How do you screen for diabetes?
One way is to get a random blood
sugar test. Lets say someone comes
in. They’re overweight, fatigued
and urinating frequently. The person doesn’t have to fast. We test the
blood sugar then and, if its over 200
and in the presence of symptoms,
they have diabetes. If you’re screening someone who has a family history but they say they feel fine, in
that setting it is best to get a fasting
blood sugar. That means no calorie
intake for eight hours. If you have a
fasting blood sugar of 126 or more,
that’s type 2 diabetes.
Smoking cigarettes and drinking
alcohol. Could those lifestyles
lead to type 2 diabetes?
In terms of causation, probably
not. Of course, smoking is bad for
anybody. But, it probably can’t lead
to diabetes. Now, excessive alcohol intake can lead to diabetes by
a number of paths. First, alcohol
has a fair number of calories so it
can be a major factor in leading to
obesity. Chronic excess intake of
alcohol can also cause the pancreas
to become scarred and not work
properly. That can lead to insulin
deficiency similar to what happens
with type 1 diabetes. So alcohol can
be a factor, but in most cases where
a patient is drinking in moderation,
there’s not a really close link.
What are the dangers of
uncontrolled type 2 diabetes?
Diabetes is the seventh leading
cause of death in the United States,
the leading cause of blindness and
the most frequent cause of kidney
failure. I have to remind patients of
this all the time. We are so often trying to control a patients health and
we have to sometimes step back
and say, ‘Why are we doing this?’
Those are the reasons.
Is type 1 diabetes passed along
genetically in a way similar to
type 2 diabetes?
How will treatment change?
Talking about type 1 diabetes,
it is typically onset in childhood
and is a lifelong condition,
correct?
As of right now. But, in your lifetime,
that will change.
4
There are several avenues of research which are going on in type
1 diabetes that are very promising.
One avenue is research which will
lead to the development of what is
called a closed loop insulin pump.
It will probably be available in the
United States within a couple of
years. This is a device where a sensor is inserted under the skin and
detects glucose levels. The information is relayed to the pump and the
pump will know how much insulin
to secrete, acting as an artificial
pancreas. There’s another avenue
of research that could potentially
lead to a cure, but we’re further
away from that goal.
Actually not. The genetics of type
1 diabetes and type 2 diabetes are
very different. Type 1 diabetes is
part of an umbrella of diseases we
call auto-immune diseases. Families who have this auto-immune
tendency pass it from generation to
generation, but it could manifest in
different ways. It could be type 1 diabetes. It could be an auto-immune
thyroid disease. It could be Crohn’s
Disease or Lupus. All of these are
auto-immune conditions.
With type 1 diabetes, I’ll ask the patient if they have a relative who has
injected insulin. Most of the time
they’ll say no. But if you ask further
questions about family members
who have some of the diseases I
just mentioned, often times there
is a family member that fits the
criteria. That’s something I call the
auto-immune thread.
VITAL SIGNS Volume 11 • Issue 3