A word from Dr. Pfenninger Screening for pre-diabetes and Type II diabetes mellitus|
Unbelievably, about 115 million people in the U.S. have pre-diabetes or diabetes. “Pre-diabetes” is defined as impaired fasting glucose, an impaired glucose tolerance test, or an increased average blood glucose (sugar) level as indicated by the elevated blood hemoglobin A1C level.
The definition of levels are as seen in the attached table.
A difficult issue to deal with when talking about diabetes is all the different terms involved. “Type I diabetes” is usually diagnosed in children and young adults. Previously it was called juvenile-onset diabetes mellitus (JODM), or insulin-dependent diabetes (IDDM). It occurs in approximately 5 percent of people who have diabetes. Type I diabetes is an auto-immune disease where the cells in the pancreas that make insulin are attacked by our immune system. Some experts feel that viruses may be involved in this. There is little or no insulin made by the body.
Type II diabetes was previously known as adult-onset diabetes (AODM) or non-insulin dependent diabetes mellitus (NIDDM). It is usually diagnosed in adults. In a normal-functioning body, insulin is made in response to the stimulus of food. The insulin allows glucose (sugar) to enter the cells to create energy. However, in Type II diabetes, although insulin is made, the cells don’t use it appropriately. This is called “insulin resistance.” Initially, the body will make more insulin to compensate, but eventually it is not enough and blood sugars rise. Most people with diabetes have Type II. Approximately 27 million Americans have, by definition, Type II. Eighty-six million are diagnosed with “pre-diabetes.” In pre-diabetes although glucose levels are not totally normal, they are still not high enough to meet the criteria for true diabetes mellitus.
Many older patients will refer to “sugar diabetes.” Basically, when we talk about diabetes, it is all “sugar” (glucose) related.
Hemaglobin A1C is a type of blood test which is able to determine what the average glucose level was over the past two to three months. It’s an excellent test and very reliable and provides more of an average than a single glucose reading.
There are many risk factors for diabetes. These include genetics; family history; some ethnic groups like African Americans, native Alaskans and Hispanics; excessive weight (the most likely reason that many children are now being diagnosed with Type II diabetes); some livers that put out too much sugar; age (over 45); lack of exercise; a diet of red and processed meats; and increased dietary dairy and sweets. Some medications like diuretics may also increase blood glucose. Stress is a common factor. Women who have diabetes during their pregnancy or a baby weighing over 9 pounds at birth are more likely to have diabetes. Another condition in women, polycyctic ovary syndrome (PCOS), also can be a risk factor.
Initially, blood sugars are elevated without any symptoms. Once sugars become high enough, the following symptoms are likely: increasing thirst, and urinating often, blurred vision, slow healing of wounds, recurrent yeast infections, numbness or pain in the fingers and toes, and fatigue. One-third of those with diabetes will experience sexual problems, with many men experiencing erectile dysfunction.
Because there is a late onset of symptoms, it is important to identify diabetes early. The United States Preventive Services Task Force (USPSTF) has just completed its review of screening guidelines for diabetes (2015). It recommends that all adults 40 to 70 years of age who are overweight or obese be screened every three years with a hemoglobin A1C level, a fasting plasma glucose level, or an oral glucose tolerance test. They recommend consideration of screening at a younger age or at a lower body weight in adults with any of the risk factors mentioned above.
Type II diabetes, if untreated, significantly increases the risk of multiple conditions including kidney failure; a buildup of plaque in the arteries leading to strokes, heart attacks, peripheral vascular disease with lower limb amputations; blindness; dementia; and depression.
Treatment for pre-diabetes and Type II diabetes starts with changing lifestyles. The USPSTF strongly recommends intensive behavior counseling to help those diagnosed improve their diet and increase physical activity. Losing just 7-10 percent of weight cuts risk of complications in half. Exercise is immensely important. Blood pressure needs to be controlled. Reducing stress through relaxation techniques like meditation, yoga and tai chi are important.
If behavior modifications don’t bring glucose levels down, then medications are needed. Some increase insulin output and some just help the cells use glucose better. When medications fail, insulin is needed. There are also now newer non-insulin injectables which make the body produce more insulin.
We certainly hear a lot more about diabetes nowadays. As a physician, I see many more people coming in with the diagnosis of pre-diabetes or Type II diabetes. It really appears that most of it is based on our change in lifestyles as we have become more sedentary and consume excessive processed foods. As we live longer, the effects of diabetes have a longer time period to affect us. The diagnosis should not be taken lightly and must be screened for and addressed.