefully translate into lifelong control of their diabetes. It is also important to recognize the impact that a chronic condition such as this can have on a young life. This is truer than ever when it comes to adolescents because of the strong desire to fit in. Children with diabetes are at higher risk for depression and anxiety. In addition, the experimental nature of teenage years can lead to alcohol and/or substance abuse, which can be more harmful to diabetics. It is therefore very important to make sure that children with diabetes have a good support system, pivotally during adolescence.
November is recognized as American Diabetes Month by the American Diabetes Association. The theme they have chosen this year is “This is Diabetes”. The focus will be on the small successes and issues that Americans with diabetes face on a day to day basis. Ultimately, the goal is to raise awareness and educate the public about the severity and impact of this growing disease. November 14 each year has been termed National Diabetes Day by the International Diabetes Federation and World Health Organization. On this day and during the entire month, take part in the cause and visit the American Diabetes Association website at Diabetes.org to learn more. In addition, lots of resources exist to help families and children cope with and manage their diabetes. One such example is Camp Conrad Chinnok, an outdoor camp for children with diabetes where they are surrounded by peers and learn about living a healthy life and properly taking care of their diabetes. To find out more about this camp, visit http://www.diabetescamping.org/cal. As someone living with diabetes and having to learn the hard way how much effort is required to manage, I know I will be taking part in spreading awareness this November. Will you?
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