In the United States alone, 25.8 million adults and children now have diabetes. The International Diabetes Federation pegs the worldwide total at more than 366 million, recently having made a sharp upward revision. More than 90 percent of these diabetics are type 2, the version of the disease largely induced by a lifestyle of unhealthy eating and inactivity, although some people, including me, are more genetically prone to it than others. We have what you might call a hair trigger.
The good news for type 2 diabetics is that the disease can be well managed. While some people do this admirably, others do so poorly. It’s estimated that seven million Americans don’t manage their diabetes at all, because they don’t know they have the disease. It’s hard to quantify the presence of an invisible disease in those who remain unaware, needless to say.
In my book Sugar Nation (Hyperion, 2011), I reference that famous quote from the Kevin Spacey character in The Usual Suspects: “The greatest trick the Devil ever pulled was convincing the world he didn't exist.” Type 2 diabetes feeds on apathy and denial as voraciously as it feeds on excess sugar.
Given the toll type 2 diabetes takes—amputations, kidney failure, heart disease, and blindness are among the many devastating consequences—how can so many people remain in the dark? For starters, the disease works for a long while in stealth mode. Rising blood sugar and its metabolic syndrome “partners in crime,” high blood pressure and low good cholesterol, lay the groundwork for the disease before manifesting into symptoms. It’s not unusual to have type 2 diabetes for a significant amount of time, even many years, without having enough symptoms to know you’re sick.
People also underestimate the danger type 2 diabetes poses. When the American Diabetes Association asked subjects to rate the threat posed by various diseases, cancer received mostly 9s and 10s but diabetes mostly 4s and 5s. This lack of fear makes it easy to turn a blind eye to symptoms even when they do become discernable. Telltale signs include eating more, drinking a lot of fluids, and going to the bathroom frequently. Symptoms can include weakness and fatigue, a wound that doesn’t heal as fast as it normally would, a decrease in vision, tingling nerves, and headaches. All are easy to chalk up to stress or aging. Often, they’re recognized as symptoms only in hindsight.
The earlier someone rebels against the metabolic process underpinning type 2 diabetes, the better the chances for a successful outcome. Hence the need for early detection or, better yet, prevention. Begun early enough and followed consistently, dietary changes and exercise can manage or reverse glucose intolerance without the assistance of drugs. But you have to know you have diabetes before you can confront it. Wait and it might be too late.
How do we diagnose the undiagnosed so that they can begin changing their lifestyle and receiving treatment? Raising public awareness is essential, as are more widespread screenings. Testing blood sugar is easy and inexpensive. We should also try to reduce the number of diabetics, which will by definition reduce the number of unaware diabetics. Encouraging exercise, warning against the dangers of processed foods and added sugars, and teaching the overweight to lose unwanted pounds safely and effectively can help do this.
One thing’s for sure, though: Until we recognize how big this problem is and alert all of those affected by it, a society-wide solution will elude us.