Questions About Diabetes (Part 2)


13. What is Type 2 diabetes?


In Type 2 diabetes, the body becomes gradually more resistant to its own insulin, that is, the pancreas is producing enough insulin (at least to start) but for some reason, the cells don’t respond to that insulin the way they used to, so blood sugar levels spike higher and they stay higher for longer periods. Eventually, if Type 2 diabetes persists long enough, the body runs out of its insulin-producing capacity, so many Type 2 diabetics eventually require insulin replacement.


14. How common is Type 2 diabetes?


This is by far the most common form of diabetes, accounting for roughly 90 % of all cases of diabetes. Frighteningly, though, this condition is increasing rapidly, and affecting much younger people than it used to, particularly in some ethic groups that are at higher genetic risk for diabetes, so that some experts are now speaking of a “Type 2 diabetes epidemic”.


15. Why does a person get Type 2 diabetes?


Although we don’t know exactly why the body stops responding to insulin, we certainly know some of the risk factors that allow that to happen, and the most prominent of those are clearly carrying excess weight and not being active enough, that is, living a sedentary lifestyle. Very simply, the more excess weight you carry, especially around the middle, and the more sedentary you are, the greater the risk that you will develop insulin resistance. Over the last few years, though, experts have noted that Type 2 diabetes runs in a sort of “disease pack” along with other “western” conditions, particularly high blood pressure and abnormal cholesterol levels, so if you have either of those problems, you are also significantly more at risk of getting diagnosed with Type 2 diabetes than if those levels are normal.


16. So who is most at risk for Type 2 diabetes?


This is a very long list so I will just highlight a few particularly high-risk groups:

- Anyone with the pre-diabetes or the metabolic syndrome

- Anyone who is overweight and sedentary

- Anyone with abnormal cholesterol levels or high blood pressure

- Anyone whose mom, dad, or siblings have had diabetes

- People in some high-risk ethnic groups, particularly Aboriginals, South Asians, Asians,

- African Americans, Hispanics

- Any woman who has had gestational diabetes

- Any women who has given birth to a baby that weighed more than 4 kg

- Women with polycystic ovary syndrome (PCOS)

Age is also listed as a risk factor for Type 2 diabetes, and in the old days, in fact, the condition was called adult-onset diabetes because it was hardly ever seen in anyone under the age of 40.Very sadly, however, Type 2 diabetes is now being diagnosed in kids as young as 8 and 9, mostly because of how fat and sedentary some young kids have become. This is a very worrisome situation because of the increased risk of diabetes-related complications these kids will face as young adults.

Also, a recent study found that overweight, sedentary siblings of people affected with Type 2 diabetes are also at much higher risk of developing abnormal glucose levels eventually.


17. When should you get tested for diabetes?


Clearly, anyone with symptoms suggestive of diabetes should get tested right away with a simple fasting blood sugar test. However, as stated earlier, the symptoms of Type 2 diabetes can be very subtle, and may take a long time to manifest themselves which is why we rely on screening tests for early detection of diabetes. Canadian guidelines still use the age of 40 as the starting point for screening tests for diabetes in the general population, with regular follow-up screening every three years after that, although I’m pretty certain that if weights continue to rise as they are currently doing among young adults, we are soon going to see recommendations to start those screening tests start at a much younger age than 40. In groups that are at particularly high risk, such as Aboriginals and South Asians, people who have the metabolic syndrome, people who are obese and sedentary, screening tests should start sooner than age 40.


18. Can Type 2 diabetes be prevented, or at least headed off before it causes much damage?

 Of course. Type 2 diabetes should always be treated first with lifestyle modification – losing weight and doing regular exercise – a simple regime that has proven to be very effective at controlling insulin resistance and lowering the risk of developing diabetes. In fact, one of the most famous studies to show how well lifestyle modification can work in the real world concluded that 30 minutes of moderate exercise 5 times a week (the equivalent of a brisk 2 mile walk) combined with a low-fat diet (I don’t think the actual diet you choose matters much so long as long as you choose to control your calorie intake and especially your portion control) could cut their risk of diabetes by a whopping 58% in a high-risk population. This has led the experts to say that at least 80 % of Type 2 diabetes is preventable.

In other words, and I can’t state this strongly enough, it can be done, and without too much effort or sacrifice. The problem is that most people are resistant to eating less and doing more. Hence, most people living with Type 2 diabetesrequire medications that aim to control blood sugar levels. When those medications stop working, people with Type 2 diabetes have to go on insulin replacement.


19. What is gestational diabetes?


Gestational diabetes is the abnormally high glucose level in pregnancy that affects 3.8% of pregnant women. Occurrence is even greater in some higher risk populations such as Aboriginal people. Current guidelines call for all pregnant women to be screened for gestational diabetes between the 24 and 28th week of pregnancy. Women at particularly high risk of gestational diabetes include:

- Women who have had previous abnormal glucose levels

- Obese women

- Women in high risk ethnic groups such as Aboriginals and South Asians

- Women with polycystic ovary syndrome

- Women who have given birth to a heavy baby

- Women over the age of 35

Gestational diabetes is a potentially serious condition that, left untreated, leads to a higher risk of health problems in the mother during both pregnancy and labour, as well as to the baby. In fact, according to a recent study, children born to moms with gestational diabetes can be affected adversely for years after they are born. The good news, though, is that gestational diabetes is usually well-controlled with diet and weight-gain restriction, but roughly 40 % of moms who get gestational diabetes will go on to develop Type 2 diabetes at some point in their lives.


20. Why is it so important to control blood sugar levels?


Because, as stated earlier, prolonged, high blood sugar levels damage the arteries, which is why diabetes is linked to a much higher risk of complications that include:

- heart attacks

- strokes

- limb amputations

- nerve damage

- kidney failure

- eye disease (see below)

- skin ulcers

- severe infections

- erectile dysfunction (which is why every male – that’s every male - who has erectile dysfunction should get a blood glucose test, as well as a cholesterol test)

- a host of other severe health problems.

Diabetes is also related to a higher risk of several cancers, including cancer of the colon, which is the second leading cause of cancer death in Canada, and cancer of the liver.


21. What is HBA1c and why does my doctor worry so much about it?


Hemoglobin A1C is a measure of how well a person with diabetes has been controlling their blood sugar levels over a period of 2-4 months. Thus, in determining the chances of developing diabetic eye problems, for example, the eye doctor will be much more concerned with the HbA1C level than with the most recent blood sugar levels.


22. Is diabetes associated with changes to the brain?


Very much. In fact, the more we learn about dementia, especially Alzheimer’s disease, the more we are beginning to realize that most of the risk factors for Alzheimer’s disease are very similar to the risk factors for Type 2 diabetes. In fact, there is such an intimate connection between blood sugar levels and changes consistent with Alzheimer’s disease that some experts even believe Alzheimer’s disease should be called Type 3 diabetes.


23. Which eye problems are more common with diabetes?


The short answer is most of the serious ones, which is why diabetes is considered to be the number one cause of blindness in North America. Thus, people with diabetes have a significantly higher risk of ending up with glaucoma (too much pressure in the eye), cataracts (clouding of the lens), and the really big vision-killer, diabetic retinopathy, which is damage to the retina, the layer of tissue that lies at the back of the eye and which transmits images to the brain. And because the rate of Type 2 diabetes is going up so quickly, eye experts are very worried that we will soon see an explosion of people with eye problems, many of those occurring in younger people.


24. How often should people with diabetesget their eyes checked?


At least once a year, more often if there are already problems in the eyes or if the blood sugar readings fluctuate a lot. Who should people with diabetes stay in touch with? For the best outcome it is essential to remain in regular contact with:

- Their family doctor

- A diabetes team (if one is available on the community) which should in turn provide access to a nutritionist, a Diabetes Nurse Educator, a podiatrist, and (if necessary) an endocrinologist

- A knowledgeable pharmacist

- An ophthalmologist