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Diabetes: The Good, The Bad and The Ugly

Mrs. Simmons looked somewhere between stunned and a little depressed.  I had just informed her of the unwelcome news that her lab results showed she was now a diabetic.  “How can that be, I feel as good as ever?”

These days it’s a rather common thing in my office for me to be delivering this news, or even more commonly, that someone is pre-diabetic (something called impaired glucose tolerance).  Often they had few if any symptoms to tip them off.

If you read health news from time to time, you may have seen that we are currently in the midst of what has been called a diabetes epidemic. The incidence of type 2 diabetes has more than doubled since 1990 and the CDC recently reported that about 40% of US adults will develop diabetes, primarily type 2, in their lifetime, and more than 50% of ethnic minorities will be affected.  On top of that, nearly 30% of diabetes sufferers don’t know they have the malady.

So what is diabetes?  There are primarily two types: type 1 is what used to be called insulin-dependent diabetes or juvenile onset diabetes.  But the type I deal with day in and day out is type 2 diabetes mellitus (DM2), formerly called non-insulin-dependent diabetes or adult-onset diabetes.  DM2 involves elevated blood sugar resulting from the combination of decreased amounts of insulin being secreted from the pancreas, increased resistance to the effects of that insulin on the rest of the body, and excessive secretion of a hormone called glucagon which has many effects opposite to those of insulin.

Why the big increase in DM2?  Although some people certainly have more or less of a genetic tendency to DM2, the forces driving the diabetes epidemic are primarily three:  obesity, physical inactivity, and the excessive carbohydrate intake of our American diet.

So what’s the big deal about blood sugar running a bit high (or sometimes a lot high), especially if I don’t really feel that bad?  Unfortunately the complications of DM2, especially when it’s not well controlled, are many and serious.  Diabetes:

  • is the major cause of blindness in adults aged 20-74 in the U.S. accounting for some 20,000 newly blind persons every year.
  • is the leading contributor to kidney failure in the U.S.
  • is the leading cause of non-traumatic lower limb amputations in the U.S.
  • triples the incidence of heart disease
  • increases risk for many types of cancer
  • causes neuropathy (nerve damage) in the extremities, leading to numbness or constant burning pain

How would someone know if they had DM2?  Some people have the classic symptoms of increased urination, increased thirst, increased appetite or blurred vision.  But many individuals feel pretty normal, especially early in the disease.  So a blood test is the most reliable way to really know.

Ok, so that’s a lot of the bad and ugly news about DM2; what about some good news?  There really is some good news.  It is one of the most satisfying parts of my practice to see how dramatically DM2 numbers can improve and even reverse when someone gets serious about changing their lifestyle to treat their disease.  We’ve had many folks with out-of-control DM2 who started exercising regularly and dropped their carb intake to well under 100 grams per day with the result of excellent control and minimal complications of their DM2, often with no meds, and with a side benefit of some welcome weight loss and increased energy.

Even better, adopt the low carb way of eating and incorporate aerobic exercise (even a brisk walk is a place to start) for 30 minutes 5 days a week before diabetes ever sets in.  But if you haven’t been checked for diabetes recently, get it checked so you can tackle it before it ever gets bad or ugly.

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