Vital Signs Volume 11, Issue 3 - Page 4

How do you screen for diabetes? One way is to get a random blood sugar test. Lets say someone comes in. They’re overweight, fatigued and urinating frequently. The person doesn’t have to fast. We test the blood sugar then and, if its over 200 and in the presence of symptoms, they have diabetes. If you’re screening someone who has a family history but they say they feel fine, in that setting it is best to get a fasting blood sugar. That means no calorie intake for eight hours. If you have a fasting blood sugar of 126 or more, that’s type 2 diabetes. Smoking cigarettes and drinking alcohol. Could those lifestyles lead to type 2 diabetes? In terms of causation, probably not. Of course, smoking is bad for anybody. But, it probably can’t lead to diabetes. Now, excessive alcohol intake can lead to diabetes by a number of paths. First, alcohol has a fair number of calories so it can be a major factor in leading to obesity. Chronic excess intake of alcohol can also cause the pancreas to become scarred and not work properly. That can lead to insulin deficiency similar to what happens with type 1 diabetes. So alcohol can be a factor, but in most cases where a patient is drinking in moderation, there’s not a really close link. What are the dangers of uncontrolled type 2 diabetes? Diabetes is the seventh leading cause of death in the United States, the leading cause of blindness and the most frequent cause of kidney failure. I have to remind patients of this all the time. We are so often trying to control a patients health and we have to sometimes step back and say, ‘Why are we doing this?’ Those are the reasons. Is type 1 diabetes passed along genetically in a way similar to type 2 diabetes? How will treatment change? Talking about type 1 diabetes, it is typically onset in childhood and is a lifelong condition, correct? As of right now. But, in your lifetime, that will change. 4 There are several avenues of research which are going on in type 1 diabetes that are very promising. One avenue is research which will lead to the development of what is called a closed loop insulin pump. It will probably be available in the United States within a couple of years. This is a device where a sensor is inserted under the skin and detects glucose levels. The information is relayed to the pump and the pump will know how much insulin to secrete, acting as an artificial pancreas. There’s another avenue of research that could potentially lead to a cure, but we’re further away from that goal. Actually not. The genetics of type 1 diabetes and type 2 diabetes are very different. Type 1 diabetes is part of an umbrella of diseases we call auto-immune diseases. Families who have this auto-immune tendency pass it from generation to generation, but it could manifest in different ways. It could be type 1 diabetes. It could be an auto-immune thyroid disease. It could be Crohn’s Disease or Lupus. All of these are auto-immune conditions. With type 1 diabetes, I’ll ask the patient if they have a relative who has injected insulin. Most of the time they’ll say no. But if you ask further questions about family members who have some of the diseases I just mentioned, often times there is a family member that fits the criteria. That’s something I call the auto-immune thread. VITAL SIGNS Volume 11 • Issue 3