WHAT IS DIABETES?

Diabetes: The Silent Epidemic

Ask anyone if they know someone who has diabetes. Almost everyone will say yes, because about 1 in 10 people in America have the disease.

In five years, that number may rise to 5 in 10, a full 50% of the population.

Diabetes, once rare and thought of as a disease of old age, is relentlessly tightening its grip on America, despite decades of dire predictions, calls to action, and billions of dollars spent on research and care. Genetics, non-nutritious diets, inactivity, and obesity all play a role in the surging rates of this chronic, incurable – but manageable -- illness.

Diabetes is truly a silent disease, affecting the pancreas and allowing sugar to accumulate in the blood. Too much blood sugar wreaks havoc. It damages the vessels that supply blood to our organs, upping the risk for heart disease, stroke, kidney disease, vision and nerve problems. Blood circulation can become constricted, resulting in hundreds of thousands of amputations a year.

What Is Diabetes?

What makes someone’s body go so haywire?


Diabetes undercuts one of the most basic functions of our bodiesour ability to store sugar into our cells. The cause: either the pancreas stops producing insulin, the hormone that manages our blood sugar levels, or the body becomes unable to properly use the insulin. Without enough insulin, our bodies can't store the sugar in fat, muscles, and other cells to use as energy. The extra sugar flowing through our blood vessels eats away at our organs, and myriad health problems emerge. This complex cause and effect is not well understood by the public. People with diabetes are often blamed for their disease, even though the disease is biological. Such shaming doesn’t happen with other diseases, such as cancer, heart disease or other medical conditions.


Does diabetes affect all ages and races?


Yes. Statistically, Native Americans, African Americans, Latinos and Asian Americans have a higher rate of diabetes than the white population. But our genes do not work in a vacuum, and diabetes is not predestined for any racial group. Communities where newcomers are eating highly processed American diets for the first time are especially vulnerable. Diabetes also can be related to poverty, which is usually accompanied by less access to fresh whole foods, exercise and health care.


Do bad eating habits cause diabetes?


Not everyone who consumes a lot of sugar gets the disease. But processed, sugary drinks and foods are certainly part of the problem. Some companies target communities of color with ads for sodas and high-sugar snacks. In these communities of color, people may also have limited access to healthy foods. And many of us, in all communities, are living increasingly sedentary lives.


Aren’t there two types of diabetes?


Yes, there are two types of diabetes, and they are both complex and can be difficult to manage. In Type 1 diabetes (formerly known as “juvenile diabetes”) the immune system attacks and destroys the part of the pancreas that makes insulin. Scientists believe the attack may be genetic or triggered by a virus or other environmental factors. With Type 2 (formerly known as “adult-onset diabetes”), which accounts for about 95 percent of diabetes cases, the body resists the insulin the pancreas produces, and over time insulin production fails. Type 2 is triggered by many factors: the person’s genes, their environment, getting too little exercise, gaining too much weight and eating too much highly processed, sugary food. Both types are skyrocketing, and both are occurring at younger and younger ages.


What happens if someone’s blood sugar levels are too high or too low?


Blood sugar levels can drop precipitously from some diabetes medications and cause a whole range of symptoms, including loss of consciousness. Low blood sugar can be fatal. High blood sugar—essentially a state of untreated diabetes—can put a person in immediate danger and also cause long-term nerve and organ damage.


Will diabetes go away if a person takes insulin?


People with Type 1 diabetes and some people with Type 2 use insulin, but it is not a cure; it is a treatment that is replacing what the pancreas should produce. Type 2 diabetes can also be treated with other medications, diet changes and weight loss, but again, this is treatment, not a cure.


Is diabetes a new disease?


Records of diabetes go back to the pharaohs. One ancient papyrus describes treating the disease with seeds, honey and yellow ochre clay. There were no better treatments until 1921, when insulin was discovered.


What are the first signs that a person might have diabetes?


One of the most common signs is frequent urination, along with unquenchable thirst, sugar cravings, and general malaise.


What are the new methods or treatments?


Diabetes costs the U.S. more than $325 billion a year, but public funding for the disease does not match the disease burden. Even with the limited funding, there are promising new ways to treat the disease. Some of the most exciting treatments, still in early stages, are aimed at diabetics who require insulin: devices that are called an “artificial pancreas,” an “autonomous insulin delivery” (AID) device, or a “closed loop” system. These systems use communication between three small portable devices -- a continuous glucose monitor, a smart phone and an insulin pump -- to take over monitoring and dosing the person’s insulin needs. The system checks and adjusts insulin doses every five minutes, eliminating hundreds of decisions that most people with diabetes have to make every day.



Daphne Northrop, editorial project manager at WGBH in Boston, is a broadly published author and editor who specializes in education and health.