What is Diabetes

What is Diabetes? Dr. Larry Ellingson: Diabetes is a disease where the body either doesn't get insulin to reduce the sugar in your blood or it is utilizing inefficiently, and therefore you have to build up the sugar and all the resulting complications come from there. Richard Rubin: As you might know there are two different kinds of diabetes, what we now call Type 1 Diabetes, it used to be called Childhood Diabetes or Insulin-Dependent Diabetes. That type of diabetes is less common, tends it to be the people who are young at that disease, kids or into their 20's, about a million people with Type 1 diabetes. At this point we think there are probably about 10 million people who had diagnosed Type 2 diabetes what we used to call Adult Onset or Non-insulin-dependent Diabetes. That number is really only those who were diagnosed with Type 2 diabetes, there are probably almost as many people who have undiagnosed Type 2 diabetes. So there might be almost 20 million people with Type 2 diabetes. Dr. Larry Ellingson: I think today the most common form of diabetes is Type 2, oftentimes referred to in the past as Adult Onset, but we are now seeing it much younger, where the body is not producing enough insulin or inefficiently using it and most of those 95-plus percent of the patients have Type 2 diabetes today. Richard Rubin: The biggest difference between Type 1 and Type 2 is what's happening with your pancreas and your insulin producing cells. When you have Type 1 there is some sort of an autoimmune process. We don't understand it very well, but it attacks those cells and pretty quickly kills them all. So the body is making no more insulin at all. Someone with Type 1 must take insulin by injection in order to survive. When you have Type 2 diabetes, there are two things going on. One is that your body might be making plenty of insulin, maybe even more than the normal amount, but your body is not using it effectively, what they call insulin-insensitive. Often overweight is a contributing factor to make insulin sensitive. So folks with Type 2 diabetes especially in the beginning might be making less insulin than they need, but they are still making some, and the basic problem at first is that their body is not using the insulin effectively. Now because there are fewer cells over time that are making that insulin, over time those cells burn out, and finally, people with Type 2 diabetes almost always have some of the problems of people with Type 1, because they are making less, and less and less, less insulin. So then they have a double problem. The insulin resistance plus not making enough insulin, get those blood sugars of people with type 2 higher and higher and higher. What are the risk factors for Diabetes? Dr. Larry Ellingson: Weight, certainly being overweight. Lack of exercise, poor nutrition, smoking, all contribute to those, to diabetes. Richard Rubin: That's why Type 2 diabetes is increasing so much. Having a family member who has Type 2 diabetes is also a high risk factor. Also women are more likely to get Type 2 diabetes than men. Dr. Larry Ellingson: Certain ethnic populations have a higher incidence. African-American, Latino and Asian have a higher incidence of diabetes than Caucasian. Richard Rubin: Type 1, it's really hard to say and really -- I guess the only risk factor there is, it is a genetic disease just like Type 2 diabetes is. So that if you have other people with Type 1 in the family, you are more likely to get it, that was still very rare. People often ask me, well, my dad has Type 1 diabetes, what are my chances of getting it? Or my mom has Type 1 diabetes, what are my chances of getting it? The statistics as they are, there are not great statistics that is that we are not actually sure about the answer to the question. But it seems like if you've a father with Type 1, you've about 6% chance of developing in yourself. If you have a mom with Type 1, you have about 3% chance of developing in yourself. So it's better to have a mom with Type 1 than dad with Type 1 if you won't avoid getting the disease. What are the symptoms of Diabetes? Richard Rubin: Basically, what we are talking about is symptoms of high blood sugar, whether you've Type 1 diabetes or Type 2 diabetes. When you have high blood sugars, you're very likely to have certain symptoms, and they include feeling thirsty and urinating a lot. Those are clear signs of high blood sugar. For some people too, high blood sugars lead to feeling tired, run down, people feeling like they have no energy. One of my patients once said to me, I feel like I am walking through molasses when my blood sugars are high. So those are some of the common symptoms. Dr. Larry Ellingson: Sometimes you'll get blurred vision, particularly as you get older in Type 2 patients where you think your vision is blurry. It maybe simply that your blood sugars are elevated and the glucose is concentrating in the lens of your eye, and therefore you looks blurry and you think you need glasses, but that's really, probably an indicator that you should go to the doctor and get your blood sugars checked. Oftentimes seen in elderly patients because they are not managing their blood sugars very well. Richard Rubin: In addition, people who have high blood sugars tend to feel depressed more likely. They sometimes spend more time in bed than other people. They don't sleep as well often because they are up during the night urinating because their blood sugars are so high, because urinating and drinking are also common symptoms of high blood sugar, and people miss more work when they have high blood sugars. What is the role of nutrition, exercise and other lifestyle factors in Diabetes management? Richard Rubin: Well, diet nutrition are really the foundation for any kind of health including health with diabetes, because the food that you take in powerfully affects the blood sugar levels that you have. And so you want to be eating healthy in order to control your blood sugars. This really fits with the whole low-carb fad, I would call it that's going on now, because carbohydrates are the thing that most likely to affect your blood glucose level. So when people want to control their blood-glucose levels who have diabetes, they are primarily counting the carbs they are eating, because it's the carbs, they are going to have the biggest affect right-away on their blood sugar levels. Now nutrition is also important for other reasons, because people with diabetes often focus on their blood sugar levels. But what we talk about now -- when you want to live healthy with diabetes you have to pay attention not only to the blood sugar level, which is measured now by the A1c test that gives you an idea of what your average blood glucose has been over about a three month period. But also the B & the C. ABC, A1c, but also blood pressure and cholesterol. Because blood pressure and cholesterol also contributes substantially to the risk factors for people who have diabetes. Heart attack and stroke are higher in people who have high cholesterol and high blood pressure and those are the diseases that kill most people with diabetes, about three quarters of all people with diabetes will die from heart attack or stroke. So when you think about nutrition, you've got to not only think about the effect of what you read on your blood glucose levels, but also on your blood pressure and your cholesterol levels as well. So you've got to be a healthy eater in all regards to live well with diabetes. Dr. Larry Ellingson: I believe the cornerstone of treatment in the first blush going after diabetes is to manage your diet and get some exercise. Eat less, walk more. Very simple, very difficult to do, very difficult to change behavior. But that's really where you start managing your diabetes, either Type 1 or Type 2 is. Watch what you eat, get more exercise, it just makes your body run better all the way around. Richard Rubin: Exercise is great. We recommend exercise for everybody to be healthy. We know in the study of people who had pre-diabetes that exercise and diet to help those people lose only an average of 10 pounds dramatically reduce their risk of going from pre-diabetes to diabetes. In fact, they reduced it by 58% compared to the control group in that study. So losing 10 pounds through diet and exercise that reducing the risk of diabetes by almost two-thirds, 58%, a very impressive gain. Exercise does help you control your blood glucose levels. Everyone with diabetes knows that. It helps you control your weight, and that also helps you control your blood glucose levels, especially if you have Type 2 diabetes. It makes you feel good, and it specifically improves insulin-sensitivity, which is I mentioned is one of the factors that determines how good your blood glucose control is going to be if you have Type 2 diabetes. Dr. Larry Ellingson: I think all the studies they have shown that just a simple 5% reduction in body weight improves your sensitivity to the utilization of glucose by insulin. So by doing some exercise and watching your body weight, I think we can all get tuned up a little bit better. Richard Rubin: In the old days, I am talking about 300 years ago. One of the very first physicians who looked at diabetes was a professor who thought a British guy, Thomas Willis was his name, and what he said was that diabetes was caused by depression, that depression cause diabetes. In fact, he said something like, the cause of diabetes is an emotional stress -- an emotional state I call extreme sorrow. So for about 300 years, right up into the mid or last century people were looking for what they call the Diabetogenic Personality. What is that personality or that emotional state that causes diabetes, didn't find the thing? So at that point, probably the mid 70s or late 70s when I came on the scene and started doing research in this area, we thought, well, there isn't an association between depression and diabetes, but it's the other way around. Diabetes is such a demanding disease, diabetes makes people more depressed. Now everybody brought that and certainly there are some evidence for that, but then about ten years ago a couple of very interesting studies were done that took people who did not have diabetes or said they didn't have diabetes, divided them into those who were depressed and those who weren't depressed, and then followed them over a period of time. What they found was fascinating. Both of these studies, one in the United States and one in Japan, both of these studies found the people who had been depressed at the beginning of the study were twice as likely to develop Type 2 diabetes during the course of the study than people who weren't depressed. So maybe Willis was right, and we can believe that that might be true. First of all, people are depressed, tend to do those things that make it more likely you're going to get Type 2 diabetes. They are less active, they smoke more, they eat more food, they are more likely to be overweight. So could be the depression triggers behavior that causes you to be at higher risk for developing diabetes. So what we now have a reason to believe is that it can work both ways, that the emotions can affect your diabetes and the diabetes can affect your emotions. Complicated, interesting, and it gives us other ways to help people who have diabetes. If we improve their emotional state they are not only going to feel better emotionally, they are going to feel better physically, because it's going to improve self care and blood glucose control. If we treat depression and people who don't have diabetes but are at risk we might actually be able to prevent them from ever developing diabetes. Kind of exciting!