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Diabetes affects the way the body handles digested carbohydrates. If neglected, diabetes can cause serious health complications, from blindness to kidney failure.

Approximately 8% of the population in the United States has diabetes. This means that approximately 16 million people have been diagnosed with the disease, according to national statistics. The American Diabetes Association estimates that diabetes accounts for 178,000 deaths, 54,000 amputations, and 12,000 to 24,000 cases of blindness each year. Blindness is 25 times more common among diabetic patients compared to non-diabetics. It is proposed that by the year 2010, diabetes will overtake both heart disease and cancer as the leading cause of death through its many complications.

Diabetics have a high blood glucose level. The level of sugar in the blood is regulated by insulin, a hormone produced by the pancreas, which releases it in response to the consumption of food. Insulin causes cells in the body to take up glucose from the blood. Glucose is used as fuel for cellular functions.

The diagnostic standards for diabetes have been fasting plasma glucose levels greater than 140 mg/dL on two occasions and plasma glucose greater than 200 mg/dL after a 75-gram glucose load. More recently, the American Diabetes Association lowered the criteria for a diagnosis of diabetes to fasting plasma glucose levels equal to or greater than 126 mg/dL. Fasting plasma levels outside the normal range require further testing, usually by repeating the fasting plasma glucose test and (if indicated) giving the patient an oral glucose tolerance test.

Symptoms of diabetes include excessive urination, excessive thirst and hunger, sudden weight loss, blurred vision, delayed wound healing, dry and itchy skin, repeated infections, fatigue, and headache. These symptoms, although suggestive of diabetes, can also be due to other reasons.

There are two different types of diabetes.

Type I diabetes (juvenile diabetes or insulin-dependent diabetes): The cause of type I diabetes is the inability of the pancreas to produce insulin. It is responsible for 5-10% of diabetes cases. The pancreatic islet cells of Langerhans, which secrete the hormone, are destroyed by the body’s own immune system, probably because it mistakes them for a virus. Viral infections are believed to be the trigger that triggers this autoimmune disease. It is more common in Caucasians and runs in families.

If left untreated, death occurs within a few months of the onset of juvenile diabetes, as the body’s cells starve because they no longer receive the hormonal drive to absorb glucose. While most Type I diabetics are young (hence the term Juvenile Diabetes), the condition can develop at any age. Autoimmune diabetes can definitely be diagnosed by a blood test that shows the presence of anti-insulin/anti-islet cell antibodies.

Type II diabetes (non-insulin-dependent diabetes or adult-onset diabetes): This diabetes is the result of tissues in the body becoming resistant to insulin. It represents 90-95% of cases. Often the pancreas produces higher than average amounts of insulin, but the body’s cells do not respond to its effect due to the chronically high level of the hormone. Eventually, the pancreas can exhaust its overactive secretion of the hormone, and insulin levels drop below normal.

The tendency to type II diabetes is hereditary, but it is unlikely to develop in people of normal weight who follow a low- or moderate-carbohydrate diet. Obese, sedentary people who consume poor-quality diets based on refined starch, which constantly activates pancreatic insulin secretion, are prone to developing insulin resistance. Native peoples, such as North American Indians, whose traditional diets did not include refined starch until its recent introduction by Europeans, have extremely high rates of diabetes, up to 5 times the rate of Caucasians. Blacks and Hispanics are also at higher risk. Although type II diabetes is not fatal in a matter of months, it can cause health complications for several years, leading to severe disability and early death. As with type I diabetes, the condition is found primarily in one age group, in this case, people over the age of 40 (which is why it is often called adult-onset); however, with the increase in childhood and adolescent obesity, it is showing up in children as well.

If neglected, diabetes can lead to life-threatening complications, including kidney damage (nephropathy), heart disease, nerve damage (neuropathy), retinal damage and blindness (retinopathy), and hypoglycemia (drastic reduction in glucose levels). Diabetes damages the blood vessels, especially the smaller end arteries, leading to severe and premature atherosclerosis. Diabetics are prone to foot problems because neuropathy, which affects about 10% of patients, causes the feet to lose feeling. Foot injuries, common in everyday life, go unnoticed and these injuries do not heal due to poor circulation through the small arteries of the foot. Gangrene and subsequent amputation of fingers or toes is the consequence for many elderly patients with poorly controlled diabetes. These sequelae usually appear earlier in type I than in type II diabetes, because type II patients have some of their own insulin production left over to dampen changes in blood sugar levels.

Type I diabetes is a serious disease and there is no permanent cure for it. However, the symptoms can be controlled by strict dietary control and insulin injections. Implanted pumps that release insulin immediately in response to changes in blood glucose are in the testing stages.

In theory, since it is caused by diet, type II diabetes should be preventable and manageable with dietary changes alone, but in practice, many diabetics (and many obese people without diabetes) find it personally impossible to lose weight or follow a healthy diet. Therefore, they are often treated with drugs that reset the body’s response to insulin, and in some cases, insulin injections.

Please note that this article is not a substitute for medical advice. If you suspect you have diabetes or are in a high-risk group, see your doctor.

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