What Is Diabetes Mellitus MD?
Diabetes Mellitus Definition
Diabetes also called (Diabetes Mellitus) is a chronic metabolic disease that occurs either when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin it produces leading to hyperglycemia.
Insulin is a hormone that regulates blood sugar.
Hyperglycemia, or raised blood sugar, is a common effect of uncontrolled diabetes and over time leads to serious damage to many of the body’s systems, especially the nerves and blood vessels (small vessels (microvascular), large vessels (macrovascular).
What happens to a person with diabetes mellitus?
Diabetes dramatically increases the risk of various cardiovascular problems, including coronary artery disease with chest pain (angina), heart attack, stroke, and narrowing of arteries (atherosclerosis). If you have diabetes, you’re more likely to have heart disease or stroke. Nerve damage (neuropathy).
People with diabetes can benefit from education about the disease and treatment, good nutrition to achieve normal body weight, and exercise, with the goal of keeping both short-term and long-term blood glucose levels within acceptable bounds. In addition, given the associated higher risks of cardiovascular disease, lifestyle modifications are recommended to control blood pressure.
Weight loss surgery in those with obesity and type two diabetes is often an effective measure. Many are able to maintain normal blood sugar levels with little or no medications following surgery and long-term mortality is decreased. There is, however, short-term mortality risk of less than 1% from the surgery.
This difficult disease, once called adult-onset diabetes, is striking an ever-growing number of adults. Even more alarming, it’s now beginning to show up in teenagers and children.
Diabetes is a growing problem throughout the world. The global prevalence of established diabetes was estimated to be 2.8% in 2000 and is projected to be 4.4% by 2030.
Diabetes Mellitus occurs throughout the world but is more common (especially type 2) in more developed countries. The greatest increase in rates has however been seen in low and middle-income countries, where more than 80% of diabetic deaths occur. The fastest prevalence increase is expected to occur in Asia and Africa, where most people with diabetes will probably live in 2030.
The increase in rates in developing countries follows the trend of urbanization and lifestyle changes, including increasingly sedentary lifestyles, less physically demanding work, and the global nutrition transition, marked by increased intake of foods that are high energy-dense but nutrient-poor (often high in sugar and saturated fats, sometimes referred to as the “Western-style” diet).
Diagnosis is by measuring plasma glucose.
- Fasting plasma glucose (FPG) levels
- Glycosylated Hb (HbA1c)
- Sometimes oral glucose tolerance testing
Type 1 diabetes is caused by an absence of insulin due to autoimmune-mediated inflammation in pancreatic beta cells.
Type 2 diabetes is caused by hepatic insulin resistance (causing an inability to suppress hepatic glucose production), peripheral insulin resistance (which impairs peripheral glucose uptake) in combination with a beta-cell secretory defect.
General diabetes treatment: diet, exercise, and drugs that reduce glucose levels, including insulin and oral antihyperglycemic drugs.
All patients with type 1 Diabetes Mellitus require insulin therapy.
For type 2 Diabetes Mellitus, oral antihyperglycemics, injectable glucagon-like peptide-1 (GLP-1) receptor agonists, insulin, or a combination.
To prevent complications, often renin-angiotensin-aldosterone system blockers (ACE inhibitors or angiotensin II receptor blockers), statins, and aspirin.
Treatment of diabetes mellitus involves both lifestyle changes and drugs. Patients with type 1 diabetes require insulin. Some patients with type 2 diabetes may be able to avoid or cease drug treatment if they are able to maintain plasma glucose levels with diet and exercise alone.
Treatment involves the control of hyperglycemia to relieve symptoms and prevent complications while minimizing hypoglycemic episodes.
Education about causes of Diabetes Mellitus, diet, exercise, drugs, self-monitoring with fingerstick testing, and the symptoms and signs of hypoglycemia, hyperglycemia, and diabetic complications is crucial to optimizing care. Most patients with type 1 DM can also be taught how to adjust their insulin doses.
Surgical treatment for obesity, such as gastric banding, sleeve gastrectomy, or gastric bypass, also leads to weight loss and improved glucose control in patients who have diabetes mellitus and are unable to lose weight through other means.
All patients with diabetes mellitus should be vaccinated against Streptococcus pneumonia (once) and influenza virus (annually).
Diabetes mellitus control can be monitored by measuring blood levels of
Self-monitoring of whole blood glucose using fingertip blood, test strips, and a glucose meter is most important. It should be used to help patients adjust the dietary intake and insulin dosing and to help physicians recommend adjustments in the timing and doses of drugs.
Many different monitoring devices are available. Nearly all require test strips and a means for pricking the skin and obtaining a blood sample. Most come with control solutions, which should be used periodically to verify proper meter calibration.
Amazon Next Bayer Contour Next Blood Glucose Test Strips, Pack of 6, 300 Strips
Diabetes complications can be delayed or prevented with adequate glycemic control; heart disease remains the leading cause of mortality in diabetes mellitus.
Later complications include vascular disease, peripheral neuropathy, nephropathy, retinopathy, and predisposition to infection
Immune dysfunction is another major complication and develops from the direct effects of hyperglycemia on cellular immunity. Patients with diabetes mellitus are particularly susceptible to bacterial and fungal infections.
Diabetes significantly increases the risk of heart disease. It is the leading cause of kidney failure and new cases of blindness in adults.
How diabetes affects the body
Over time, diabetes can damage the heart, blood vessels, eyes, kidneys, and nerves.
Adults with diabetes have a two to three-fold increased risk of heart attacks and strokes.
Combined with reduced blood flow, neuropathy (nerve damage) in the feet increases the chance of foot ulcers, infection, and the eventual need for limb amputation.
Diabetic retinopathy is an important cause of blindness and occurs as a result of long-term accumulated damage to the small blood vessels in the retina. 2.6% of global blindness can be attributed to diabetes.
Diabetes is among the leading causes of kidney failure.
Types of Diabetes Mellitus
There are 2 main categories of diabetes mellitus – type 1 and type 2
Type 1 and type 2 diabetes were identified as separate conditions for the first time by the Indian physicians Sushruta and Charaka in 400–500 CE with type 1 associated with youth and type 2 with being overweight.
The term “Mellitus” or “from honey” was added by Briton John Rolle in the late 1700s to separate the condition from diabetes insipidus, which is also associated with frequent urination.
Effective treatment was not developed until the early part of the 20th century when Canadians Frederick Banting and Charles Herbert Best isolated and purified insulin in 1921 and 1922. This was followed by the development of the long-acting insulin NPH in the 1940s.
The term “type 1 diabetes” has replaced several former terms, including childhood-onset diabetes, juvenile diabetes, and insulin-dependent diabetes mellitus (IDDM). Likewise, the term “type 2 diabetes” has replaced several former terms, including adult-onset diabetes, obesity-related diabetes, and noninsulin-dependent diabetes mellitus (NIDDM).
Type 1 Diabetes
Type 1 diabetes is characterized by deficient insulin production to the point that insulin concentrations are no longer adequate to control plasma glucose levels and require daily administration of insulin. The cause of type 1 diabetes is not known and it is not preventable with current knowledge.
Type 1 Diabetes Symptoms
Symptoms include excessive excretion of urine (polyuria), thirst (polydipsia), constant hunger, weight loss, vision changes, and fatigue. These symptoms may occur suddenly.
Several viruses (including coxsackievirus, rubella virus, cytomegalovirus, Epstein-Barr virus, and retroviruses) have been linked to the onset of type 1 DM.
Diet may also be a factor. Exposure of infants to dairy products (especially cow’s milk and the milk protein beta-casein), high nitrates in drinking water, and low vitamin D consumption has been linked to increased risk of type 1 DM. Early (< 4 mo) or late (> 7 mo) exposure to gluten and cereals increases islet cell autoantibody production. Mechanisms for these associations are unclear.
Type 2 Diabetes
Type 2 diabetes (formerly called non-insulin-dependent, or adult-onset) results from the body’s ineffective use of insulin. Type 2 diabetes comprises the majority of people with diabetes around the world and is largely the result of excess body weight and physical inactivity.
Although several genetic polymorphisms have been identified over the past several years, no single gene responsible for the most common forms of type 2 Diabetes Mellitus has been identified.
Obesity and weight gain are important determinants of insulin resistance in type 2 DM. They have some genetic determinants but also reflect diet, exercise, and lifestyle.
Type 2 Diabetes Symptoms
Symptoms may be similar to those of type 1 diabetes but are often less marked. As a result, the disease may be diagnosed several years after onset, once complications have already arisen.
Type 2 DM is becoming increasingly common among children as childhood obesity has become epidemic. Until recently, this type of diabetes was seen only in adults but it is now also occurring increasingly frequently in children.
A condition in which blood sugar is high, but not high enough to be type 2 diabetes. Many people destined to develop type 2 DM spend many years in a state of prediabetes.
Gestational diabetes is hyperglycemia with blood glucose values above normal but below those diagnostic of diabetes, occurring during pregnancy.
Women with gestational diabetes are at an increased risk of complications during pregnancy and at delivery. They and their children are also at increased risk of type 2 diabetes in the future.
Gestational diabetes is diagnosed through prenatal screening, rather than through reported symptoms.
Diabetes insipidus is an uncommon disorder that causes an imbalance of fluids in the body. This imbalance makes you very thirsty even if you’ve had something to drink. It also leads you to produce large amounts of urine.16 Feb 2019
What is the difference between Diabetes Insipidus and Mellitus?
Diabetes mellitus is more commonly known simply as diabetes. It’s when your pancreas doesn’t produce enough insulin to control the amount of glucose, or sugar, in your blood. Diabetes Insipidus is a rare condition that has nothing to do with the pancreas or blood sugar.
A disorder of salt and water metabolism marked by intense thirst and heavy urination. Diabetes Insipidus occurs when the body can’t regulate how it handles fluids. The condition is caused by a hormonal abnormality and isn’t related to diabetes.
Diabetes Insipidus Symptoms
People may experience:
Whole-body: excessive thirst, water-electrolyte imbalance, dehydration, fatigue, or malaise
Urinary: excessive urination, frequent urination, or bedwetting
Also common: headache or weight loss
Diabetes Insipidus Treatment
Treatment consists of fluids. Depending on the form of the disorder, treatments might include hormone therapy, a low-salt diet, and drinking more water.
Treatable by a medical professional
Requires a medical diagnosis
Lab tests or imaging always required
Chronic: can last for years or be lifelong
For informational purposes only. Consult your local medical authority for advice.
IV fluids and Fluid replacement
Antidiuretic and Diuretic
Low sodium diet
Polygenic Forms of Diabetes
The most common forms of diabetes, type 1 and type 2, are polygenic, meaning the risk of developing these forms of diabetes is related to multiple genes.
Environmental factors, such as obesity in the case of type 2 diabetes, also play a part in the development of polygenic forms of diabetes. Polygenic forms of diabetes often run in families. Doctors diagnose polygenic forms of diabetes by testing blood glucose in individuals with risk factors or symptoms of diabetes.
Genes provide the instructions for making proteins within the cell. If a gene has a mutation, the protein may not function properly.
Genetic mutations that cause diabetes affect proteins that play a role in the ability of the body to produce insulin or in the ability of insulin to lower blood glucose. People have two copies of most genes; one gene is inherited from each parent.
Monogenic Forms of Diabetes
Some rare forms of diabetes result from mutations in a single gene and are called monogenic. Monogenic forms of diabetes account for about 1 to 5 percent of all cases of diabetes in young people. In most cases of monogenic diabetes, the gene mutation is inherited; in the remaining cases, the gene mutation develops spontaneously.
Most mutations in monogenic diabetes reduce the body’s ability to produce insulin, a protein produced in the pancreas that helps the body use glucose for energy.
Neonatal diabetes mellitus (NDM) and maturity-onset diabetes of the young (MODY) are the two main forms of monogenic diabetes. MODY is much more common than NDM. NDM first occurs in newborns and young infants; MODY usually first occurs in children or adolescents but may be mild and not detected until adulthood.
Advances in diabetic care have resulted in an improvement in morbidity and mortality rates, and many persons with diabetes live full, productive lives.
However, there are situations where blood glucose levels become too high (hyperglycemia) or too low (hypoglycemia). In either of these situations, not enough glucose crosses the cell membrane of brain cells, causing a deterioration of the patient’s mental status. Diabetes signs and symptoms are associated with each condition.
Circulating glucose is the primary source of energy for the brain, which is therefore vulnerable to low blood glucose levels. In order to protect the brain, a number of physiological mechanisms are activated to minimize the effects of hypoglycemia.
The normal blood glucose range is 90 – 130 mg/dcl. As blood glucose levels (BGL) fall, the body reacts by releasing glycogen from the liver and large skeletal muscles. Glycogen can be used by these organs to maintain metabolism. However, critical organs such as the brain and heart do not possess glycogen; they have to depend upon normal BGLs to function properly.
As hypoglycemia worsens, the body enters a phase commonly known as insulin shock. The patient’s skin becomes cool and diaphoretic. The heart rate rises and the patient may become tachypneic. Confusion sets in. The patient may become combative and noncooperative as he loses consciousness.
In people with type 1 diabetes, an absolute insulin deficiency precludes the first-line defense against falling blood glucose levels. In addition, with the loss of the pancreatic α-cell glucagon secretory response, the last remaining defenses are the release of epinephrine and autonomic warning symptoms, which also become attenuated in these patients.
In people with type 2 diabetes, the residual β-cell function initially preserves the insulin first-line defense. However, with the progressive loss of β-cell function and repeated hypoglycemic events, the endogenous glucose counter-regulatory response is lost.
Hypoglycemia can cause a variety of symptoms that can be classified as either neurogenic (autonomic) or neuroglycopenic. Neurogenic symptoms are caused by physiological responses to low glucose concentrations; neuroglycopenic symptoms, due to glucose deprivation in the central nervous system, are more distressing and severe.
As patients with type 1 diabetes depend on exogenous insulin, they are unable to down-regulate insulin secretion as a first-line response, so they experience a higher frequency of hypoglycemic events than those patients with type 2 diabetes.
Neurogenic: Trembling, sweating, anxiety, hunger
Neuroglycopenic: Cognitive impairment, confusion, behavioral changes,
Loss of consciousness (even death) in severe cases
In addition to antidiabetic treatment, there are other causes of hypoglycemia including:
Delayed or missed meals
The use of recreational drugs or excessive alcohol consumption
Age-related impairment of the counter-regulatory hormone responses.
More long-term factors that can influence the risk include a change in weight, renal or liver dysfunction, and concomitant medications. In addition, depression, which many people with diabetes suffer from, has been found to be associated with the risk of severe hypoglycemia.
The most common symptoms of diabetes mellitus are those of hyperglycemia. The mild hyperglycemia of early DM is often asymptomatic; therefore, diagnosis may be delayed for many years.
More significant hyperglycemia causes glycosuria (abnormally high levels of sugar in the urine) and thus an osmotic diuresis, leading to urinary frequency, polyuria (Renal disorder; production of large volumes of pale dilute urine), and polydipsia (Excessive thirst as in cases of diabetes or kidney dysfunction) that may progress to orthostatic hypotension and dehydration.
Severe dehydration causes weakness, fatigue, and mental status changes. Symptoms may come and go as plasma glucose levels fluctuate. Hyperglycemia can also cause weight loss, nausea and vomiting, and blurred vision, and it may predispose to bacterial or fungal infections.
Patients with type 1 DM typically present with symptomatic hyperglycemia and sometimes with diabetic ketoacidosis (DKA).
The triad of uncontrolled hyperglycemia, metabolic acidosis, and increased total body ketone concentration characterizes DKA.
Most patients with DKA have autoimmune type 1 diabetes
Patients with type 2 DM may present with symptomatic hyperglycemia but are often asymptomatic, and their condition is detected only during routine testing. In some patients, initial symptoms are those of diabetic complications, suggesting that the disease has been present for some time.
The body uses the hormone insulin to help glucose move across cell membranes, out of the bloodstream, and into the cell where it is used for metabolism. The body closely regulates insulin and glucose levels so that there is a precise balance of the two.
If insulin is not present in the correct amount, blood glucose levels (BGL) begin to rise. Paradoxically, there may be an excessive amount of glucose in the bloodstream, yet the cells themselves are starving for it.
This triggers the hunger reflex to set in, causing the patient to eat (Polyphagia, also known as hyperphagia), increasing blood glucose levels (BGL) even more. As in hypoglycemia, confusion sets in as the brain begins to malfunction. Eventually, the patient loses consciousness.
The body does not tolerate high BGLs. The kidney’s nephrons can become “clogged,” causing them to fail. The body tries to excrete excess glucose through the urinary tract by forcing the patient to urinate excessively (polyuria). As dehydration sets in, the body triggers a thirst reflex, causing the patient to drink more fluids to compensate (polydipsia).
Meanwhile, the body begins to use stored fats and proteins to create energy metabolism. This is not as efficient as using glucose; rather than creating simple byproducts of water and carbon dioxide during glucose metabolism, fat metabolism results in ketone bodies, which can cause the body to become dangerously acidotic (diabetic ketoacidosis or DKA).
The body tries to excrete the ketones by breathing them out of the respiratory tract. The odor associated with exhaled ketone bodies has been described as “sweet,” “acetone” and, ominously, like alcohol.
Medications used to treat diabetes do so by lowering blood sugar levels. There are a number of different classes of anti-diabetic medications. Some are available by mouth, such as metformin, while others are only available by injection such as GLP-1 agonists.
Type 1 diabetes can only be treated with insulin, typically with a combination of regular and NPH insulin, or synthetic insulin analogs.
Metformin is generally recommended as a first-line treatment for type 2 diabetes, as there is good evidence that it decreases mortality. It works by decreasing the liver’s production of glucose.
Several other groups of drugs, mostly given by mouth, may also decrease blood sugar in type 2 diabetes mellitus. These include agents that increase insulin release, agents that decrease absorption of sugar from the intestines, and agents that make the body more sensitive to insulin.
Derangement of glucose homeostasis and the eventual development of diabetes is a multifactorial process involving genetics, ethnic and racial heritage, and environmental factors. Although the precise interplay of these factors is not yet fully understood, long-term trials have provided evidence to support aggressive
efforts to prevent and manage this disease.
Evidence-based guidelines for the comprehensive management of diabetes focus primarily on lifestyle changes, management of cardiovascular disease risk factors, and management of blood glucose levels.
lifestyle modification can help patients lose weight and reduce the incidence of type 2 diabetes in at-risk patients. One large study compared usual care with intensive lifestyle intervention. Although only 38 percent of participants achieved and maintained the weight loss goal of 7 percent of baseline body weight, the incidence of type 2 diabetes was reduced by 58 percent.
Prevalence: In 2018, 34.2 million Americans, or 10.5% of the population, had diabetes.
Nearly 1.6 million Americans have type 1 diabetes, including about 187,000 children and adolescents
Undiagnosed: Of the 34.2 million adults with diabetes, 26.8 million were diagnosed, and 7.3 million were undiagnosed.
Prevalence in Seniors: The percentage of Americans age 65 and older remains high, at 26.8%, or 14.3 million seniors (diagnosed and undiagnosed).
New cases: 1.5 million Americans are diagnosed with diabetes every year.
Prediabetes: In 2015, 88 million Americans age 18 and older had prediabetes.
Diabetes in Youth
About 210,000 Americans under age 20 are estimated to have diagnosed diabetes, approximately 0.25% of that population.
In 2014—2015, the annual incidence of diagnosed diabetes in youth was estimated at 18,200 with type 1 diabetes, 5,800 with type 2 diabetes.
Diabetes by Race/Ethnicity
The rates of diagnosed diabetes in adults by race/ethnic background are:
7.5% of non-Hispanic whites
9.2% of Asian Americans
12.5% of Hispanics
11.7% of non-Hispanic blacks
14.7% of American Indians/Alaskan Natives
The breakdown among Asian Americans:
5.6% of Chinese
10.4% of Filipinos
12.6% of Asian Indians
9.9% of other Asian Americans
The breakdown among Hispanic adults:
8.3% of Central and South Americans
6.5% of Cubans
14.4% of Mexican Americans
12.4% of Puerto Ricans
Diabetes was the seventh leading cause of death in the United States in 2017 based on the 83,564 death certificates in which diabetes was listed as the underlying cause of death. In 2017, diabetes was mentioned as a cause of death in a total of 270,702 certificates.
Diabetes may be underreported as a cause of death. Studies have found that only about 35% to 40% of people with diabetes who died had diabetes listed anywhere on the death certificate and about 10% to 15% had it listed as the underlying cause of death.
Cost of Diabetes
Updated March 22, 2018
$327 billion: Total cost of diagnosed diabetes in the United States in 2017
$237 billion was for direct medical costs
$90 billion was in reduced productivity
After adjusting for population age and sex differences, average medical expenditures among people with diagnosed diabetes were 2.3 times higher than what expenditures would be in the absence of diabetes.
How Does Diabetes Work in the Body?
Our cells depend on a single simple sugar, glucose, for most of their energy needs. That’s why the body has intricate mechanisms in place to make sure glucose levels in the bloodstream don’t go too low or soar too high.
When you eat, most digestible carbohydrates are converted into glucose and rapidly absorbed into the bloodstream. Any rise in blood sugar signals the pancreas to make and release insulin. This hormone instructs cells to sponge up glucose. Without it, glucose floats around the bloodstream, unable to slip inside the cells that need it.
How Does Diabetes Occur?
Diabetes occurs when the body can’t make enough insulin or can’t properly use the insulin it makes.
One form of diabetes occurs when the immune system attacks and permanently disables the insulin-making cells in the pancreas. This is type 1 diabetes, once called juvenile-onset, or insulin-dependent, diabetes. Roughly 5 to 10 percent of diagnosed diabetes cases are type 1 diabetes.
The other form of diabetes tends to creep up on people, taking years to develop into full-blown diabetes. It begins when muscle and other cells stop responding to insulin’s open-up-for-glucose signal.
The body responds by making more and more insulin, essentially trying to ram blood sugar into cells. Eventually, the insulin-making cells get exhausted and begin to fail. This is type 2 diabetes.
Diabetes mellitus is a syndrome with disordered metabolism and inappropriate hyperglycemia due to either a deficiency of insulin secretion or a combination of insulin resistance and inadequate insulin secretion to compensate.
Type 1 diabetes is due to pancreatic islet B cell destruction predominantly by an autoimmune process, and these persons are prone to ketoacidosis. While type 2 diabetes is the more prevalent form and results from insulin resistance with a defect in compensatory insulin secretion.
In people that are healthy, the pancreas, an organ located behind the liver and stomach, secretes digestive enzymes and the hormones insulin and glucagon into the bloodstream to control the amount of glucose in the body.
The release of insulin into the blood lowers the level of blood glucose by allowing glucose to enter the body cells, where it is metabolized. If blood glucose levels get too low, the pancreas secretes glucagon to stimulate the release of glucose from the liver.
Diabetes 1 vs 2
Type 1 Diabetes
Type 1 diabetes is usually diagnosed in children and young adults. It develops when the body’s immune system destroys pancreatic beta cells, the only cells in the body that make the hormone insulin, which regulates blood glucose.
Only 5% of people with diabetes have this form of disease. To survive, people with type 1 diabetes must have insulin delivered by injection or a pump.
Type 2 Diabetes
Type 2 diabetes is the most common form of diabetes. The causes of type 2 diabetes are multi-factorial and include both genetic and environmental elements that affect beta-cell function and tissue (muscle, liver, adipose tissue, and pancreas) insulin sensitivity.
In type 2 diabetes, either the body does not produce enough insulin, or the cells ignore the insulin. It usually begins as insulin resistance, a disorder in which the cells do not use insulin properly. As the need for insulin rises, the pancreas gradually loses its ability to produce it.
When glucose builds up in the blood instead of going into cells, it can cause far-reaching health implications like heart disease, nerve damage, and kidney damage. Diabetes is the leading cause of kidney failure, non-traumatic lower-limb amputations, and new cases of blindness among adults in the United States.
Diabetes Mellitus can lead to serious complications, resulting in multiple diseases or disorders that affect multiple systems that may result in premature death.
No treatments definitely prevent the onset or progression of type 1 diabetes mellitus.
Type 2 diabetes mellitus usually can be prevented with lifestyle modification.
The key to preventing type 2 diabetes can be boiled down to five words: Stay lean and stay active.
Information from several clinical trials strongly supports the idea that type 2 diabetes is preventable. About 9 cases in 10 could be avoided by taking several simple steps.
In the group assigned to weight loss and exercise, there were 58 percent fewer cases of diabetes after almost three years than in the group assigned to usual care. Similar results were seen in a Finnish study, and in a Chinese study.
Diabetes Risk Factors
Although the genes you inherit may influence the development of type 2 diabetes, they take a back seat to behavioral and lifestyle factors. Data from the Nurses’ Health Study suggest that 90 percent of type 2 diabetes in women can be attributed to five such factors: excess weight, lack of exercise, a less-than-healthy diet, smoking, and abstaining from alcohol.
Similar factors are at work in men. Data from the Health Professionals Follow-up Study indicate that a “Western” diet, combined with lack of physical activity and excess weight, dramatically increases the risk of type 2 diabetes in men.
Diabetes Guidelines to Lower Your Risk
Making a few lifestyle changes can dramatically lower the chances of developing type 2 diabetes. The same changes can also lower the chances of developing heart disease and some cancers.
Diabetes Weight Loss
Excess weight is the single most important cause of type 2 diabetes. Being overweight increases the chances of developing type 2 diabetes sevenfold. Being obese makes you 20 to 40 times more likely to develop diabetes than someone with a healthy weight.
Losing weight can help if your weight is above the healthy-weight range. Losing 7 to 10 percent of your current weight can cut your chances of developing type 2 diabetes in half.
Inactivity promotes type 2 diabetes. Working your muscles more often and making them work harder improves their ability to use insulin and absorb glucose. This puts less stress on your insulin-making cells.
Four dietary changes can have a big impact on the risk of type 2 diabetes.
1. Choose whole grains and whole-grain products over highly processed carbohydrates.
There is convincing evidence that diets rich in whole grains protect against diabetes. Whole grains are also rich in essential vitamins, minerals, and phytochemicals that may help reduce the risk of diabetes. whereas diets rich in refined carbohydrates lead to increased risk.
2. Skip the sugary drinks, choose water, coffee, or tea instead.
Like refined grains, sugary beverages have a high glycemic load, and drinking more of this sugary stuff is associated with an increased risk of diabetes.
Combining the Nurses’ Health Study results with those from seven other studies found a similar link between sugary beverage consumption and type 2 diabetes. Studies also suggest that fruit drinks – Kool-Aid, fortified fruit drinks, or juices – are not the healthy choice that food advertisements often portray them to be.
There is mounting evidence that sugary drinks contribute to chronic inflammation, high triglycerides, decreased “good” (HDL) cholesterol, and increased insulin resistance, all of which are risk factors for diabetes.
There’s convincing evidence that coffee may help protect against diabetes, emerging research suggests that tea may hold diabetes-prevention benefits as well, but more research is needed.
There’s been some controversy over whether artificially sweetened beverages are beneficial for weight control and, by extension, diabetes prevention.
A recent long-term analysis on data from 40,000 men in the Health Professionals Follow-Up Study finds that drinking one 12-ounce serving of diet soda a day does not appear to increase diabetes risk. So in moderation, diet beverages can be a good sugary-drink alternative.
3. Choose good fats instead of bad fats
The types of fats in your diet can also affect the development of diabetes. Good fats, such as the polyunsaturated fats found in liquid vegetable oils, nuts, and seeds can help ward off type 2 diabetes.
Trans fats do just the opposite. These bad fats are found in many kinds of margarine, packaged baked goods, fried foods in most fast-food restaurants, and any product that lists “partially hydrogenated vegetable oil” on the label.
Eating polyunsaturated fats from fish also known as “long-chain omega 3” or “marine omega 3” fats does not protect against diabetes, even though there is much evidence that these marine omega 3 fats help prevent heart disease. If you already have diabetes, eating fish can help protect you against a heart attack or dying from heart disease.
4. Limit red meat and avoid processed meat; choose nuts, whole grains, poultry, or fish instead.
The evidence is growing stronger that eating red meat (beef, pork, lamb) and processed red meat (bacon, hot dogs, deli meats) increases the risk of diabetes, even among people who consume only small amounts.
The latest support comes from a “meta-analysis,” or statistical summary, that combined findings from the long-running Nurses’ Health Study I and II and the Health Professionals Follow-Up Study with those of six other long-term studies.
The researchers looked at data from roughly 440,000 people, about 28,000 of whom developed diabetes during the course of the study. They found that eating even small amounts of processed red meat each day – just two slices of bacon, one hot dog, or the like – increased diabetes risk by 51 percent.
The good news from this study: Swapping out red meat or processed red meat for a healthier protein source, such as nuts, low-fat dairy, poultry, fish, or whole grains, lowered diabetes risk by up to 35 percent. Not surprisingly, the greatest reductions in risk came from ditching processed red meat.
Why do red meat and processed red meat appear to boost diabetes risk? It may be that the high iron content of red meat diminishes insulin’s effectiveness or damages the cells that produce insulin. The high levels of sodium and nitrites (preservatives) in processed red meats may also be to blame.
Red and processed meats are a hallmark of the unhealthful “Western” dietary pattern, which seems to trigger diabetes in people who are already at genetic risk.
If You Smoke, Try to Quit
Add type 2 diabetes to the long list of health problems linked with smoking. Smokers are roughly 50 percent more likely to develop diabetes than nonsmokers, and heavy smokers have an even higher risk.
Alcohol Now and Then May Help
A growing body of evidence links moderate alcohol consumption with reduced risk of heart disease. The same may be true for type 2 diabetes.
Moderate amounts of alcohol – up to a drink a day for women, up to two drinks a day for men—increases the efficiency of insulin at getting glucose inside cells. And some studies indicate that moderate alcohol consumption decreases the risk of type 2 diabetes.
If you already drink alcohol, the key is to keep your consumption in the moderate range, as higher amounts of alcohol could increase diabetes risk. If you don’t drink alcohol, there’s no need to start – you can get the same benefits by losing weight, exercising more, and changing your eating patterns.
Diabetes Mellitus Resources