What Is Diabetes?

Reasons for the Diabetes Epidemic
How Diabetes Happens
Type 2 Diabetes
Type 1 Diabetes
Two Other Types of Diabetes

While diabetes has long been part of human life, its frequency has rocketed upward in recent years. In the last two decades, the number of people with diabetes around the world has risen from 30 million to 230 million. That number is expected to keep climbing and reach 350 million by 2025. The World Health Organization has declared diabetes the health hazard for the twenty-first century.

The situation is no different in the United States, where this disease is now the seventh leading cause of death. From 1997 to 2003, the numbers of Americans diagnosed with diabetes rose by an astounding 41 percent. By 2007, 8 percent of all the people in this country—24 million—had diabetes. More than 6 million of those people do not realize they have the disease, which puts them at great risk. Researchers say the diabetes epidemic will continue to grow worse, since more than 57 million additional Americans have a condition called prediabetes, or high blood sugar not yet at diabetic levels. These people have a high likelihood of developing full-blown diabetes.

This epidemic is creating serious problems for children. In the past, diabetes of any kind was uncommon in kids. Today, however, tens of thousands of young Americans have diabetes, and “of all babies born [in America] in 2000, one-third will become

diabetic sometime in their lives unless they begin eating a lot better and getting a lot more exercise,”⁶ according to the Centers for Disease Control and Prevention.

Reasons for the Diabetes Epidemic

The reason so many children and adults now live with diabetes or face its threat in the future is because of another epidemic now under way in the United States: being seriously over-weight. By far the largest cause for the alarming upswing in the number of diabetes cases is the upsurge of obesity that has hit adults and children alike in the United States. Obesity is the “fastest-growing cause of disease and death in America today,”⁷ according to Richard Carmona, the former surgeon general of the United States.

Nearly two out of three Americans are overweight or obese, and more than 15 percent of young Americans aged six to seventeen fall into that category—more than 8 million. Many of them will develop diabetes, since obese children are twice as likely to develop the disease than those of normal weight. Obesity increases the chances of developing at least one form of diabetes. That form of diabetes is called type 2 diabetes. Too much fat, especially around the waist and abdomen, harms the process by which muscles can absorb glucose. And since diabetes occurs when glucose absorption is poor or nonexistent, being fat can contribute to the development of diabetes.

“A direct result of the obesity epidemic is that type 2 diabetes, previously unheard of in young people, is trickling into our schools,” Carmona said. “And if left unchecked, it leads to serious illness and possible death.”⁸

Fortunately, though, type 2 diabetes can often be prevented by a lifestyle that includes eating a healthy diet and getting enough activity. Furthermore, once someone has developed type 2, it can often be well controlled that same way.

But neither of these epidemics will disappear quickly. According to Carmona, “This effort is probably going to be intergenerational because we have a society of 200 million people who need to change their purchasing patterns, their eating patterns, activity patterns. It will take a while. If we start today, hopefully

we build a legacy, the children inherit it, and it gets better as the generations go along, because we didn't get here overnight. It's taken us decades.”⁹

How Diabetes Happens

Diabetes is a chronic illness, which means it lasts a long time, perhaps for life. It is not contagious. Diabetes occurs because the body cannot properly use the sugar that comes from food. The body gets most of its quick energy from a kind of sugar called glucose, and it pulls glucose out of food during digestion. The process of digestion breaks down food into very, very small parts that can be absorbed by the bloodstream. Diabetes results when something happens to disrupt part of this process.

When a person begins eating, digestion also begins. Saliva starts the complex process of breaking down that bite of chicken or bread or apple even before it leaves the mouth. Swallowing food sends it down the esophagus and delivers it to the stomach, where strong natural acids called gastric juices continue breaking down the food into smaller and smaller pieces.

The intestines are next in line in the digestion process. An average adult human intestine can be more than 30 feet (9m) long, divided into the small and large intestines. Food traveling all that way has plenty of time to break down into the tiniest, most basic forms our bodies can use, including molecules of proteins, carbohydrates, fats, and vitamins. One important kind of carbohydrate is the sugar called glucose, which keeps muscles moving and creates important chemical reactions in the body by providing instant energy.

Glucose is also the only energy source for the brain. It is absorbed through the intestinal walls into the bloodstream, and then it travels to every part of the body.

The pancreas is a flat gland located behind the stomach. It is about the size of a hand. Inside the pancreas are thousands of cell clusters called islets of Langerhans, and they contain a special kind of cell called beta cells. The beta cells create insulin, which is a hormone that combines with glucose to help glucose move into all the trillions of cells in the body and give

them energy so they can do their jobs well. A healthy pancreas produces just the right amount of insulin around the clock, based on the amount of glucose circulating in the bloodstream. (This glucose in the bloodstream is also called blood sugar.)

However, if the pancreas cannot make insulin, or if the body cannot use the insulin it produces, the glucose cannot get into the cells. It stays in the bloodstream, keeping the blood sugar levels high and causing damage to the organs in the body. For instance, the eyes of a diabetic person can be damaged by high blood sugars causing blockages in the tiny blood vessels or preventing enough oxygen from reaching the eyes. This can lead to blindness. Diabetes can also cause the kidneys to fail, and then they cannot properly eliminate waste products from the body, which leads to death. Diabetes harms the nervous system by causing a condition called neuropathy. When neuropathy affects the nerves in the feet or legs, they become numb. This can lead to serious foot infections and even amputation of the feet or legs.

Four types of diabetes affect millions of Americans as well as millions of other people around the world. They are type 2, type 1, type 1.5, and gestational. By far, the most common is type 2.

Type 2 Diabetes

About 75 percent of people with diabetes have type 2. With type 2 diabetes, the pancreas can make insulin, but the body cannot use it properly, and so glucose cannot get into the cells. This condition is called insulin resistance. The blood glucose builds up to dangerous levels in the blood and starts to produce symptoms of diabetes.

In the past, most people with type 2 diabetes were adults. It used to be called “adult onset diabetes” for this reason. However, more and more children are developing this version of diabetes, so it is now simply called “type 2.” About 19–20 million Americans have type 2 diabetes.

Type 2 diabetes can take many years to develop. People in this developing stage are called prediabetic—their blood glucose levels are higher than normal but not yet in the diabetic range. They are becoming insulin resistant and will develop diabetes unless they take steps to stop the process.

Can Sugar Cause Diabetes

Many people have the mistaken idea that eating too much sugar causes diabetes. Since diabetes used to be called Sugar Disease and is so closely linked with the blood sugar called glucose, it is easy to see the reason for this mistake. But evidence shows that simply eating lots of sugar does not cause diabetes.

According to family practitioner John Messmer, “A much bigger problem is that people are substituting refined sugar for fresh food and consuming sugary foods rather than whole grains, fruits and vegetables. Whole grain bread is better than donuts, whole grain cereal is better than sugary kids’ cereals, and fresh fruit is better than syrup laden canned fruit.”

In fact, eating too much of anything—carbohydrates, fats, or proteins—can make you fat, and being overweight can cause diabetes. For overall health, eating a healthy diet with moderate amounts of a wide variety of wholesome foods is best. And do not forget the exercise.

John Messmer, “The Lowdown on Sugar: Is Sugar as Unhealthy as Everyone Claims?” www.thedietchannel.com/the-Low-down-on-sugar.htm.

People with type 2 have a strong genetic tendency to develop diabetes. This means they often have one or more relatives who also have type 2. However, other causes also play a big role, especially being obese and having an inactive lifestyle. Too much fat interferes with the muscles being able to use insulin, and lack of exercise only makes it worse.

Actor Mark Consuelos, who is married to actress Kelly Ripa, does not look like he could develop type 2 diabetes. He is slender and healthy, eats properly, and works out regularly. However, his grandfather died of complications from type 2, and his father, great aunt, aunt, and cousin all have it. In addition, he is Hispanic, an ethnic group with high numbers of type 2 diabetics. So he has pledged to maintain his healthy, active lifestyle in the hope that he will not develop the disease.

Fortunately, if he should be diagnosed with type 2 later in life, he has good role models in his family for successfully managing diabetes. His father, diagnosed in 2001, is still “able to participate in activities such as aerobics, weight training, and taking walks with his grandchildren,”¹⁰ he says.

Many times, people with type 2 diabetes can bring their illness under control by losing weight and maintaining a healthy diet and getting more exercise. Sometimes they have to take insulin as well, but not always.

Some people are not able to control their diabetes, or they do not realize the terrible consequences of not controlling it. Becky Allen remembers her grandmother and her great aunt, who developed type 2 in middle age and did not eat a healthy diet. In fact, they so loved sugary foods, they would eat too much of them and then manipulate their insulin to make up for the rise in the blood glucose levels. This is a dangerous thing to do. Becky remembers what happened to her beloved grandmother and aunt: “As they aged and their bodies manifested the cumulative results of denial—the heart disease, excess weight, progressive loss of vision, the terribly long healing process from any casual injury or broken bone (of which there were many), poor circulation, and the attendant terror of some related amputation—they came too late to any recognition of how the choices they had made impacted their health.”¹¹

Type 1 Diabetes

When someone's pancreas cannot make insulin, the person has type 1 diabetes. This type of diabetes occurs mainly in children, and so it used to be called juvenile diabetes. However, as more cases have been found in adults, the term “juvenile” has been

dropped from the name and replaced with “type 1.” About 10 percent of Americans with diabetes have this type. That is an estimated 850,000 to 1.7 million people, with about 125,000 of those being age nineteen and under.

Type 1 diabetes is usually an autoimmune disease. This means that the immune system makes a mistake and begins attacking healthy body parts. Normally, the immune system produces antibodies that destroy bad viruses and bacteria that get into the body, like an army rushing out to stop an invading enemy. For instance, when someone gets a cut on the hand, the immune system immediately starts making antibodies that rush to the cut to prevent infection.

However, with an autoimmune illness, the immune system goes haywire. No one knows why, but it mistakenly sees healthy cells as an enemy and attacks them. When it destroys the beta cells in the pancreas, the body can no longer produce any insulin at all, creating type 1 diabetes.

Alyssa Brandenstein of Evansville, Indiana, was diagnosed with type 1 right around her thirteenth birthday. She had been an energetic, straight-A student all through school, but then mysteriously, “I was always tired, school was harder to understand, and I just wanted to go to sleep all the time. I didn't feel happy,”¹² she said.

Then she suddenly lost a lot of weight over a couple of weeks, and “there was a big change in her,”¹³ says her mother, Mindy. Alyssa's doctor ordered a blood test, which discovered the diabetes, and she developed a condition called ketoacidosis, which can be life-threatening if not treated. Her family rushed her to the hospital, where she was treated for three days in January 2007. While she was there, she and her family received intense training on how to deal with this new situation.

When Alyssa first got sick, she was scared because she did not know what was wrong with her. But when she got her diagnosis of type 1, “I was happy, too, because I knew I would get better,” she says. “And I had lots of people to help me.”¹⁴

Today, with proper care, Alyssa is leading much the same life she did before her diagnosis. She and her friend even made a video about her illness, titled “Alyssa's Dream,” and put it on YouTube.

Ethnic Groups and Type 2 Diabetes

Various ethnic groups in the United States have different rates of diabetes, mainly due to cultural, societal, and environmental reasons. Genetics had also been thought to play a large role, but a recent study by Australian and U.S. researchers seems to have changed that belief.

“When it comes to diabetes, we're finding that genes are no more important for ethnic minorities than for anyone else,” said Stephanie Fullerton, a population geneticist and bioethicist at the University of Washington and coauthor of the study. Factors such as poor diet, housing segregation, and poverty were stronger indicators of the disease than genetic inheritance.

According to the Minority Organ Tissue Transplant Education Program:

• Native Americans have the highest rates of diabetes not only in this country but in the world. This means that the disease and its complications are major causes of death and health problems for them. Amputations, a complication of diabetes, are three to four times higher in Native Americans than in other ethnic groups.
• African Americans are 1.7 times more likely to have diabetes than whites. One-third of the 2.3 million African Americans who have diabetes do not know it, which means they are already beginning to suffer from its complications without treatment.
• Latinos/Hispanic people have twice the rate of type 2 diabetes as whites, with 1.2 million of them having the disease. About 24 percent of Mexican Americans in the United States have type 2 diabetes.

Quoted in “No Sign That Ethnic Groups’ Genes Cause Diabetes,” ScienceDaily, April 16, 2007. www.sciencedaily.com/releases/2007/04/070416132455.htm.

People with type 1 diabetes must take insulin shots several times each day to replace the natural insulin their bodies are no longer making. For that reason, type 1 is sometimes called insulin-dependent diabetes. Alyssa gives herself four insulin shots a day.

Two Other Types of Diabetes

Researchers and doctors now have a name for the kind of diabetes that combines qualities of both types 1 and 2 diabetes. Adults who are diagnosed with diabetes, but are not overweight, have very little resistance to insulin and do not immediately need insulin treatment. They are said to have Latent Autoimmune Diabetes in Adults (LADA), or type 1.5 diabetes. Sometimes people who are first thought to have type 2 are later found to have type 1.5. About 15 percent of diabetics have this type.

The other type of diabetes is called gestational diabetes. “Gestation” or “gestational” refers to the time of pregnancy. Therefore, gestational diabetes happens when a woman is pregnant, and it can happen even if she did not have diabetes before. If left untreated, it can harm the mother as well as the baby. About 4 percent of pregnant women develop this condition. This kind of diabetes disappears after the baby is born, although more

than half of the women who develop this type while they are pregnant will develop type 2 diabetes later in life.

These four types of diabetes all occur when something goes wrong with the pancreas and its ability to produce insulin or the body's ability to use insulin in the proper way. This serious illness is affecting more and more people in the United States and around the world. Fortunately, modern medicine has developed many new treatments and medications that can help people with diabetes live better and longer.