Diabetes is no respecter of body systems
Published on Friday, November 1, 2024
By: Gary Pettus, gpettus@umc.edu
Few other illnesses cause so much grief in the human body in so many ways.
“Diabetes is one of the few medical conditions that can affect all body systems from head to toe,” said Dr. Vishnu Garla, associate professor of medicine-endocrinology at the University of Mississippi Medical Center.
“It can affect the vision, nerves, kidneys, cardiovascular system; it can increase your risk of dementia; it can contribute to falls, decreased muscle mass and osteoporosis [weak and brittle bones].
“As our knowledge of diabetes grows, so will the list of problems it causes.”
The more we learn about this preventable and manageable disease, the better it will be for the health of the nation it’s ravaging. About 38 million people in the U.S. have diabetes, estimates the Center for Disease Control and Prevention, and about 1 in 5 don’t know they have it.
The disease extorted more than $400 billion from this country’s economy in 2022.
“It is one of the most important health problems we have today,” Garla said. “It is insidious and can start before we realize it.”
About 1 in 6 Mississippians are living with it; the state ranks No. 2 nationally for diabetes prevalence, reports the Mississippi State Department of Health. It is the state’s eighth leading cause of death and descends on the body in the form of one of two main types.
“Type 1 diabetes is characterized by insulin deficiency,” Garla said, referring to the hormone that regulates glucose – the main type of sugar in the blood.
“About 5 to 10 percent of patients who have diabetes have type 1. It’s diagnosed, typically, during a person’s childhood or teenage years. Type 1 patients need to be on insulin every day.”
Without enough insulin, which the pancreas makes, sugar builds up in the bloodstream and can damage the body in a number of ways.
But most people who have diabetes – about 90 to 95%, Garla said – have type 2. “They may have sufficient insulin, but the body doesn’t use it properly or the pancreas may not make enough. When we mention diabetes, we are commonly referring to type 2.”
The differences between type 1 and type 2 elude many people. Genetics – heredity – is strongly related to type 1, although other factors can trigger it. An unhealthy lifestyle, including a diet high in sugar and other carbohydrates, is commonly linked to type 2.
“Still, even though children are more likely to have type 1, gone are the days when we though type 2 diabetes affected only adults,” said Dr. Simeen Pasha, UMMC associate professor of pediatrics-endocrinology.
“Because of the obesity epidemic, we are certainly seeing more children develop type 2. The incidence within the last 15 to 20 years has skyrocketed, mostly because of the worsening of obesity.”
Diabetes screening is recommended for children by age 10 or by puberty, whichever comes first, but only if they are obese or overweight and have certain risk factors: family history, “especially if mom had diabetes and if she had gestational diabetes,” Pasha said.
Native Americans, African Americans and people of Hispanic origin are at higher risk. “Type 2 affects Hispanic and African American youth at higher rates,” Pasha said. “Caucasian children have the highest rate of type 1, but we see it in all ethnicities.”
For children and teens, type 1 brings a unique set of problems. “Management of type 1 means insulin, and as children grow, their insulin needs change,” Pasha said.
“They often have to increase insulin doses to keep up with the body’s needs. We also see that, with both types of diabetes, some children are not wanting to check their blood sugar in front of their friends or be seen taking their medications, or do anything like that to make them stand out or seem different from their peers.
“So, unfortunately, in that school setting and when they are with their peers, there is an increased likelihood that they will not be as compliant in taking their medications. Kids with type 1 and type 2 should have access to a mental health provider to make sure they have appropriate means to cope.
“Those with diabetes need the support of adults and their school. Otherwise, it’s more difficult for children to take on the management of their diabetes care.”
The consequences of inadequately managed diabetes can be disastrous. “With type 1, if you’re not taking insulin as you should, you can go into diabetic ketoacidosis, or DKA,” Pasha said. “You can become very dehydrated, and this can lead to admission to the ICU.
“DKA affects the kidneys and the brain and can cause stroke-like symptoms. Low blood sugar is dangerous and can lead to seizures. If diabetes is not managed, damage can be long-term as well, especially to the eyesight, kidneys and nerves.” It could mean a lower-limb amputations.
If you don’t have diabetes already, there are ways to head it off, especially type 2. Improve your diet by cutting back on carbohydrates, including foods with added fat, sugar and sodium; replacing sugary drinks with water; consuming less salt (under 2,300 milligrams per day, but less if you have high blood pressure); cutting out, or cutting back on alcohol.
Those are guidelines from the American Diabetes Association. But there’s more.
“A healthy lifestyle includes getting about 150 minutes of exercise per week,” Garla said. “And losing 5 to 7% of your body weight can significantly reduce your risk of developing type 2.”
These measures are especially important for those living in the no-man’s land of prediabetes, that territory between normal and high blood sugar. An estimated 97 million-plus adults in the U.S. reside there, reports the National Institute of Diabetes and Digestive and Kidney Diseases.
The warning signs for prediabetes are the same for a full-blown case of the disease: increased thirst, frequent urination, blurred vision, fatigue, unexplained weight loss, slow-healing wounds.
“Another sign is the darkening of the skin behind the neck and in body folds,” Pasha said.
But, as opposed to diabetes, which can be treated but not cured, prediabetes can be erased. See lifestyle changes.
Such changes can also benefit patients who have diabetes. And, for them, new treatments have either arrived or are in the works.
“There has been a lot of progress,” Garla said. “Management of diabetes has changed. There are multiple different medications, including GLP-1 agonists such as Ozempic, which is for type 2 patients.”
For type 1 diabetes, the development of an artificial pancreas has been ongoing for the last several years, Pasha said. “It would be a system of automated insulin delivery. There are already systems with continuous glucose monitors and compatible insulin pump devices which relieve the patient of much of the burden of diabetes care.
“There’s also a relatively new medication, teplizumab, which can delay the onset of stage 3 [when insulin is needed for treatment] in type 1 diabetes for up to three years. We are working to make it available here at UMMC.
“And, within the last few years, children with type 2 have had access to the GLP-1 agonists that have been available to adults for years.”
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UMMC diabetes management clinics provide diagnosis and treatment, patient education, insulin therapy and more. For an appointment with an endocrinologist, call 601-984-5525; for an online appointment request, go here. More information about endocrinology services for children is available here.
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