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Monday, Aug. 14, 2017



Testing Type 1 and Type 2 diabetes

According to the Centers for Disease Control, 30.3 million people living in the United States have diabetes – only 23.1 million of those are diagnosed. Another 84.1 million adults have prediabetes. If we combine both numbers, 114.4 million people are either affected by diabetes or prediabetes, which is about 43.3 percent of the total U.S. population. That means nearly four out of 10 of us are either going to get diabetes or already have diabetes. These estimates are higher in Louisiana due to a higher obesity rate.

Our body needs a hormone called “insulin” to use carbohydrates, or sugar, as energy. Insulin is secreted by the pancreas. Diabetes develops when our body cannot handle carbohydrates either due to absence or deficiency of insulin or resistance to insulin. If diabetes is developed due to the pancreas’ inability to produce insulin, it is called Type 1 diabetes. This can happen when a body develops an antibody that attacks its own pancreatic insulin-secreting cells or any other causes of pancreatic failure. Type 1 diabetes usually occurs at a young age.

Diabetes developed due to insulin resistance is called Type 2 diabetes. Type 2 usually develops in adults, with obesity as a major risk factor along with family history. Recently, an increasing number of the young suffering from obesity is also developing early onset Type 2 diabetes.

People suffering from diabetes may not have any symptoms at all, especially with Type 2, until the blood glucose level rises significantly. Common symptoms include excessive thirst with frequent urination, tiredness and blurring of vision. A young person with Type 1 diabetes may lose excessive weight and have symptoms of diabetic ketoacidosis, which include nausea, vomiting, pain in the abdomen, rapid breathing, inability to focus and even coma.

If you exhibit signs or symptoms of diabetes or have other risk factors, a healthcare provider will order a blood test.

Untreated diabetes may give rise to other complications. One acute complication is diabetes ketoacidosis, which usually occurs with Type 1 but can also develop with Type 2. Another acute complication is hyperosmolar hyperglycemia nonketotic coma due to a very high level of blood glucose, usually with Type 2. Poorly controlled diabetes can cause retinopathy, or disease of the retina that results in impairment or loss of vision; kidney disease or damage leading to dialysis; and neuropathy, or nerve damage that can present in various manifestations including feet pain, loss of sensation, nausea, vomiting and diarrhea. Persons with diabetes with loss of sensation may not realize any cut or injury on their foot and develop infection which may not heal properly due to poor healing process due to uncontrolled diabetes. It may ultimately result in amputation of limbs. Diabetes also increases overall risk of cardiovascular disease, including heart attack and stroke. Cardiovascular disease tends to be higher and occurs at an earlier age in men, and diabetes can significantly increase those risks.

Men with diabetes have increased risk of erectile dysfunction (ED). Estimates of ED prevalence in men with diabetes vary widely, ranging from 20 to 75 percent. Those with diabetes are two to three times more likely to have ED than men who do not have diabetes, according to the National Institute of Diabetes and Digestive and Kidney Diseases. Among men with ED, those with diabetes may experience the problem as much as 10 to 15 years earlier than men without diabetes. Research also suggests that ED may be an early marker of diabetes, particularly in men ages 45 and younger. Men with diabetes may also experience retrograde ejaculation, with some semen being released into the bladder.

Both conditions can affect their sexual life, and ultimately, family life.

The best strategies to prevent those complications due to diabetes are tightening control of blood sugar, quitting smoking, and treating blood pressure and cholesterol issues.

Can we prevent diabetes? Yes and no.

There is nothing we can do to prevent Type 1, but Type 2 diabetes can be delayed or prevented with lifestyle changes that include regular exercise, eating healthy, preventing weight gain or losing weight if one is already on heavier side.

Is there any cure for diabetes?

Unfortunately, the answer is no except in a few cases of Type 1 diabetes patients who are referred for a pancreas transplant, which may cure diabetes. So, diabetes control is most important to prevent complications and prolonging life.

Health-care providers can help control diabetes by prescribing different types of medicine and/or insulin. But the most important factor in diabetes control is the patient himself. Patients need to eat low carbohydrate foods, take medicine as prescribed and monitor glucose by using a glucometer at home.

Dr. Kamal Bhusal is an assistant professor of clinical medicine in endocrinology, diabetes and metabolism at LSU Health Shreveport.

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