7 Million U.S. Adults Don’t Know They Are Diabetics

Approximately one in four American adults who have diabetes don’t even know it.

Diabetes is a group of metabolic disorders that involve the hormone insulin, which is responsible for controlling glucose levels in the blood, aka, “blood sugar.”  Glucose is a simple sugar that is found in foods and the liver, and provides for energy and proper functioning of cells.  Its level must be maintained within certain parameters so as to avoid hyperglycemia (high blood sugar) and hypoglycemia (low blood sugar).

A spike in blood sugar generally occurs as the result of eating.  This triggers the release of insulin, which is produced by special cells in the pancreas called beta cells.  Insulin helps the cells in the intestines absorb glucose, where it enters the bloodstream and gets transported throughout the body to provide energy.   Operating properly, this process normalizes and maintains appropriate glucose levels.  Insulin can be seen as a “key,” which opens the cells in the body and allows for glucose absorption.  Insulin also facilitates storage of glucose in the form of glycogen in the liver, fat and muscle for later use.  When the system isn’t working optimally, diabetes can result.

Diabetes is the seventh leading cause of death and it affects approximately thirty million Americans.  Untreated, it can cause blindness, kidney failure and nerve damage.  It is a serious illness and must be carefully managed.  Risk factors include hypertension (high blood pressure), obesity and family history.

There are three main types of diabetes:

1. Gestational Diabetes affects between two and ten percent of pregnant women. Hormone changes that occur during pregnancy can lead to elevated blood sugar levels, which can be dangerous to both the mother and the baby, and result in gestational diabetes.  Most cases resolve themselves shortly after birth, but these babies remain at risk for obesity and Type II Diabetes later in life.  There is no way to predict who will get it, but pregnant women can improve their odds by losing extra weight before pregnancy, eating healthy and staying active while they are pregnant.
2. Type I Diabetes is an autoimmune disorder that is typically diagnosed during childhood. An autoimmune disorder occurs when the body launches an inappropriate immune response against itself.  In this case the insulin-producing beta cells are attacked, rendering the person unable to produce insulin.  When this happens, the body is unable to absorb and use the glucose properly, which causes it to build up in the bloodstream.  Over time, high blood sugar causes many complications that damage the heart, blood vessels, kidneys and eyes.  It causes nerve damage, skin and mouth infections, poor blood flow to the feet (which can result in amputation) and complications with pregnancy.  Diabetes Type I may be caused by genetic factors, environmental factors or exposure to certain viruses.

At its base diabetes is an endocrine disturbance of glucose regulation, but the complications and consequences of diabetes are due to vascular phenomena.  In fact, most people with diabetes will die of vascular complications.  High glucose levels affect the endothelium (the layer of cells lining the vessels that plays a critical role in their tone and structure).  When the endothelium is negatively impacted by diabetes, atherosclerosis can result.  The hardening of these vessels is a dangerous situation that can cause heart issues and end-organ damage.  Small vessel damage is a specific type of deterioration that occurs with diabetes.  While its mechanism isn’t well understood, there are likely several contributing factors.  One of the culprits seems to be glycation end products, or GAEs , which are fats and proteins that have been exposed to glucose.  These byproducts clog the small vessels in the kidneys, eyes, heart and brain and can cause irreparable damage.   Five to ten percent of diabetic patients are Type I.

Though there is no cure for this disease, it is manageable with insulin injections and there are some promising therapies on the horizon.  On January 4, 2018, researchers at University of Pittsburg and Children’s Hospital of Pittsburgh published a study in which they were able to temporarily reverse Type I Diabetes in mice.  The team used gene therapy to direct alpha cells in the pancreas to produce insulin (normally done by the beta cells) and the mice stayed at normal glucose levels for several months before their immune systems figured out what was happening and eventually killed them off.  Studies in non-human primates are going well and the scientists hope to eventually bring the treatment to clinical trials.

3. Type II Diabetes is much more common and typically occurs in adulthood. This is when the body can still produce insulin but doesn’t make enough or use it properly.  Type II is sometimes referred to as “insulin resistant” because the insulin isn’t wholly effective at getting the glucose from the blood into the body’s cells.  When this happens, the pancreas will initially produce more insulin in an effort to compensate, but this will eventually result in increased blood sugar or   Why the body’s ability to properly maintain insulin levels becomes compromised is not fully understood, but poor diet, obesity and genetic factors are thought to be contributing factors.  Healthy lifestyle choices can help to prevent Type II Diabetes – even if your family has a history.  Eating healthy foods, staying active and maintaining a healthy weight can go a long way toward avoiding Type II.

While diabetes is very common, it is treatable and, in some cases, even preventable.  If you are one of an additional eighty-six million Americans that are pre-diabetic, you can take steps to change that.  If you are concerned, your physician can test you and provide helpful resources.  Learn more at diabetes.org.