HEALTH SENSE
What everybody needs to know about diabetes By Dr. Charles Steiner Tanana Valley Clinic
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ovember is National Diabetes Month, a time when communities across the country join forces to raise awareness about Type 1 and Type 2 diabetes. According to the Centers for Disease Control and Prevention, more than 100 million U.S. adults are living with diabetes or prediabetes. For every two people with diagnosed diabetes, there is one person who has diabetes and does not know it. Of greater concern, the prevalence of diabetes is increasing at an alarming rate, causing many health experts to label it as an epidemic. Type 1 and Type 2 diabetes are different disorders, although both affect blood sugar control. Type 1 diabetes involves the ability of the pancreas to secrete insulin. It often has a genetic cause and is not generally related to lifestyle. Type 2 diabetes represents a gradual process when the body’s ability to manage carbohydrates, especially glucose, becomes gradually less effective over many years. This is called insulin resistance and is often related to being overweight or being under fit. Prediabetes is the time when insulin resistance goes up and before the blood sugars are high enough to be diagnosed as diabetes. Closer to home, the Alaska Department of Health and Social Services recently reported that diabetes is among Alaska’s leading causes of death. Its prevalence has risen from 3.8% in 2000 to 9.9% in 2018. More than 100,000 Alaska adults have been diagnosed with diabetes or prediabetes, with more likely at risk but not yet diagnosed. I am a family physician at the Tanana Valley Clinic and have been helping 22
November 2020 — AlaskaPulse.com
patients with diabetes for over 20 years. Below I address some of the most commonly asked questions about diabetes.
Q. What is diabetes? A. Diabetes is a chronic health condition associated with abnormally high levels of sugar (glucose) in the blood. Insulin is the hormone primarily controlling blood glucose levels. An inability of the body to properly use insulin or the absence or insufficient production of insulin causes diabetes. Q. What is the difference between Type 1 and Type 2 diabetes? A. Type 1 diabetes, or insulindependent diabetes, occurs when the pancreas produces too little or no insulin. Although Type 1 diabetes usually appears during childhood or adolescence, it can also develop in adults. Type 2 diabetes occurs when cells resist the effects of insulin — also called insulin resistance. To compensate, the body increases the secretion of insulin. At some point it can no longer keep up and then secretion drops off to the point where it may no longer be produced. You can think of it as your pancreas working as hard as it can, but eventually it gets tired and is not able to produce the insulin it needs to anymore. About 90% of people have Type 2 diabetes and 8% of people have Type 1. Gestational diabetes, (where blood sugar
increases during pregnancy), accounts for the remainder. Q. How do you test for diabetes? A. One common test for diabetes is called a glycated hemoglobin (A1C) blood test, which measures average blood sugar for the past three months. The test does not require fasting. An A1C level of 6.5% or higher indicates that you have diabetes. An A1C between 5.7% and 6.4% indicates prediabetes. Below 5.7% is considered normal. Physicians recommend getting a baseline A1C test at age 45, or sooner if you are overweight, or have one or more risk factors for prediabetes or Type 2 diabetes. Risk factors include family history of diabetes, high blood pressure, polycystic ovary syndrome, are inactive, have a history of gestational diabetes or of having heavy babies (greater than 9 pound birthweight) or are a member of certain ethnic groups (Black, Hispanic, American Indian or Asian American). Q. What can I do to prevent diabetes? A. Type 1 diabetes is an autoimmune disorder and can be managed but not prevented. You can manage the disease by eating healthy, exercising and working with your doctor to identify treatment options. Insulin is the only currently available treatment of Type 1 diabetes. Researchers are working to fully understand what triggers the autoimmune disease and hope to learn more about ways to prevent, treat and cure the disease. Individuals with Type 2 diabetes have options to manage or prevent their disease. Prior to developing Type 2 diabetes, most people have prediabetes — their blood sugar is higher than normal but not high enough yet for a diabetes diagnosis. More than 88 million U.S.
