Diabetes Health Article

Demographics

According to the American Diabetes Association, the number of individuals with diabetes in the United States in the year 2002 reached 6.3% of the population, or 18.2 million. This statistic included 210,000 individuals under the age of 20. The risk for death among individuals with diabetes is approximately two times that of non-diabetics. In 2002 research, cardiac disease and stroke were determined to be the leading cause of diabetes-related mortality, responsible for 65% of deaths. Diabetic adults have two to four times increased risk for both cardiac disease and stroke than non-diabetics. Approximately 73% of adult diabetics have elevated blood pressure or use prescription medication for hypertension. The leading cause of new cases of adult blindness from 20–74 years of age is diabetic retinopathy. Approximately 60–70% of diabetics have some degree of nervous system damage called neuropathy. Severe forms of diabetic neuropathy account for more than 60% of non-traumatic lower-limb amputations in the United States.

Preexisting diabetes that is unsuccessfully controlled before conception and during the first trimester of pregnancy can result in major birth defects in 5–10% of pregnancies and spontaneous abortions in 15–20% of pregnancies. If diabetes is unsuccessfully controlled during the second and third trimesters of pregnancy, it can cause high infant birth weight that poses a risk to both mother and child. Gestational diabetes occurs most frequently in African-American, Hispanic or Latino-American, and Native American populations. It is most common among obese women with a family history of diabetes. Women who have gestational diabetes have a 20–50% chance of developing type II diabetes within 5–10 years.

Type II diabetes is associated with obesity, family history of diabetes, prior history of gestational diabetes, impaired glucose tolerance, physical inactivity, older age, and specific ethnicities. According to the Surgeon General, gaining between 11–18 lbs (4.9–8 kgs) above normal weight doubles the risk of developing type II diabetes. Type II diabetes is increasingly diagnosed in children and adolescents, and is most common in females. African-American, Hispanic or Latino-American, Native American, and some Asian-American, native Hawaiian, or other Pacific Islander populations are particularly at high risk for type II diabetes.

By 2002, 8.4% of non-Hispanic Caucasians (12.5 million) over 20 years of age had diabetes. Regional studies done in 2002 indicated that type II diabetes is becoming more common among Native American, African-American, and Hispanic and Latino children and adolescents. Approximately 11.4% of non-Hispanic blacks (2.7 million) over 20 years of age had diabetes. Generally, non-Hispanic blacks are 1.6 times more likely to develop diabetes than non-Hispanic Caucasians. Approximately 8.2% of Hispanic or Latino Americans (2 million) over 20 years of age had diabetes. Generally, Hispanic or Latino Americans are 1.5 times more likely to have diabetes than non-Hispanic Caucasians. Mexican Americans, the largest Hispanic or Latino subgroup, are more than twice as likely to have diabetes than non-Hispanic Caucasians. Correspondingly, residents of Puerto Rico are 1.8 times more likely to be diagnosed with diabetes than non-Hispanic Caucasians in the United States. Approximately 14.5% of Native Americans and Alaskan natives (107,775) who receive care from the Indian Health Service (IHS) over 20 years of age had diabetes. Within this ethnic group, diabetes is least common among Alaskan natives (6.8%) and most common among Native Americans of the southeastern United States (27%). However, Native Americans and Alaska natives generally have 2.2 times increased risk of developing diabetes than non-Hispanic Caucasians. Native Hawaiians, Japanese, and Filipino residents of Hawaii had approximately two times increased risk to be diagnosed with diabetes than Caucasian residents of Hawaii.

Type I diabetes accounts for 5–10% of diabetes cases, and affects approximately one in every 400–500 children and adolescents. Type II diabetes accounts for 90–95% of all diabetes. This form of diabetes may remain undiagnosed for many years. Increased awareness has led to a rapid rise in the number of cases diagnosed each year, in what has been described as epidemic proportions in the United States. In 1990, 4.9% of the American population was diagnosed with diabetes. In 2001, this proportion increased to 7.9%. In the year 2002, the NIH estimated that diabetes costs more than $130 billion in total health care and was the fifth leading cause of death. According to the CDC, from the year 1980 through 2002, the proportion of diabetic Americans increased from 5.8 million to 13.3 million individuals. Estimates revealed that of the children with birth year 2000, one in three will develop diabetes over their lifetime. According to the CDC, more than 1.3 million adults between 18 and 79 years of age were diagnosed as new cases of diabetes in 2003. The CDC estimates that from 1997 to the year 2003, the number of new cases of diagnosed diabetes increased by 52%. Diabetes is predicted to become one of the most common diseases in the world within decades, affecting at least half a billion individuals.

Type I diabetes may cause the sudden onset of any of the following symptoms:

• increased thirst, especially for sweet beverages
• increased urination
• weight loss, despite increased appetite
• nausea or vomiting
• abdominal pain
• fatigue
• absence of menstruation

Type II diabetes may proceed for long periods of time with no symptoms. When diabetes is present, symptoms include the following:

• increased thirst, especially for sweet beverages
• increased urination
• increased appetite
• fatigue
• blurred vision
• frequent or slow-healing infections (including urinary tract, vaginal, skin)
• dry, itchy skin
• tingling or numbness in hands or feet
• erectile dysfunction in men

Diabetes mellitus impacts many organ systems and can result in many complications. Diabetic ketoacidosis (DKA) is a complication of diabetes caused by the buildup of byproducts of fat metabolism called ketones. Ketone buildup occurs when glucose is not available as a fuel source. Diabetics have a deficiency of the insulin hormone used to metabolize glucose for energy. Because glucose is not being made available for cells to use as energy, body fat is alternatively metabolized. The byproducts of fat metabolism are ketones. The ketones accumulate in the blood and so become present in the urine. DKA develops when ketones are in high enough amounts to cause the blood to acidify. In response, the liver begins releasing glucose to use as an energy source instead of fatty acids. Because the cells cannot take in this glucose in the absence of insulin, it only further elevates the blood glucose level. DKA may be the first symptom that leads to the initial diagnosis of type I diabetes. It may also be a sign that a diagnosed type I diabetic is developing a need for increased insulin. Type I diabetics are more prone to the development of DKA than type II diabetics. In a type I diabetic, DKA can result from infection, trauma, heart attack, or surgery. Type II diabetics usually develop ketoacidosis incidentally under conditions of severe stress. Recurrent episodes of DKA in type II diabetics are usually the result of poor compliance with treatment or diet.

The symptoms of DKA may include the following:

• fruity breath odor
• fatigue
• appetite loss, nausea, or vomiting
• rapid deep breathing
• difficulty breathing, especially when lying down
• decreased consciousness
• mental stupor that may progress to coma
• muscular stiffness or aching
• headache
• low blood pressure

Diabetics may endure periods of hypoglycemia if their blood sugar is unsuccessfully controlled or if they imbibe even small amounts of alcohol. Hypoglycemia is a low level of blood glucose that occurs when the balance between insulin, food intake, and physical exertion is disturbed. Symptoms of mild hypoglycemia include hunger, sweating, anxiety, and increased heart rate. Severe hypoglycemia can lead to a confused mental state, slurred speech, weakness, lack of coordination, dizziness, drowsiness, and loss of consciousness. The loss of consciousness due to low levels of blood sugar is called a hypoglycemic coma.

Diabetics are prone to infections from even simple lacerations. Damage to the peripheral nervous system, called diabetic peripheral neuropathy, may result in decreased blood flow and loss of sensation to the limbs. When there is loss of sensation to the feet, an infection developing from a laceration may go unnoticed and therefore not be properly cared for. Diabetics also have decreased immune defenses with which to fight infection. Because of lack of peripheral sensation, deficient oxygen supply from decreased blood flow, and reduced immune defense, diabetics are prone to developing peripheral gangrene. Small cuts with infections can rapidly progress to death of the tissue, which may require amputation of the affected limb to preserve the life of the patient. Gangrene is responsible for many limb amputations in diabetics. Diabetic individuals are advised to keep their feet clean and dry, and to thoroughly inspect daily for any sign of injury or infection.

Poorly controlled blood sugar also predisposes diabetics to fungal infections of the skin, nails, female genital tract, and urinary tract. Diabetic nephropathy is kidney disease that may occur early in diabetes. Diabetics tend to have severe urinary tract infections and are prone to kidney damage as a result. Diabetics also have an increased vulnerability to kidney damage from high blood pressure. Late-stage kidney disease may display symptoms that result from excessive protein in the urine. These symptoms include swelling around the eyes in the morning, swelling of the legs, unintentional weight gain from fluid accumulation, poor appetite, fatigue, headache, and frequent hiccups.

Diabetic retinopathy develops in 80% of diabetics after 15 years with the disease. Diabetic retinopathy is damage to capillary blood vessels that nourish the retina of the eye due to the effects of poorly controlled blood

sugar. Signs of diabetic retinopathy include decreased visual acuity and floating spots within the field of vision. Diabetics may also develop cataracts, which are clouding of the lens of the eye that develop slowly and painlessly with increasing visual difficulty. The signs of cataracts include cloudy vision and difficulty with night driving due to glare from bright lights. Initially, most diabetics experience only mild vision problems. However, both diabetic neuropathy and cataracts can progress into blindness. Diabetic retinopathy is a leading cause of legal blindness among adults in the United States. The best defense against severe vision loss is early detection and treatment via annual eye examinations, and steps to maintain control over blood sugar, blood pressure, and blood cholesterol.