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