Diabetes

Definition

Diabetes is a disease in which the body has problems producing or using insulin, a hormone needed to convert sugar, starches and other food into energy.

Compared to the general population, African Americans are disproportionately affected by diabetes:

• 4.9 million (an increase from 3.7 million in 2007), or 18.7% of all African Americans, aged 20 years or older, also have diabetes.
• According to the Office of Minority Health, in 2018, non-Hispanic blacks were twice as likely as non-Hispanic whites to die from diabetes.
• 25 percent of African Americans between the ages of 65 and 74 have diabetes.
• 1 in 4 African American women over 55 years of age has diabetes.
• African American adults are 60 percent more likely than non-Hispanic white adults to be diagnosed with diabetes by a physician.
• In 2017, non-Hispanic blacks were 3.2 times more likely to be diagnosed with end stage renal disease as compared to non-Hispanic whites.
• In 2017, non-Hispanic blacks were 2.3 times more likely to be hospitalized for lower limb amputations as compared to non-Hispanic whites.
• According to the American Association of Retired Persons, Black people are at significantly higher risk of developing type 2 diabetes than white people.

Diabetes is associated with an increased risk for a number of serious, sometimes life-threatening complications, and certain populations experience an even greater threat. Good diabetes management can help reduce your risk; however, many people are not even aware that they have diabetes until they develop one of its complications.

Blindness. More than 1 million African Americans may have diabetic retinopathy by 2030.

Kidney Disease. African Americans constitute more than 35% of all patients in the U.S. receiving dialysis for kidney failure, but only represent 13.2% of the overall U.S. population. Diabetes is the leading cause of kidney failure in African Americans.

Amputations. Diabetics undergo 130,000 amputations each year, often in low-income and underinsured neighborhoods. Black patients lose limbs at a rate triple that of others.

Heart Disease and Stroke. Heart disease and stroke account for about 65 percent of deaths in people with diabetes. Adults with diabetes have heart disease death rates about 2 to 4 times higher than adults without diabetes. The risk for stroke is 2 to 4 times higher and the risk of death from stroke is 2.8 times higher among people with diabetes.

Alternative Names

Noninsulin-dependent diabetes; Diabetes – type 2; Adult-onset diabetes

Causes

Type 2 diabetes develops when the body becomes resistant to insulin or when the pancreas stops producing enough insulin. Exactly why this happens is unknown, although excess weight and inactivity seem to be contributing factors.

Insulin is a hormone that comes from the pancreas, a gland situated just behind and below the stomach. When you eat, the pancreas secretes insulin into the bloodstream. As insulin circulates, it acts like a key by unlocking microscopic doors that allow sugar to enter your cells. Insulin lowers the amount of sugar in your bloodstream. As your blood sugar level drops, so does the secretion of insulin from your pancreas.

Glucose — a sugar — is a main source of energy for the cells that make up muscles and other tissues. Glucose comes from two major sources: the food you eat and your liver. After intestinal digestion and absorption, sugar is absorbed into the bloodstream. Normally, sugar then enters cells with the help of insulin.

The liver acts as a glucose storage and manufacturing center. When your insulin levels are low — when you haven’t eaten in a while, for example — the liver metabolizes stored glycogen into glucose to keep your glucose level within a normal range.

Symptoms

High blood sugar levels can cause several symptoms, including:

• Blurry vision
• Excess thirst
• Fatigue
• Frequent urination
• Hunger
• Weight loss

Exams and Tests

The fasting blood glucose test is the preferred test for diagnosing diabetes in children and nonpregnant adults. The test is most reliable when done in the morning. However, a diagnosis of diabetes can be made based on any of the following test results, confirmed by retesting on a different day:

• A blood glucose level of 126 milligrams per deciliter (mg/dL) or higher after an 8-hour fast. This test is called the fasting blood glucose test.
• A blood glucose level of 200 mg/dL or higher 2 hours after drinking a beverage containing 75 grams of glucose dissolved in water. This test is called the oral glucose tolerance test (OGTT).
• A random —taken at any time of day—blood glucose level of 200 mg/dL or higher, along with the presence of diabetes symptoms.
• Gestational diabetes is diagnosed based on blood glucose levels measured during the OGTT. Glucose levels are normally lower during pregnancy, so the cutoff levels for diagnosis of diabetes in pregnancy are lower. Blood glucose levels are measured before a woman drinks a beverage containing glucose. Then levels are checked 1, 2, and 3 hours afterward. If a woman has two blood glucose levels meeting or exceeding any of the following numbers, she has gestational diabetes: a fasting blood glucose level of 95 mg/dL, a 1-hour level of 180 mg/dL, a 2-hour level of 155 mg/dL, or a 3-hour level of 140 mg/dL.

Treatments

Treatment for type 2 diabetes requires a lifelong commitment to:

• Blood sugar monitoring
• Healthy eating
• Regular exercise
• Possibly, diabetes medication or insulin therapy

These steps will help keep your blood sugar level closer to normal, which can delay or prevent complications.

If managing your diabetes seems overwhelming, take it one day at a time. And remember that you’re not in it alone. You’ll work closely with your diabetes treatment team — doctor, diabetes educator and registered dietitian — to keep your blood sugar level as close to normal as possible.

Monitoring your blood sugar? Depending on your treatment plan, you may check and record your blood sugar level once a day or several times a week. Ask your doctor how often he or she wants you to check your blood sugar. Careful monitoring is the only way to make sure that your blood sugar level remains within your target range.

Even if you eat on a rigid schedule, the amount of sugar in your blood can change unpredictably. With help from your diabetes treatment team, you’ll learn how your blood sugar level changes in response to:

• Food. What and how much you eat will affect your blood sugar level. Blood sugar is typically highest one to two hours after a meal.
• Physical activity. Physical activity moves sugar from your blood into your cells. The more active you are, the lower your blood sugar level.
• Medication. Any medications you take may affect your blood sugar level, sometimes requiring changes in your diabetes treatment plan.
• Illness. During a cold or other illness, your body will produce hormones that raise your blood sugar level.
• Alcohol. Alcohol and the substances you use to make mixed drinks can cause either high or low blood sugar, depending on how much you drink and whether you eat at the same time.
• Stress. The hormones your body may produce in response to prolonged stress may prevent insulin from working properly.
• For women, fluctuations in hormone levels. As your hormone levels fluctuate during your menstrual cycle, so can your blood sugar level — particularly in the week before your period. Menopause may trigger fluctuations in your blood sugar level as well.

Healthy eating

Contrary to popular perception, there’s no diabetes diet. You won’t be restricted to a lifetime of boring, bland foods.

Instead, you’ll need plenty of:

• Fruits
• Vegetables
• Whole grains

These foods are high in nutrition and low in fat and calories. You’ll also need to eat fewer animal products and sweets.

Counting carbohydrates in your food is another thing you’ll need to incorporate into meal planning. A registered dietitian can help you learn to count carbohydrates and put together a meal plan that fits your health goals, food preferences and lifestyle. Once you’ve covered the basics, remember the importance of consistency. To keep your blood sugar on an even keel, try to eat the same amount of food with the same proportion of carbohydrates, proteins and fats at the same time every day.

Low glycemic index foods also may be helpful. The glycemic index is a measure of how quickly a food causes a rise in your blood sugar. Foods with a high glycemic index raise your blood sugar quickly. Low glycemic foods may help you achieve a more stable blood sugar. Foods with a low glycemic index typically are foods that are higher in fiber.

Physical activity

Everyone needs regular aerobic exercise, and people who have type 2 diabetes are no exception. Physical activity lowers blood sugar. Check your blood sugar level before any activity. You might need to eat a snack before exercising to help prevent low blood sugar if you take diabetes medications that lower your blood sugar or insulin.

Diabetes medications and insulin therapy? Some people who have type 2 diabetes can manage their blood sugar with diet and exercise alone, but many need diabetes medications or insulin therapy. Some studies indicate that early intervention with medication, even before the A1C is significantly elevated, may improve control of blood sugar levels over time.

Possible Complications

After many years, diabetes can lead to other serious problems:

• You could have eye problems, including trouble seeing (especially at night) and light sensitivity. You could become blind.
• Your feet and skin can develop sores and infections. After a long time, your foot or leg may need to be removed. Infection can also cause pain and itching in other parts of the body.
• Diabetes may make it harder to control your blood pressure and cholesterol. This can lead to a heart attack, stroke, or other problems. It can become harder for blood to flow to your legs and feet.
• Nerves in the body can become damaged, causing pain, tingling, and a loss of feeling.
• Because of nerve damage, you could have problems digesting the food you eat. You could feel weakness or have trouble going to the bathroom. Nerve damage can also make it harder for men to have an erection.
• High blood sugar and other problems can lead to kidney damage. The kidneys might not work as well, and they may even stop working.

When to Contact a Medical Professional

Call 911 if you have:

• Chest pain or pressure, shortness of breath, or other signs of angina
• Loss of consciousness
• Seizures

Call your health care provider or go to the emergency room if you have symptoms of diabetic ketoacidosis. Also call your doctor if you have:

• Blood sugar levels that are higher than the goals you and your doctor have set
• Numbness, tingling, or pain in your feet or legs
• Problems with your eyesight
• Sores or infections on your feet
• Symptoms that your blood sugar is getting too low (feeling weak or tired, trembling, sweating, feeling irritable, having trouble thinking clearly, fast heartbeat, double or blurry vision, feeling uneasy)
• Symptoms that your blood sugar is too high (being very thirsty, having blurry vision, having dry skin, feeling weak or tired, needing to urinate a lot)
• You are having blood sugar readings below 70 mg/dL

You can treat early signs of hypoglycemia at home by eating sugar or candy, or by taking glucose tablets. If your signs of hypoglycemia continue or your blood glucose levels stay below 60 mg/dL, go to the emergency room.

Preventions

Recent studies have proven that people at high risk for type 2 diabetes can often prevent or delay the onset of diabetes with 30 minutes of physical activity 5 days a week and by losing 5 to 7% of their body weight. In other words, you don’t have to knock yourself out to prevent diabetes. The key is: small steps lead to big rewards. Here are some tips that might help.

Easy steps to increase activity:

• Put away the TV remote control and get up to change the channel.
• Try walking around the house while you talk on the phone.
• Park the car farther away from stores, movie theaters or your office.
• Get off the bus one stop early, if you are in a safe place to walk.
• Visit museums, the zoo or an aquarium. These are great ways to be active with your family.

Eat right. Try some of these tips to get started: