Diabetes is one of the most prevalent diseases of modern society. An increasing number of people are developing this complex metabolic disease, in which high blood sugar occurs because the pancreas does not produce enough insulin or because the cells in the body do not respond to the insulin being produced.

Type 1 diabetes is due to an absolute lack of insulin (often diagnosed in childhood or young adulthood), and requires daily insulin injections or an insulin pump to provide a continual dose of this important hormone that moves sugar, an energy source, from blood to cells.

Type 2 diabetes is the more common disease, often diagnosed in adulthood and associated with obesity. In this case, there is an insufficient amount of insulin or the body’s cells cannot adequately use the insulin produced. “The consumption of highly processed carbohydrates can only be indirectly implicated in the development of diabetes,” notes Dr. Bruce Lowrie, a specialist in internal medicine and geriatrics with Des Peres Hospital. “Obesity is a risk factor for the development of Type 2 diabetes, and the consumption of highly processed carbohydrates can contribute to obesity.” There are no dietary risk factors for the development of Type 1 diabetes.

“Juvenile diabetes, or Type 1 diabetes, is an autoimmune disease in which the body's immune system attacks and destroys insulin-producing cells in the pancreas, which stops the production of insulin,” explains Dr. Kanwal Khan, a specialist in internal medicine with St. Luke’s Hospital. “Because of the increasing incidence of obesity, both types of diabetes can sometimes overlap in both age groups.”

Statistics underscore the increasing incidence of diabetes among Americans. The National Diabetes Information Clearinghouse, part of the National Institutes of Health, estimates that diabetes affects 25.8 million people of all ages, comprising 8.3 percent of the U.S. population. Of that number, 7 million people who have the disease are undiagnosed.

Dr. Charles Kilo, chairman of the Kilo Diabetes and Vascular Research Foundation and a professor of immunology and pathology at Washington University School of Medicine, attributes the ‘explosion’ of Type 2 diabetes to an aging population, cultural and social changes, reduced physical activity, dietary changes and increased obesity.

“Cells become resistant to insulin due to increased blood sugar levels, excessive caloric intake that leads to obesity, or inherited genetic disease,” Kilo says. Symptoms may develop gradually, although some people never experience them, accounting for many of the undiagnosed cases. Possible signs of Type 2 diabetes include a dry mouth, increased hunger and/or thirst, frequent urination, unexplained weight loss, fatigue, blurred vision and headaches.

Kilo notes that Type 2 diabetes decreases life expectancy by about a decade, increases the risk of heart disease and stroke, and causes nerve damage, blindness and kidney failure.

“Type 2 diabetes can be controlled with a proper diet and regular exercise,” Khan adds. “If your diabetes is not under control with these measures, then medical intervention will be needed—and there is currently no cure. If the patient stops taking insulin, it is always necessary for them to follow a diabetic diet and to monitor blood sugars.”

Following a diabetic meal plan is key to controlling the disease, and the diet should be individually developed to provide a balanced distribution of calories, high fiber, low cholesterol and low sodium. Kilo also recommends education for all diabetes patients, a regular exercise program, blood-sugar monitoring and control, treatment of cardiovascular risk factors and medication, as needed.

“In my opinion, an individual who has succeeded with their regimen of diet, exercise and has lost sufficient weight to be able to do without insulin, still has Type 2 diabetes and should continue to treat it with the lifestyle modifications that have been so successful so far,” Lowrie says. “They may be able to forego monitoring their blood sugar, or do it less often.”

Khan sums up with this advice: “Healthy eating and physical activity should be a part of one's daily routine. Regular follow-up with your physician and healthy eating are essential if you have diabetes in order to prevent long-term complications, such as heart disease, kidney issues and strokes. Also, if you have a family history of diabetes, let your primary-care physician know.”

Support Systems for Diabetes

A diabetes diagnosis can seem overwhelming. Patients receive information about medication, diet, exercise and blood sugar testing. Support is a key to learning how to manage diabetes and can help relieve some of the stress surrounding a diagnosis.

In St. Louis, there are a variety of support services available to help patients and families better understand and cope with diabetes.

The Juvenile Diabetes Research Foundation (JDRF) Greater Missouri and Southern Illinois chapter lists a plethora of resources and events at www.jdrfstl.org. Diabetes research information also is available in the site’s ‘publications’ section.

For children diagnosed with diabetes within the previous three months, the JDRF provides a ‘Bag of Hope.’ The bag contains Rufus, the cuddly bear with diabetes, kid-appropriate books, a DVD, JDRF and T1D information, and more.

Individuals diagnosed with Type 1 diabetes at any age can connect with a JDRF mentor and access Juvenation, the JDRF’s social networking site. Downloadable toolkits containing practical information for parents who need to communicate with their child’s school about a diabetes diagnosis or for adults who are living with Type 1 diabetes also are available.

The American Diabetes Association’s (ADA) St. Louis office also supports those living with Type 1 or 2 diabetes. General information about ADA resources and programs are available at www.diabetes.org. By clicking on ‘In My Community,’ you can find a list of St. Louis area events and programs.

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