-Diabetes, More Common Than You Think By Mark Brown, MD

November is National Diabetes month. Educating the public about this disease can prevent many of the debilitating complications which arise often because people do not know they have the disease. There are an estimated 66,000 people in Maine with diabetes. In the United States, it is estimated that there are 8 million people who have been diagnosed with diabetes and an additional 8 million people with undiagnosed diabetes.

Diabetes is the leading cause of new cases of blindness between the ages of 20 and 74 years of age and is the leading cause of kidney failure. Also, 60 to 70 percent of patients with diabetes have mild to severe nerve damage, which is a major contributing cause of lower extremity amputations.

More than one-half of the lower limb amputations in the United States are performed in patients with diabetes. Diabetes is a disease of altered blood sugar (glucose) control, accompanied by complications in the body's arteries. Complications to the smaller arteries include damage to the eyes, kidneys and nerves. These complications may lead to blindness, kidney failure and loss of, or painful sensations in, extremities.

Complications with larger arteries may lead to cardiovascular and peripheral vascular diseases. These refer to heart disease, strokes and diseases of the arteries of the extremities. Cardiovascular disease is two to four times more common in diabetics, and peripheral vascular disease is four times more common in individuals with diabetes.

Generally, individuals with diabetes are now classified into one of three categories, type 1, type 2 and gestational diabetes. Type 1 diabetes results from the destruction of the insulin-secreting cells of the pancreas, usually leading to an absolute insulin deficiency. The destruction of the insulin-secreting cells may be due to an auto immune process or an unknown cause.

In type 2 diabetes there is a combination of decreased insulin secretion and resistance to the insulin being secreted, ultimately resulting in hyperglycemia (elevated blood sugar). All patients with type 1 diabetes require treatment with insulin, however, patients with type 2 diabetes may be managed by diet alone, or with oral anti diabetic medications, or with a combination of oral agents and insulin, or with insulin alone. Gestational diabetes, which occurs in some pregnant women, may be treated with diet or insulin since oral medications are not recommended during pregnancy.

Approximately 80 percent of the individuals with diabetes in the United States. are type 2. There are approximately 10,000 to 15,000 new cases of type 1 diabetes diagnosed each year, while more than 600,000 new cases of type 2 diabetes are diagnosed each year.

Symptoms of diabetes include frequent urination, hunger and unexplained weight gain or loss. Screenings for diabetes should be considered for all persons age 45 and older and repeated every three years. Screenings at a younger age should be considered for obese persons, first-degree relatives of persons with diabetes, members of high-risk ethnic groups, such as African American, Hispanic, and Native American, mothers of babies weighing 9 or more pounds at birth, women with a history of gestational diabetes, patients with high blood pressure, and patients with lipid disorders.

If you are diabetic and would like more information about our Diabetes Education Program, which can help you tailor a diet and exercise program to control your blood sugar levels, please call 288-5081, ext. 1315.