Diabetes

Diabetes is an epidemic in countries around the world as well as one of the major health problems affecting Americans. The World Health Organization (WHO) describes this metabolic disorder as a monumental global public health threat.

How Many People Have Diabetes?

A new study in The Lancet counted more than 520 million cases in 2021 (Lancet, June 22, 2023). As a result, the researchers predict that 1.3 billion people will have this metabolic disease by 2050. Most individuals have type 2 diabetes; experts estimate that appropriate intervention could prevent or reverse this much of the time. Obesity is driving this pandemic to a large extent. The countries with the highest rates are in North Africa and the Middle East. Oceania is also a hot spot, with high rates in American Samoa, the Cook Islands, Nauru, Niue and Palau.

Experts have estimated in the past that 22 million Americans have diabetes (MMWR, March 30, 2018). That’s nearly 9 percent of the population. Unfortunately, up to one-fourth of these people have not been diagnosed with diabetes. Consequently, they lack treatment.

One of the best ways to prevent complications from diabetes is to control blood sugar carefully. The good news is that keeping blood sugar within normal limits can cut the risk of life-threatening consequences such as heart attack and stroke nearly in half.

What Is Diabetes?

In this condition, cells of the body can’t get energy from the sugar (glucose) circulating in the blood. They may literally starve to death in the midst of plenty. Imagine yourself in a lifeboat in the middle of the ocean. You are desperately thirsty, surrounded by water, but there’s not a drop to drink. With diabetes, the bloodstream has too much glucose, but because insulin is lacking or not effective, it cannot transport this sugar into the cells that need it.

This metabolic disruption creates conditions ripe for heart disease and stroke. Other potential complications include nerve damage (known as neuropathy), sexual dysfunction, kidney disease, and even blindness. But if people can treat diabetes successfully to keep blood sugar within the normal range, they minimize their complication rate. Below, we describe how doctors determine blood sugar levels.

Type 1 Diabetes Requires Insulin:

Doctors classify the disease into two categories. In type 1 diabetes, the immune system attacks the pancreas and destroys the cells that make insulin. Since insulin is crucial for glucose to get into the cells from the bloodstream, the type 1 diabetic must get insulin from somewhere else. Usually, this means injections, often several times a day. (Inhaled insulin may offer another option, but it is not popular.) This disease has also been termed insulin-dependent diabetes, which is descriptive, or juvenile diabetes, which is not very helpful. Not all people newly diagnosed with type 1 diabetes are children, and not all children diagnosed with out-of-control blood sugar have type 1 diabetes. This disease is very complicated and requires careful medical supervision. Consequently, we urge those with type 1 diabetes to discuss their insulin regimen with their specialist. We will not discuss it here.

Many Options for Treating Type 2 Diabetes:

In type 2 diabetes, by contrast, there is insulin in the bloodstream, sometimes too much of it, but the cells become resistant to its action. Many people with type 2 diabetes are able to control their blood sugar level with diet, exercise, and oral medication. As a result, type 2 diabetes is also referred to as non-insulin-dependent diabetes, or adult-onset diabetes.

The latter term is left over from an earlier era. With the increase in childhood obesity, more children are being diagnosed with type 2 diabetes all the time. Type 2 diabetes is the most common kind, and it is increasing at an alarming rate. The Centers for Disease Control and Prevention projects that one in three children currently under the age of 5 will develop this kind of diabetes during their lifetime. If they are Latinx, the odds are that one in two will become diabetic.

Why Is There a Surge in Diabetes?

Everyone agrees that diabetes has reached epidemic levels. What is unclear is why. Most experts blame the problem on obesity and inactivity. But there are voices in the wilderness suggesting that there may be other factors that are also contributing to this public health nightmare. Some suggest that high-fructose corn syrup, which is widely used as an inexpensive sweetener in juice, soft drinks, and processed foods, might predispose people to diabetes. In animal research, this sugar leads to insulin resistance and poor glucose tolerance. Until this controversy is sorted out, we discourage the consumption of foods and beverages containing high-fructose corn syrup.

Does Environmental Contamination Contribute?

Another even scarier scenario involves the compound bisphenol A (BPA). You’ve probably never heard of this chemical, but the chances are very good that you have it circulating in your body. BPA shows up in the bloodstream of 95 percent of Americans. You will often find BPA in clear, hard plastic. There may be some in your water bottle or jug. It is also in the plastic lining of cans of soft drinks and beer. Canned foods, food storage containers, pacifiers, baby teethers, and dental sealants may contain BPA.

The plastic industry will tell you that small amounts of BPA are nothing to worry about. A study published in the journal Environmental Health Perspectives, however, suggests that when mice are exposed to low levels of BPA for several days, they develop insulin resistance (Environmental Health Perspectives, Sep. 1, 2010). This discovery is particularly alarming because the Environmental Protection Agency considers the levels of BPA used in the experiment safe for humans. This study was published more than a decade ago. Since then, scientists have discovered a number of detailed mechanisms that explain just how BPA disrupts metabolism (International Journal of Molecular Sciences, Aug. 11, 2020).

What About Forever Compounds?

BPA is not the only suspect. Manufacturers use other compounds known as “forever chemicals” in food packaging. They also help prevent stains, so manufacturers put them in clothes and furniture. Such per- and polyfluoroalkyl substances (PFAS) appear to disrupt normal glucose metabolism, though studies are not conclusive (Frontiers in Endocrinology, Aug. 5, 2022).

Preventing Type 2 Diabetes:

Diabetes is common, and its complications are devastating. Below, we offer a variety of strategies to prevent or control this disease. Remember, though, that whatever tactics you adopt, you must work in close collaboration with your health-care providers.

• Preventing diabetes is possible. Keep your weight under control, emphasize nonstarchy vegetables over pasta or bread, and avoid soft drinks, fruit juice, and processed meats.
• Learn your numbers. Fasting blood glucose between 100 and 125 mg/dL indicates prediabetes. Your doctor may also want to determine your glycosylated hemoglobin. This test is an indication of average blood sugar over the past several weeks. HbA1c (or just plain A1c) below 5.7% is normal, but the bell rings for prediabetes between 5.7% and 6.4%. Anything higher indicates diabetes.
• Get plenty of exercise, preferably including some time outdoors so you have 10 to 15 minutes of sunshine on your face and hands several days a week. The YMCA offers a Diabetes Prevention Program that has demonstrated efficacy. If you don’t get outside, take 800 to 1,200 IU of vitamin D3 daily.
• If you develop diabetes, learn to monitor your blood sugar. Keep track of how exercise and food affect it. A continuous glucose monitor can make this task easier, especially if you link it with a food and activity diary.
• Consider cinnamon or vinegar to help smooth out blood sugar in reaction to a carbohydrate meal.
• If you’re contemplating using herbs or dietary supplements such as chromium, bitter melon, fenugreek, Gymnema sylvestre, or nopal, check with your health-care providers before taking them. Monitor your blood sugar carefully.
• If medication becomes necessary, make sure that you and your physician find the safest and most effective option for you. You shouldn’t have to suffer with dreadful side effects to keep your blood sugar under control.