a growing dilemma diabetes:

story by | lara lunde, MD

Diabetes is a word heard often in discussion centering around the current state of healthcare. We, as a society, are bombarded with statistics such as, ‘23.6 million Americans have diabetes and an additional 58 million Americans have pre-diabetes’ as quoted by the North Dakota Department of Health. I can go further and quote another frightening statement that ‘ diabetes is in the top seven causes of deaths for all age groups 25 and older ’. The statistics are alarming to any set of ears, but allow me to disturb you even further with this staggering statistic—‘with current trends, 1 out of 3 children born today will develop diabetes during their lifetime’. Do I have your attention?

what’s it look like?

Diabetes is defined in Stedman’s Medical Dictionary as a condition caused by an “absolute or relative deficiency of insulin” thereby causing a multitude of other complications related to elevated sugar levels in the body.

Medical providers are often the first-line for discovering, testing and diagnosing diabetes. Common symptoms and signs of diabetes or a pre-diabetic state range from vague symptoms such as fatigue, weight loss, frequent urination, increased thirst, and/or frequent infections to more specific symptoms such as increased nighttime urination, lethargy, skin pigmentation changes, daytime urinary incontinence in a previously continent child, and/or visual changes. The younger the child, the harder it is to diagnose. For diaper-clad children, we often look to the child who has continuous diaper dermatitis. Unfortunately, younger children under the age of six, tend to present more severe symptoms and signs at diagnosis than older children or adults. Extreme cases of diabetes can result in emergency room visits and/ or admission to the hospital. Once suspicion is raised based on history collection or physical findings, then the appropriate lab work often reveals and confirms the diagnosis.

Diabetes is a complicated medical diagnosis, and to make matters worse, the lines between Type 1 and Type 2 become easily blurred. In the medical world, we use jargon such as “insulin dependent” or “juvenile onset”. Over time, we have made progress in truly defining these terms on a more standard basis, so that individuals and families can obtain the information they are seeking from appropriate sources. The internet often serves as a primary source of information, but the information obtained can be misleading. For this reason, most primary care physicians try to stick with the terms, Type 1 and Type 2. Factors used to aid in their differentiation include body characteristics, age, insulin resistance, family history, and the presence of certain biochemical markers. Still, with increasing incidence of Type 2 diabetes in children, making the final diagnosis can be challenging even to an experienced clinician. what causes it?

Risk factors for diabetes are multiple. Genetic links are often an immediate interest for parents. Type 1 diabetes is significantly increased in close relatives with reports as high as 30% when both parents are affected. Twins are associated with a 50%–90% lifetime risk if they are identical and 8% if they are fraternal. For Type

2 diabetes, it appears the risk is roughly 40% if one parent is affected and increases to 60% if both parents are affected. Ethnicity is also considered heavily when weighing risk. Native Americans, African-Americans, Asian-American, and Pacific Islander children carry a higher risk for developing diabetes. Girls are more likely to develop Type 2 diabetes, but boys tend to have higher percentages in Type 1 diabetes. There are disease states that are associated with causing diabetes including

Jill Henning, Agent

Bus: 701-893-3000 jill@jillhenning.net