More than 18.2 million people (or 6.3 percent of the population) in the United States have diabetes. There are two main types of diabetes. Type 1 diabetes usually occurs during childhood or adolescence. Type 2 diabetes, which is the most common form of the disease, usually occurs in people who are 45 years of age or older. However, the rate of diagnosis of type 2 diabetes in children and adolescents is increasing.

• Diabetes Can Be Silent
• Definition of Diabetes
• Warning Signs of Diabetes
• Type 1 Diabetes
• Type 2 Diabetes
• Other Types of Diabetes
• Pre-Diabetes: Impaired Glucose Tolerance (IGT) and Impaired Fasting Glucose (IFG)
• Complications of Diabetes
• Source

Diabetes Can Be Silent

Diabetes can go silently undetected for a long time without symptoms. Many people first become aware that they have diabetes when they develop one of its potentially life-threatening complications, such as heart disease, blindness or nerve disease.

Fortunately, diabetes can be managed with proper care. Diabetes is a chronic (life-long) condition that can have serious consequences. However, with careful attention to your blood sugar control, lifestyle modifications and medications, you can manage your diabetes and may avoid many of the problems associated with the disease. The Palo Alto Medical Foundation (PAMF) can help you make the transition of managing your disease easier.

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Definition of Diabetes

Diabetes is a disease in which the body does not produce or properly use insulin, a hormone that is needed to convert sugar, starches and other food into energy needed for daily life. The cause of diabetes is a mystery, although both genetics and environmental factors such as obesity and lack of exercise appear to play roles. There are two major types of diabetes:

• Type 1
  An autoimmune disease in which the body does not produce any insulin, most often occurring in children and young adults. People with type 1 diabetes must take daily insulin injections to stay alive. Type 1 diabetes accounts for five to 10 percent of diabetes. Risk factors for type 1 diabetes, which is an autoimmune disease, include genetic and environmental factors.
• Type 2
  A metabolic disorder resulting from the body's inability to make enough, or properly use, insulin. Type 2 diabetes is the most common form of the disease, accounting for 90 to 95 percent of diabetes. It is associated with older age, obesity, a family history of diabetes, prior history of gestational diabetes, impaired glucose tolerance, physical inactivity and ethnicity.
  
  Type 2 diabetes is nearing epidemic proportions, due to an increased number of older Americans and a greater prevalence of obesity and sedentary lifestyles. It is also beginning to be diagnosed more frequently in children and adolescents.
• Gestational Diabetes
  Gestational diabetes develops in two to five percent of all pregnancies but disappears when a pregnancy is over. Women who have had gestational diabetes are at increased risk for developing type 2 diabetes later in life. After pregnancy, five to 10 percent of women with gestational diabetes are found to have type 2 diabetes, and women who have had gestational diabetes have a 20 to 50 percent chance of developing diabetes in the next five to 10 years.
• Other specific types of diabetes result from specific genetic syndromes, surgery, drugs, malnutrition, infections and other illnesses. Such types of diabetes may account for five percent of all diagnosed cases of diabetes.

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Warning Signs of Diabetes

Type 1 Diabetes:

• Frequent urination
• Unusual thirst
• Extreme hunger
• Unusual weight loss
• Extreme fatigue
• Irritability

Type 2 Diabetes:*

• Any of the symptoms for type 1 diabetes


• Frequent infections


• Blurred vision


• Cuts or bruises that are slow to heal
  
• Tingling or numbness in the hands or feet
  
• Recurring skin, gum or bladder infections

* Often people with type 2 diabetes have no symptoms.

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Type 1 Diabetes

Type 1 diabetes is a disease that results from the body's failure to produce insulin, the hormone that "unlocks" the cells of the body allowing glucose to enter and fuel them. There are two forms of type 1 diabetes. Immune-mediated diabetes mellitus results from an autoimmune process in which the body's immune system attacks and destroys the insulin-producing cells of the pancreas. Since glucose cannot enter the cells, it builds up in the blood and the body's cells literally starve to death. The second form, idiopathic type 1, refers to rare forms of the disease that have no known cause. People with type 1 diabetes must take daily insulin injections to stay alive.

• There are an estimated 850,000 to 1.7 million people with type 1 diabetes in the United States today.
  
• The risk of developing type 1 diabetes is higher than virtually all other severe chronic diseases of childhood.
  
• Peak incidence occurs during puberty, around 10 to 12 years of age in girls and 12 to 14 years of age in boys.
  
• The symptoms for type 1 diabetes can mimic the flu in children.
  
• Type 1 diabetes tends to run in families. Brothers and sisters of children with type 1 diabetes have about a 10 percent chance of developing the disease by age 50.
  
• The identical twin of a person with type 1 diabetes has a 25 to 50 percent chance of developing type 1 diabetes.
  
• There is a higher incidence of type 1 diabetes in Caucasians than in other ethnicities.

Who is at greater risk for type 1 diabetes?

• Siblings of people with type 1 diabetes
• Children of parents with type 1 diabetes

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Type 2 Diabetes

Type 2 diabetes results from insulin resistance (a condition in which the body fails to make enough insulin or does not properly use the insulin it does produce), combined with relative insulin deficiency. Type 2 diabetes can often be controlled through weight loss, improved nutrition and exercise, but many people may need oral medications and/or insulin to control their diabetes.

• Of the 17 million Americans with diabetes, 90 to 95 percent (16 million) have type 2 diabetes. Of these, roughly one-third are unaware they have the disease.
• People with type 2 diabetes usually develop the disease after age 45, but they are often not aware they have diabetes until severe symptoms occur or until they are treated for one of its serious complications.
• The risk for type 2 diabetes increases with age. Nearly 18.4 percent of the United States' population who is 65 years of age or older has diabetes.
• Diabetes is the fifth deadliest disease in the United States. However, studies indicate that diabetes is generally under-reported on death certificates, particularly in the cases of older persons with multiple chronic conditions such as heart disease and hypertension. Because of this, the toll of diabetes is believed to be much higher than officially reported.

Who is at greater risk for type 2 diabetes?

• People with impaired glucose tolerance (IGT) and/or impaired fasting glucose (IFG)
• People more than 45 years of age
• People with a family history of diabetes
• People who are overweight
• People who do not exercise regularly
• People with low HDL cholesterol or high triglycerides and high blood pressure
• Certain ethnic groups (African Americans, Hispanics, Asian and Pacific Islanders, and Native Indians)
• Women who had gestational diabetes, a form of diabetes occurring in 2 to 5 percent of all pregnancies, or who have had a baby weighing 9 pounds or more at birth
  

Type 2 diabetes is more common among these ethnic groups:

• African Americans are 2 times as likely to have type 2 diabetes than the general population. An estimated 2.8 million African Americans, or 13 percent, have diabetes.
  
• Hispanics are 1.9 times as likely to have type 2 diabetes. For example, diabetes affects 2 million Hispanics, or 10.2 percent of the Mexican-American population.
  
• Overall prevalence of type 2 diabetes in American Indians is 15.1 percent. On average, American Indians and Alaska Natives are 2.6 times more likely to have diabetes than the general population. In some tribes, 50 percent of the population has diabetes.

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Other Types of Diabetes

Gestational diabetes is a temporary form of insulin resistance that usually occurs halfway through a pregnancy as a result of excessive hormone production in the body, or the pancreas' inability to make the additional insulin that is needed during some pregnancies in women without a previous history of type 1 or type 2 diabetes. Gestational diabetes usually goes away after pregnancy, but women who have had gestational diabetes are at an increased risk for later developing type 2 diabetes. Researchers have identified a small percentage of diabetes cases that result from specific genetic syndromes, surgery, chemicals, drugs, malnutrition, infections, viruses and other illnesses.

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Pre-Diabetes: Impaired Glucose Tolerance (IGT) and Impaired Fasting Glucose (IFG)

• Impaired glucose tolerance (IGT) and impaired fasting glucose (IFG) define a condition known as pre-diabetes, and studies suggest they may be reversible.
• IGT is a condition in which the blood sugar level is elevated (140-190 mg/dl in a 2-hour oral glucose tolerance test) but not high enough to be classified as diabetes.
• IFG is a condition in which the fasting blood sugar level is elevated (110-125 mg/dl after an overnight fast) but not high enough to be classified as diabetes.
• Among U.S. adults 40 to 74 years of age, 16 million (15.6 percent ) have IGT and 10 million (9.7 percent ) have IFG.

More information about Pre-diabetes

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Complications of Diabetes

• Heart disease and strokeApproximately 75 percent of people with diabetes will die of heart disease or stroke, and they are likely to die at a younger age than people who do not have diabetes. People with diabetes have the same cardiovascular risk as if they have already had a heart attack.
  
  People with diabetes are two to four times more likely to have heart disease (more than 77,000 deaths due to heart disease annually). Heart disease death rates are also two to four times as high as adults without diabetes. People with diabetes are two to four times more likely to suffer a stroke.
  
• Blindness due to diabetic retinopathy
  Each year 12,000 to 24,000 people lose their sight because of diabetes. Diabetes is the leading cause of new blindness in people 20 to 74 years of age.
  
• Kidney disease due to diabetic nephropathy
  Ten to 21 percent of all people with diabetes develop kidney disease. Diabetic nephropathy is the leading cause of end-stage renal disease (kidney failure), accounting for 43 percent of new cases. In 1999, 38,160 people with diabetes initiated treatment for end-stage renal disease, and 114,478 people with diabetes underwent dialysis or kidney transplantation. Kidney failure requires the patient to undergo dialysis or a kidney transplant in order to live.
  
• Nerve disease and amputations
  About 60 to 70 percent of people with diabetes have mild to severe forms of diabetes-related nerve damage, which can lead to lower limb amputations. In fact, diabetes is the most frequent cause of non-traumatic lower limb amputations. The risk of a leg amputation is 15 to 40 times greater for a person with diabetes. Each year, 82,000 people lose their foot or leg to diabetes.
  
• Impotence due to diabetic neuropathy or blood vessel blockage
  Impotence afflicts approximately 13 percent of men who have type 1 diabetes and eight percent of men who have type 2 diabetes. It has been reported that men with diabetes, over the age of 50 have impotence rates as high as 50 to 60 percent.

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Source

For more information about diabetes, please call the American Diabetes Association at 1-800-DIABETES (1-800-342-2383), or visit the Web site at www.diabetes.org/home.jsp.
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