What is Diabetes?

Diabetes is a metabolic disorder affecting over 30 million Americans or approximately 9.3% of the population.[1] The U.S. spends well over $245 billion annually on direct and indirect costs associated with this disorder. It can have devastating effects on the body including blindness, nerve and tissue damage leading to amputations, kidney failure, and even possible death.

Anyone at any age can develop diabetes. It is considered an inherited disorder which means it runs in the family; however, anyone can develop the disorder. Not only is it a genetic disease, but it also affects certain ethnicities more than others. For example, African Americans, Native Americans, and Hispanics are at the greatest risk of developing diabetes.

So, what is diabetes, can we prevent it, and how do we manage it? First here are some basics. Our metabolism creates energy from the foods we eat. During this metabolic process, our bodies break down fats, carbohydrates, and proteins to either use right away or to store for later use. A metabolic disorder, such as Diabetes, is when the normal metabolic process is disrupted for reasons we have yet to understand.

With Diabetes, the metabolic disruption occurs within the pancreas. The pancreas creates insulin which controls our blood sugars (glucose). Insulin is a hormone that helps store or use the food our bodies process. Diabetes occurs when the pancreas does not properly generate enough, or any, insulin. Or, in some cases, the body does not properly use the insulin created. The low level or misuse of insulin in the body causes increased blood glucose levels, also known as hyperglycemia.

Hyperglycemia can be toxic to the body. With the lack of insulin or poor use of it by the body, the food we eat is not properly broken down or stored which causes high blood sugars. When this occurs, the body turns on itself using its fat storage for fuel; this process is called ketoacidosis. With ketoacidosis, the body becomes malnourished, and we begin to lose weight.

There are three types of Diabetes:

  • Type I (previously known as juvenile)-typically develops in children and young adults; the immune system attacks the pancreas not allowing it produce insulin
  • Type II (previously known as insulin resistant)-typically develops as an adult; the body does not properly use insulin
  • Gestational-during pregnancy mom develops Diabetes

Understanding which type of Diabetes is important as they are medically managed differently. Diabetes is incurable and therefore requires a lifelong commitment to managing the disease. In most cases, there are warning signs; however, many miss these signs and go undetected and undiagnosed for months and sometimes years.

One of the warning signs for Type II Diabetes is called Prediabetes. With Prediabetes, blood sugar levels are higher than normal, but not to the levels considered as Diabetic. Often the medical community calls this, Impaired Glucose Tolerance (IGT). If you have Prediabetes, this is a wake-up call to make lifestyle changes to reduce the risk of developing Diabetes.

A Fasting Plasma Glucose Test (no eating for more than 8 hours) blood sugar results are as follows:

  • Normal range is >100
  • Prediabetes 100-125
  • Diabetes >126

Other warning signs may include:

  • Blurred vision
  • Dehydration, frequently thirsty
  • Fatigue
  • Frequent infections
  • Frequent urination
  • High blood pressure
  • Nausea or vomiting
  • Slow healing of scrapes and sores
  • Weight loss

Diabetes should be taken very seriously. Even when the condition is well managed, there is other health-related risks that can develop including:

  • Cardiac disease (high blood pressure, heart attacks, etc.)
  • Kidney disease
  • Nervous system diseases (neuropathy, neuralgia)
  • Peripheral vascular disease (fat and calcium deposits in arteries)
  • Skin sores (ulcers, infections) which can lead to amputations
  • Stroke
  • Weakened immune system (more susceptible to cold and flu)
  • Vision problems (blurred or blindness)

Unfortunately, there is nothing a parent or child can do to prevent Type I Diabetes. It is not only hereditary but is also an immunological disorder affecting the function of the pancreas. There is ongoing research as to study why the immune system attacks the pancreas, but there is no known cause as of today.

Fortunately, Type II Diabetes can be prevented, but it will take focus and a commitment to lifestyle changes. The unfortunate news is many cases of Diabetes go undetected every year which means for these cases it is too late, there is no prevention. If an individual gets regular checkups with his or her physician, often the warning signs are caught early, and preventative measures can be taken. Here are a few recommended lifestyle changes in preventing Type II Diabetes:

  • If overweight, lose weight. Even losing as little as 5 to 10% of your body weight makes a difference.
  • Get active! A minimum of 30 mins of moderate activity a day is highly recommended. Cardio exercises (e.g. walking, cycling, swimming, etc.) is especially beneficial.
  • Cease smoking. It’s a tough habit to break, but it is critical.
  • Minimize or abstain from alcohol The preference is to abstain from drinking alcohol because it greatly affects blood sugar levels. If you are going to have a drink here or there, avoid using sugary drinks like soda as a mixer.
  • Change your diet. Here are four ways to improve your diet:
    • Choose whole grain products, avoid processed foods (pasta, white bread, white rice, etc.)
    • Avoid sugary drinks. Drink water, coffee, or tea (non-sweetened).
    • Choose to consume good fats like what is found in almonds, seeds, or liquid olive or vegetable oil. Avoid solid fats like margarine.
    • Eat lean meats and fish. Limit intake of red meats, processed lunch meats, etc. Eat more chicken, turkey, and fish.

What causes a Diabetes?

The exact cause of Type I Diabetes is not clear. Scientists know the body’s immune system attacks itself affecting the pancreas. Researchers also know Type I is hereditary, but what they don’t understand is why the body attacks itself. There is some research that shows a triggering event such as exposure to mumps or coxsackie viruses (e.g. found in hand, foot, and mouth disease) ignites an abnormal antibody response which causes damage to the pancreas cells.

Historically, Type II Diabetes was considered an adult form of the disease. Those over the age of 30 were typically diagnosed with Type II. Nowadays, there is an alarming rate of the young population diagnosed with Type II.

For the children and young adults, Type II diabetes is mostly caused by obesity. So, teaching your children at a very early age about proper diet and minimizing their consumption of carbohydrates (sugars, white bread, pasta, sugary soda, etc.) will reduce their risk of getting Type II Diabetes.

For adults, the correlation of weight to Type II diabetes is not like that of children and young adults. For those over the age of 40, even when at a normal weight they can be at risk for Type II. As mentioned above, living a healthy lifestyle becomes more important in the battle against Type II Diabetes.

Symptoms of Diabetes

Symptoms for Type I Diabetes can show up quickly. These symptoms are:

  • Bedwetting (previously no issue)
  • Blurred vision
  • Extreme hunger
  • Fatigue
  • Increased thirsty
  • Irritable
  • Weight loss

Symptoms of Type II Diabetes are similar to Type I. They include:

  • Blurred vision
  • Excessive thirst
  • Fatigue
  • Frequent urination
  • Sores that won’t heal
  • Sweating (unusual)
  • Tingling or burning sensation in the hands and/or feet

How is Diabetes diagnosed?

Symptoms can go undetected for quite some time, but if you are experiencing any of the symptoms listed above, get checked-out. A medical provider like your family physician or an endocrinologist will diagnose Diabetes through bloodwork.

Your physician may complete the following tests:

  • Fasting Plasma Glucose (FPG)-you will be asked to fast (no food or drinks besides water) up to 8 hours before the bloodwork. He or she will assess your blood glucose levels to see if they are within the normal range; >126 mg/dl is Diabetic.
  • AC1-checks blood sugar levels over the past 3-4 months; > 6.5% is Diabetic.
  • Oral Glucose Tolerance Test (OGTT)-a 2-hour test assessing blood levels before and after a sweet drink; >200 mg/dl is Diabetic.

Treatment of Diabetes

Every individual is unique and so is the treatment approach. The basic treatments for Type I and Type II are:

  • Type I Diabetes Treatment
    • Blood glucose level checks frequently
    • Carbohydrate counting
    • Checking feet regularly for sores
    • Eating healthy
    • Staying active
    • Taking insulin (injection or pump)
  • Type II Diabetes Treatment
    • Blood glucose monitoring
    • Checking feet regularly for sores
    • Eating healthy
    • Medications (most are oral, for some insulin)
    • Staying active
    • Weight control

Beyond medical management through medications and diet, physical therapists (PTs) can also help with those who have Prediabetes or Diabetes. Your PT will work with you on establishing and managing a safe workout routine basis on your current medical status. Also, your PT will help with aches and pains that may be preventing you from being active.

Getting active and staying active is critical. For some an old injury, a medical condition, or even the fear of being embarrassed by working out in front of others may prevent someone from being active. Your PT can work with your aches and pains (e.g. arthritis) that may be preventing you from moving and being active. Your PT will also teach you proper exercise and activities levels that appropriate for you. He or she can help take away the fear of exercising.

Your PT will also help you maintain healthy feet. He or she will instruct you on proper shoe wear to prevent blisters and sores. If by chance you do get a sore on your foot, your PT can help with wound care management, which is extremely important as those who have Diabetes are at higher risk of amputation from sores that do not heal.

Next Steps

For some, Diabetes can be prevented while for other is cannot. Regardless of your current stage of the disease, finding and building a good relationship with your health care providers is important, which is a lifelong disease that needs to be medically managed closely.

As a consumer of health care, you have a choice in finding the right provider for you. Do your homework and search for a health care provider with excellent outcomes, great customer reviews, and can provide you the care you need for a reasonable cost.

Most individuals have a physician they work closely with, but they don’t always know or have a strong relationship with a PT. In fact, PTs are an integral part of managing Diabetes as they will help you get active and stay active for a healthy lifestyle. PTs are highly trained in movement (strength, flexibility, balance, and gait training), wound care management, and when needed in post-surgical care.

In most states PTs have direct access, meaning you can go directly to a physical therapist without a physician order. To determine if your state has direct access, please visit the American Physical Therapy Association’s website Physical Therapy Direct Access By State.

To find a highly qualified PT in your area, please click on the following link (FOTO PT database link). This link will help you find a PT that has top national rankings for treating diabetes as well as the secondary medical conditions that may accompany the disease.

[1] http://www.diabetes.org/diabetes-basics/statistics/?loc=db-slabnav

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