Tell me about the spectrum of diabetes .
Over 90 percent of people who have diabetes , no matter what the cause , have type 2 diabetes . That used to be called maturity onset diabetes , adult onset diabetes , and it ’ s the diabetes that most people are familiar with . In type 2 diabetes , at least when its first diagnosed , the great majority of patients have more than enough insulin in their system , but they have an increased level of insulin resistance . So their insulin levels are fine or even high , but the insulin doesn ’ t do what its supposed to do because of the resistance factor .
Type 1 diabetes used to be called childhood or juvenile onset . Type 1 diabetes comes on because the pancreas loses the ability to secrete enough insulin . Those patients don ’ t have resistance , they just don ’ t have enough insulin .
Have you seen an increase in type 2 diabetes patients during the 33 years you ’ ve been in practice ?
I see many , many more cases . Until maybe seven or eight years ago , I ’ d never seen an adolescent with type 2 diabetes , now it ’ s not uncommon .
Why is insulin important ?
The hormone insulin is important in glucose ( blood sugar ) metabolism , because it helps certain parts of the body , primarily fat cells , and to some extent liver cells . It helps those parts of the body to be able to take glucose from the blood stream and utilize it for energy . That ’ s why insulin is important . If your body is not secreting enough or if it ’ s resistant to the effects of insulin , then blood sugar levels go up .
What symptoms will a person experience at the onset of diabetes ?
Well , it would depend on the type . For type 2 , most patients have no symptoms early on . None . Because of that , there ’ s a whole screening strategy that is developed . If they aren ’ t being screened or seeing a doctor and time goes on , eventually the blood sugar levels will build to a point where they start to increase frequency of urination . They may notice they ’ re more thirsty , or have to get up at night to urinate where they didn ’ t use to . They will notice symptoms of fatigue and low energy . They just feel tired and lethargic constantly . Some people will notice a change in vision from the increase of glucose levels in the fluid in the eye . It affects the eyes ’ ability to focus properly .
What causes the body to become resistant to insulin ?
There are several factors . One is genetics . Patients usually have first degree relatives , mother , father , brothers , sisters , who have diabetes . The second factor is obesity . That ’ s what most people identify with type 2 diabetes . It equals a large person . Certainly , a majority of the people with type 2 diabetes are obese . And , the reason they have diabetes is the fact that obesity is associated with a certain level of insulin resistance .
Once a patient has type 2 diabetes , it can ’ t be completely eradicated . But , can it be contained and managed to the point where a patient can lead a normal life with diet and exercise ?
The cornerstone of any treatment plan is lifestyle . The lifestyle factors are a good nutritious diet and activity . The types of food a person eats and how much they eat are important . We teach our patients how to eat and about sound nutritional principles . With activity , there are a lot of different things you can do . Its not just saying go out and jog for 15 minutes . Walking , swimming , even things like gardening count too . We ’ re guiding people to become more active in any way they can .
VITAL SIGNS Volume 11 • Issue 3 3