Diabetes: A Global Explosion, Part I

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Caroline May, MBA, MS Nutrition, NBC-HWC

By Caroline May, MBA, MS Nutrition, NBC-HWC

This is part one of a two-part blog series on diabetes. In part one we discuss the different types of diabetes, as well as risk factors and potential methods for treatment. In part two, we take a look at pre-diabetes and diabetes prevention.

Diabetes is recognized as the world’s fastest growing chronic condition, affecting 1 in 11 adults globally. In 2017, 425 million adults ages 20 to 79 were living with diabetes, which was the fourth leading cause of death in most developed countries.

According to the Centers for Disease Control and Prevention, nearly 9.4 percent of adults in America have diagnosed diabetes, and another 84.1 million (1 in 3) have pre-diabetes. In the last 20 years, the number of adults diagnosed with diabetes in the U.S. has more than tripled.

For employers, the growing rate of diabetes among the workforce is a significant issue, especially in terms of healthcare costs. According to a study sponsored by the American Diabetes Association, medical expenditures of adults with diabetes are approximately 2.3 times higher than what expenditures would be in the absence of diabetes. In 2017, the total estimated cost of diagnosed diabetes was $237 billion in direct medical costs and $90 billion in reduced productivity.

Before we talk about why diabetes is increasing at such an alarming rate, let’s review some basic information about diabetes. What is it? Who is at risk?

What is diabetes?

Diabetes is a disease of chronic, abnormally high blood sugar caused by the body’s inefficient insulin response. There are three main types of diabetes:

  • Type 1: The body does not make insulin
  • Type 2: The body does not make enough insulin or use insulin well. Type 2 is the most common form of diabetes.
  • Gestational diabetes: This form of diabetes is triggered by pregnancy and typically resolves itself after delivery.

Common symptoms for type 1 and type 2 diabetes include:

  • Increased thirst
  • Frequent urination
  • Extreme hunger
  • Unexplained weight loss
  • Presence of ketones in the urine
  • Fatigue
  • Irritability
  • Blurred vision
  • Slow-healing sores

While diabetes can be managed, there is no “cure” for diabetes.

Who gets diabetes?

For type 1 diabetes you are considered at risk if you have a parent or a sibling with type 1 diabetes, as it is thought to have a genetic component. Unfortunately, there are still a lot of unanswered questions when it comes to the cause of type 1 diabetes.

The risks for developing type 2 diabetes are clearer and include the following:

  • Have prediabetes
  • Are overweight
  • Are 45 years or older
  • Have a parent, brother, or sister with type 2 diabetes
  • Are physically active less than three times a week
  • Have ever had gestational diabetes (diabetes during pregnancy) or given birth to a baby who weighed more than nine pounds
  • Are African American, Hispanic/Latino American, American Indian, or Alaska Native (some Pacific Islanders and Asian Americans are also at higher risk

The global obesity epidemic is considered to be a major factor in the rise of type 2 diabetes diagnoses over the past decade. Obesity has been shown to quadruple the odds that adults in most age groups will be diagnosed with diabetes.

With gestational diabetes, women are considered at risk based on the following:

  • Had gestational diabetes during a previous pregnancy
  • Have given birth to a baby who weighed more than 9 pounds
  • Are overweight
  • Are more than 25 years old
  • Have a family history of type 2 diabetes
  • Have a hormone disorder called polycystic ovary syndrome (PCOS)
  • Are African American, Hispanic/Latino American, American Indian, or Alaska Native, Native Hawaiian, some Pacific Islanders and Asian Americans are also at higher risk)

How is diabetes treated?

Managing diabetes, both type 1 and type 2, traditionally involves lifestyle changes including daily exercise, monitoring weight, tracking blood sugar levels throughout the day, healthy eating and stress management. Medications may be required to reduce high blood sugar and it may require combinations of medications and different trial periods. Insulin is required for type 1 diabetes and may be necessary for type 2.

Diabetes is a serious disease, therefore it’s important that individuals diagnosed with diabetes work closely with their healthcare providers. In addition, working with a wellness coach can be helpful when making lifestyle changes to manage diabetes. A coach can facilitate goal setting conversations surrounding unhealthy habits such as smoking or overeating. Coaches can also help individuals identify their personal, internal motivation to make lifestyle changes.

Since a diagnosis of diabetes can be a source of additional stress, stress management skills like regular physical activity, talking with friends, being informed, adequate rest, and learning to say “No” may also be addressed by a coach. Mindfulness programs can also be useful for counteracting stress.

For those accustomed to eating whatever they want and whenever they want, it may take some time and practice to get into the habit of considering the effect the food will have on them. To help with that process, many people measure blood glucose with a glucometer. A healthcare educator is likely to provide instructions on use and dictate timing and ranges. There will be a learning curve but it becomes a natural part of one’s daily routine.

It is important to manage diabetes, as complications can be severe. Common complications associated with diabetes include heart disease and stroke, nerve damage, dementia, eye problems, gum disease, infections, and kidney disease. Additionally effects of medications or mismanaging blood glucose may lead to hypoglycemia, hyperglycemia, and ketoacidosis.

In part two of our blog series on diabetes, we will look at pre-diabetes, as well as ways to help prevent or postpone diabetes.


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