There is a diabetes crisis in America, and it is getting worse.
According to the American Diabetes Association (ADA), more than 37 million Americans have diabetes – which is a staggering 11 percent of the population – and the numbers continue to rise.
The disease hits older Americans the hardest, afflicting 29 percent of those over 65. But cases are projected to increase among much younger people in coming years.
According to the CDC Newsroom: “Type 2 diabetes has substantially increased among young people over the last two decades … and the number of young people under age 20 with diabetes in the United States is likely to increase more rapidly in future decades, according to a new modeling study published in Diabetes Care in December. Given this upward trend, a total of 526,000 young people may have diabetes (including both type 1 and type 2 diabetes) by 2060.
Comparatively, 213,000 young people in the United States had diabetes in 2017.”
Current diabetes numbers include both diagnosed and undiagnosed cases, based on estimates. Of the many afflicted by the disease, 90 percent to 95 percent have type 2 diabetes. The rest have type 1.
“Diabetes affects all ages and all ethnicities, but the likelihood of contracting diabetes increases 30 percent after the age of 65, especially if there is a family history,” said Dr. Paul Graham, founding member and partner of Diabetes and Endocrine Associates of the Treasure Coast.
“You inherit a predisposition to the disease, then something in your environment triggers it.
“While both types of diabetes are genetically predisposed, the genes for type 1 and type 2 are different,” he continued. “Type 1 diabetes used to be called juvenile diabetes because it usually occurs in teenagers and young adults.
“You are genetically predisposed to type 1 at birth and when you get to be a teenager, certain viruses can attack the pancreas and damage the beta cells so you don’t make insulin. Once the pancreas stops making insulin, the condition will have to be managed by using insulin.
“Type 2 diabetes used to be called adult onset diabetes because it’s more common in middle-aged patients. Its cause is partly genetic and partly environmental. Age, diet and obesity are the triggers for type 2 diabetes, so the older you are and the more you weigh, the more likely you will get it. Type 2 means that your body doesn’t use insulin properly. Some people can control their blood-sugar levels with healthy eating and exercise, while others may need medication to manage it.”
Dr. Graham stresses that if diabetes doesn’t run in the family, you most likely won’t get the disease. You have to first be genetically predisposed and then age and weight make the difference. That being said, more teens with the diabetes gene are being diagnosed earlier because of poor diet, excess weight and lack of exercise.
Gestational diabetes affects nearly 10 percent of pregnancies in the U.S. every year. That doesn’t mean that you had diabetes before you conceived or that you’ll have diabetes after you give birth. It does mean that you carry the gene and the baby was the trigger.
Gestational diabetes can start when the mother’s body is not able to make and use all the insulin it needs for pregnancy. Fortunately, there are medications available to help the mother combat the disease.
Unfortunately, nearly one third of those mothers will eventually develop full-blown diabetes as they age and gain weight, so they should be especially conscious of their diet and exercise regimen.
Dr. Graham feels that the terms prediabetes and borderline diabetes are really misnomers. “It’s kind of like pregnancy,” he said jokingly. “You are either pregnant or you are not. There is no such thing as borderline pregnancy. And there is no such thing as borderline diabetes. Either you have normal glucose metabolism or not.
“If you do not, then you have mild early diabetes. Your blood glucose levels are higher than normal but not yet high enough to be diagnosed as diabetes. While it’s not curable, it can be controlled by weight loss. Twenty percent of diabetics can control their diabetes with weight loss and may never need medication.”
There are several ways to diagnose diabetes and yearly testing should be done in your doctor’s office or a lab.
The A1C test measures your average blood glucose for the past three months. The normal range should be less than 5.7 percent. If your blood glucose is between 5.7 percent and 6.4 percent, you are in the prediabetes or early mild diabetes stage. Higher than 6.5 percent is full blown diabetes.
The Fasting Plasma Glucose (FPG) test checks your fasting blood glucose levels. This test is given after the patient fasts for at least eight hours before the test. Normal results are less than 100mg/dl. A measurement of 100mg/dl to 125mg/dl signifies prediabetes or early mild diabetes, and above 125mg/dl is full blown diabetes.
There is also an Oral Glucose Tolerance test that checks your blood glucose level two hours before and two hours after you drink a special sweet drink. It will tell the doctor how your body processes sugar. Diabetes is diagnosed at a two-hour blood glucose of 200mg/dl or more.
One or more of these tests should be performed during your yearly physical by your primary care physician. Primary care physicians are skilled in treating type 2 diabetes with various medications that auto-regulate sugar in your bloodstream. Type 1 diabetics will most likely be referred to an endocrinologist.
Having diabetes doubles your risk of heart attack, stroke and kidney disease, and was a grim factor during the pandemic, contributing to many deaths, so controlling it is imperative. Most diabetics are also prescribed cholesterol medication to lower their cholesterol and reduce that risk.
The ADA states that you can lower your risk for type 2 diabetes by 58 percent by losing approximately 7 percent of your body weight (15 pounds if you weight 200 pounds) and by moderate exercise such as walking 30 minutes a day. Even if you don’t reach your ideal body weight, losing 10 to 15 pounds can make a huge difference in your risk of diabetes.
“Aside from a healthy lifestyle, the only way to prevent getting diabetes is to pick your parents,” Dr. Graham revealed. “There’s a reason we look like our parents. Not only do we look like them, we also are predisposed to everything they are predisposed to.”
There was good news last week for diabetes patients who need insulin when Eli Lilly announced price reductions of 70 percent for its most commonly prescribed insulins and an expansion of its Insulin Value Program that caps patient out-of-pocket costs at $35 or less per month.
Dr. Graham graduated from the University of Rochester School of Medicine and Dentistry in Rochester, N.Y., and did his residency in Internal Medicine and fellowship in Endocrinology at Wilford Hall USAF Medical Center, Lackland Air Force Base, in San Antonio, Texas. He moved to Florida in 1989 and joined the Doctors Clinic until it closed in 2001. He then cofounded Diabetes and Endocrine Associates of the Treasure Coast specializing in diabetes, thyroid, osteoporosis, adrenal and pituitary disorders. His office is located at 2835 20th St., Vero Beach. Call 772-299-3003.