( CNN ) Here’s a look at diabetes , a disease that affects millions of people around the world.
Diabetes is distinguished by high levels of blood glucose resulting from defects in insulin production, insulin action, or both. The illnes can lead to serious complications such as blindness, kidney damage, cardiovascular disease, limb amputations and premature death .
There are several types of diabetes:Prediabeties, Type 1, Type 2 and Gestational diabetes .
Prediabetes occurs when blood glucose levels is more important than normal but not yet high enough to be diagnosed as diabetes. Before developing Type 2 diabetes, people almost always have prediabetes. Research has shown that some long-term damage to the body may occur during prediabetes .
Type 1 diabetes develops when the body’s immune system destroys pancreatic beta cells, the only cells in the body that make insulin. This form of diabetes usually strikes children and young adults. Merely 5-10% of the persons with diabetes have Type 1. Risk factors for Type 1 diabetes may be autoimmune, genetic or environmental. There is no known style to avoid Type 1 diabetes .
Type 2 diabetes occurs when the body does not produce enough insulin or the cells do not use insulin properly. Type 2 diabetes is the most common kind of diabetes and in adults, it accounts for about 90% to 95% of all diagnosed cases of diabetes. It is associated with older age, obesity , family history, physical inactivity and race/ ethnicity. It is more common in African Americans, Latino Americans, American Indians, Asian Americans, Native Hawaiians and other Pacific Islanders. Type 2 diabetes in children and adolescents, although still rare, is being diagnosed more frequently .
Gestational diabetes is a form of glucose fanaticism diagnosed during pregnancy. It affects about 4% of all pregnant women. A diagnosis of gestational diabetes doesn’t mean that a woman had diabetes before she conceived, or that she will have diabetes after giving birth .
Other types of diabetes result from genetic conditions, surgery, drugs, infections and other illness. Such types of diabetes account for 1% to 5% of all diagnosed lawsuits .
Possible Symptoms of Diabetes includes:
Unexplained weight loss
Sudden changes in vision
Numbness in hands or feet
Slow healing wounds
Adults with diabetes have heart disease death rates about two to four times higher than adults without diabetes .
The risk for stroke is two to four times higher among people with diabetes .
People with diabetes are at high risk for high blood pressure
Diabetes is the leading cause of new cases of blindness among adults aged 20 -7 4 years .
Diabetes is the leading cause of kidney failure .
Between 60% and 70% of people with diabetes have mild to severe different forms of nervous system damage or neuropathy .
More than 60% of non-traumatic lower-limb amputations occur on people with diabetes .
U.S. Diabetes Statistics :
An estimated 86 million people 20 or older have pre-diabetes .
21 million people have been diagnosed with diabetes .
29. 1 million, or 9.3% of the U.S. population have diabetes .
8. 1 million people have diabetes, but have not been diagnosed .
28. 9 million, or 12.3% of all people 20 years or older have diabetes .
208, 000 people under 20 years old have type 1 or type 2 diabetes .
11. two million, or 25.9% of all people 65 or older have diabetes .
15. 5 million, or 13.6% of all men aged 20 years or older have diabetes .
13. 4 million, or 11.2% of all women aged 20 years or older have diabetes .
2012 – 1.7 million new cases of diabetes are diagnosed in people aged 20 years or older .
November 16, 2012 – The CDC releases a report showing that 18 countries had a 100% or more increased number of the prevalence of diabetes from 1995 to 2010. Forty-two states ensure an increase of at the least 50% .
Regularly dubbed Americas fattest city, Houstonites dietary selections are merely one element of its spiraling diabetes problem. Can anything be done to reversal this deadly and very costly disease in a city addicted to sugar and cars?
Diabetes is so common in Patricia Graham’s neighborhood that it has its own slang term. At churches you run into people you haven’t seen in years, and they say, Ive got sugar, she says.
Graham does not quite have sugar, but when foot surgery in 2014 reduced her activity level, her blood sugar level rose. And there is a history of diabetes in their own families: three of four brothers and her mother, who lost a leg to it.
So three times a week she comes to the smart, modern Diabetes Awareness and Wellness Network( Dawn) centre in Houston’s third ward, a historically African American district near downtown. Used by about 520 people a month, Dawn is in effect a free, city-run gym and supporting group for diabetics and pre-diabetics: a one-stop shop for inspiration, information and perspiration. Last Friday Graham, 68, was there for a walk-to session.
Not that she or the half-dozen other participants went anywhere. This was strolling on the spot to pulsating music. Had the class stepped outside they would have enjoyed perfect conditions for a saunter: a blue sky and a temperature of 21 C. If they had worked up an appetite, a soul food eatery was only a 15 -minute walk away, serving celebrated( if not exactly sugar-free) food that belies its unpromising locating in a standard shopping center on a busy road next to a dialysis centre.
Its one reason why Houston regularly finishes top, or close, in surveys that crown Americas fattest city. Unsurprisingly, it has a diabetes problem as outsized as its residents waistlines. By 2040, one in five Houstonians is predicted to have the disease.
According to data from pharmaceutical company Novo Nordisk, the prevalence of type 2 diabetes in the city is 9.1% with an estimated one in four of these being undiagnosed. Almost a third of adult Houstonians self-describe as obese, according to a 2010 -1 1 survey. Without action, the number of people with diabetes is projected to virtually treble by 2040 to 1.1 million people, with diabetes-related costs soaring from $4.1 billion in 2015 to $11.4 billion by 2040.
Graham is alarmed by the damage diabetes is wreaking on her community. I was talking to my friends and saying, so many of the person or persons we grew up with got diabetes and lost limbs, she says. Its not even so much the seniors any more, its the young people. But it doesnt scare them. They act like they’re not afraid.
Another Dawn member, Verne Jenkins, was diagnosed three years ago. I had picked up a little bit of weight that I shouldnt have, says the 63 -year-old. I knew what to eat, I knew what I was doing, I just got out of control.
Jenkins loves to bake but has cut back on carbs, red meat, salt and sugar, abstaining from one of her guilty pleasures, German chocolate cake. Not that its easy in a city with so many options: All these wonderful eateries, all these different kinds of cuisines, of course youre going to try some. I imagine it leads to our delinquency, she says.
Graham has watched her diet since she was in her 20 s. I eat pretty good, she said. She eats like white folks thats what they tell me!
Houston, Americas fourth-largest city, is one of five participating in the Cities Changing Diabetes program, along with Mexico City, Copenhagen, Tianjin and Shanghai. Vancouver and Johannesburg are soon to join the project, which attempts to understand, publicise and combat the threat through cultural analysis.
The majority of people with diabetes live in cities, says Jakob Riis, an executive vice-president at Novo Nordisk, one of the lead partners in the program alongside the Steno Diabetes Center and University College London. We need to rethink cities so that they are healthier to live in otherwise were not really addressing the root cause of the problem.
One of the programmes key and perhaps surprising findings, however, is that assessing the risk of developing diabetes is not as simple as dividing the population according to income and race. The problem is broad much like Houston itself.
The view stretches for miles from Faith Foremans eighth-floor office next to the Astrodome, the famous old indoor baseball stadium. Its an impressive sight, but for someone tasked with tackling the citys diabetes epidemic, also a fretting one: the sheer scale of the urban sprawl is part of the problem. The threat of the disease has expanded along with the city.
A low cost of living and a strong jobs market helped Houston become one of the fastest growing urban areas in the US. In answer, the city loosened its beltways. Its third major ring road is under building, with a northwestern segment set to open soon that is some 35 miles from downtown.
Once completed, the Grand Parkway whose northwestern segment has just opened will boast a circumference of about 180 miles. That is far in excess of the 117 miles of the M25, although about 14 million people live inside the boundary of Londons orbital motorway, more than twice as many as reside in the Houston area.
Large homes sprout in the shadow of recently opened sections, promising cheap middle-class living with a heavy cost: a commute to central Houston of up to 90 minutes each way during rush hour, with minimal modes of public transport options.
A lot of time in Houston is spent in a car, says Foreman, assistant director of Houstons Department of Health and Human Service. This informs one of the Cities Changing Diabetes studys most notable findings: that time poverty is among the risk factors in Houston for developing type 2 diabetes.
This means that young, relatively well-off people can also be considered a vulnerable population segment, even though they might not fit the traditional profile of people who may develop type 2 diabetes the hell is, aged over 45, with high blood pressure and a high BMI, and perhaps disadvantaged through poverty or a lack of health insurance.
You generally think of marginalised, lower income communities in poverty as your keys to health disparities but I think what we learned from our data in Houston is that we now have to expand the definition of what vulnerable is and what at-risk means. Just because we live in an urban environment, we may all indeed be vulnerable, says Foreman.
In other words , not only its residents dietary selections but the way Houston is constructed as a city appears to be contributing to its diabetes problem, so tackling the issue requires architects as well as physicians; more sidewalks as well as fewer steaks.
Urban isolation is a key challenge, says David Napier of UCL, the lead academic for Cities Changing Diabetes. Houston is growing so quickly and also expanding geographically at such a rapid rate. When you look at how difficult it is for people only to get out and stroll, or stroll to work; the fact that so many people commute long distances, expend a lot of time feeing out they have a number of obstacles to overcome, he says.
A city with notoriously lax planning regulations is now making a conscious effort to set more care into its constructed surrounding, with more modes of public transport, expanded bike roads, better parks and denser, more walkable neighborhoods all evident in recent years, even as the suburbs continue to swell.
Foremans agency has more input when officers collect to map out the future city. That is something that has been a big change over the last two or three years in Houston, she says. We are at the table and we are working with city planning to stimulate those decisions.
But prevention is a vital focus as well as treatment. Along with his team, Stephen Linder of the University of Texas school of public health the local academic result for Houstons Cities Changing Diabetes research gathered data on 5,000 households in Harris County, which includes much of the Houston area.
One way to approach such projects wasnt to focus on diabetes itself but rather to look at some of the preconditioned social factors that seemed to generate the patterns of living that then led to the clinical signs that would designate people as being prediabetic, he says from his office at the Texas Medical Center near downtown Houston the worlds largest medical complex.
These were people who had neither disadvantage nor biological risk factors. They tended to be the youngest group and would normally escape any kind of appraisal we called them the time-pressured-young. Theyre the ones who did the long commutes; theyre the ones whose perception was they could not manage their days worth of stuff, that they have no time for anything.
For this group, obesity is so prevalent in Houston that it distorts an understanding of what a healthy weight is, Linder saw. Their perception of their health was affected by their peers as opposed to other sorts of references. If all of their peers were overweight then in a relative sense the latter are fine. The judgments were about ones peers and not relative to any sort of expert criterion, he says.
Three neighborhoods were identified as having the highest concentration of people vulnerable to developing diabetes, and a Dallas-area research company, 2M, conducted detailed interviews with 125 residents. One place was particularly surprising: Atascocita, a desirable middle-class area near a large lagoon and golf course, about 30 miles north of downtown.
Houston has become, according to a 2012 Rice University study, the most ethnically diverse big metropolitan area in the US. But this cosmopolitan air one of the qualities sought by any place seeking to become a globally renowned city may also unwittingly be contributing to the diabetes crisis, the study found.
Some in Atascocita, Linder said, emphasised this sense of change and transition in their neighborhoods, that that was a source of stress for them and that they were resistant to constructing the changing nature of their own lives given the flux that was around them. Because that group happened to be older, even though they were economically procure they did have some other chronic diseases and they satisfied our biorisk characteristics.
We call them concerned seniors. They weren’t constructing changes because there was too much else going on for them. And so if we were to say to them youve got to change your diet, they would say no, I can’t handle any more changes.
This matters since food portions are no exception to the everythings bigger in Texas cliche, while Houstons location near Mexico and the deep south, its embracing of the Lone Star countries love of barbecued red meat and its enormous various forms of eateries serving international cuisine combine to unhealthy effect.
The food that had a traditional aspect to it tended not to be the healthiest food southern food thats fried and lots of butter and lots of starch, then theres African American soul food and then theres Hispanic heavy fat, prepared tamales and the like, and so we saw people various kinds of gravitated to what the UCL people called nourishing traditions, Linder said.
People use food as not only a strengthening of tradition and ritual but also as a way of connecting socially. Youve moved here from somewhere else, its a way to reinforce your identity, its a real cultural asset to have, but in a biological sense its not the best thing.
For Linder, one lesson is that generalised advice about healthy eating that has long been part of diabetes awareness efforts may not be effective locally, given the complexity and various forms of Houstons neighborhoods and the social factors that stimulate populations vulnerable to diabetes.
It does stimulate the task of dietary change a much more complex one than the simple messages about changing your diet, eat more fruit and veggies, get more colors on your plate proposed to. Those things bounce off, its not a useful situated of interventions then for that particular group who rely on these nourishing traditions and find some consolation in the change around them, he said.
Foreman agrees that a targeted approach is vital. How do you change diabetes in Houston? One neighborhood at a time, in a sense, but at the same day you have bigger things that you can change systemwide in policies and how you work together collaboratively, she said. But then as you narrow it and get more granular it is neighborhood, and what works in one neighborhood may or may not work in another.
Patricia Graham can only hope the Dawn program expands to other parts of the city to combat the dangerous union of unhealthy traditional food with a modern convenience culture. Everything is food, and I mean lots of it and all the time, she said. Some people don’t know how to cook without grease or butter. Thats only the way we learn.
In the above video you saw how simple it was to monitor and track your blood sugar levels using the Freestyle Precision Neo Test Kit. You probably now have questions about how often you should be testing your blood sugar and what readings you should be looking for and what they mean.
How Often Should I Test?
To answer that question depends on where you are on the diabetes spectrum. Remember these are guidelines only and this is something you should discuss with your doctor. This information is from everything I have personally read and learned so far on my journey.
If you are not currently taking diabetic medication:
Sunday- No testing required
Monday-Test before breakfast and two hours after breakfast (Before 70-100 mg/dl fasting or 70-120 mg/dl if not fasting, After meal 1-2 hours, < 140mg/dl)
Tuesday- No testing required
Wednesday- Test before lunch and two hours after lunch
Thursday- No testing required
Friday- Test before and two hours after dinner
Saturday- Test at bedtime
Type II Diabetic taking Diabetic Medication but not Insulin
Monday- Test before breakfast and 2 hours after breakfast (Before 70-140mg/dl, After <160mg/dl)
Tuesday- No testing required
Wednesday- Test before and after lunch
Thursday- No testing required
Friday- Test before and after dinner
Saturday- No testing required
Sunday- Test before bedtime
Type II Diabetic taking Insulin or Type I Diabetic
Sunday- Test upon waking, before lunch, before your afternoon snack, before dinner or at bedtime; and before exercising or driving (80-140 mg/dl fasting, 80-160 mg/dl,- premeal range,overall < 180 mg/dl)
Monday- Same as Sunday
Tuesday- Same as Sunday
Wednesday- Same but test after your meals as well
Thursday- Same as Sunday
Friday- Same as Wednesday
Saturday- Same as Sunday
Record your daily test results and consider keeping a food diary of what you are eating. Also, keep track of your portion sizes, if possible, particularly of carbohydrates consumed. If your numbers are high or out of range, you can cut back the portion or eliminate the offending food all together. Remember though your level of physical activity, amount of sleep, stress level etc., not just your food intake effect on your blood sugar.
Learning more about diabetes — taking action to monitor and record your results when testing your blood sugar and not allowing the minor pain and inconvenience of testing to make you a victim of diabetes.
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Often referred to as Juvenile Onset diabetes because half of folks diagnosed with this type of diabetes are under 20 years old; this type of diabetes can also be diagnosed later in life.
Normally it requires the person to require insulin injections because the immune system has a defect which caused it to attack the pancreas killing off beta cells which normally produce the hormone insulin lowering or stopping the pancreas’s ability to make Insulin. With no or little insulin to regulate and allow glucose to enter the cells to be burned for energy blood glucose rises in the blood stream causing havoc in the body.
Signs and Symptoms
Frequent Need To Urinate
Since glucose can’t reach the cells the body reverts to burning fat which causes the Type 1 Diabetic often to lose weight. The burning of fat causes the production of Ketones which in a diabetic can rise to dangerous levels which may cause a fruity odor to the breath and if not treated can be toxic and can lead to the diabetic going into a coma.
Managing Type I Diabetes
This can be a delicate balancing act and more than ever you need to seek out professional help and support.
As in the other forms of diabetes you need to be under a Doctor’s care and your insulin levels need to be closely monitored and regulated.
Through the use of injectable insulin,other medications, diet and exercize you can live with and co-exist with the disease.
We will explore in later blog posts in more detail this type of diabetes.