FAQ: About Diabetes

Q: What is diabetes?
A: Diabetes mellitus, a group of diseases characterized by high levels of blood glucose, results from defects in insulin secretion, insulin action or both. Diabetes is a disease in which the body does not produce or properly use insulin, a hormone produced by the pancreas that is needed to convert sugar, starches and other food into energy needed for daily life. Digestive juices break down most of the food we eat into glucose, a simple sugar. Glucose is the main source of fuel for the body. After digestion, the glucose passes into the bloodstream where it is available for body cells to use for growth and energy. For the glucose to get into the cells, insulin must be present. When we eat, the pancreas is supposed to produce the right amount of insulin automatically to move the glucose from our blood into our cells. In people with diabetes, however, the pancreas either produces little or no insulin, or the body's cells do not respond to the insulin that is produced. As a result, glucose builds up in the blood, overflows into the urine, and passes out of the body. Thus, the body loses its main source of fuel even though the blood contains large amounts of glucose.

Q: What are the different types of diabetes?
A: There are three main types of diabetes: Type 1, Type 2 and Gestational diabetes.

* Type 1 diabetes (also known as insulin-dependent diabetes mellitus or juvenile diabetes) is considered an autoimmune disease. In Type 1 diabetes, the immune system attacks the insulin-producing beta cells in the pancreas and destroys them. The pancreas then produces little or no insulin. Someone with Type 1 diabetes needs daily injections of insulin to live. Type 1 diabetes accounts for about 5-10 percent of diagnosed diabetes in the United States.

* Type 2 diabetes is the most common form of diabetes (also known as noninsulin-dependent diabetes mellitus or NIDDM). About 90-95 percent of people with diabetes have Type 2 diabetes. This form of diabetes usually develops in adults after the age of 40 and is most common among adults after age 55. About 80 percent of people with Type 2 diabetes are overweight.

* Gestational diabetes develops during pregnancy. This type usually disappears when the pregnancy is over, but women who have had Gestational diabetes have a greater risk of developing Type 2 diabetes later in their lives.

Q: What is the health impact of diabetes?
A: Diabetes is widely recognized as one of the leading causes of death and disability in the United States. Diabetes costs the United States $98 billion in 1997. Indirect costs, including disability payments, time lost from work, and premature death, totaled $54 billion; medical costs for diabetes care, including hospitalizations, medical care, and treatment supplies totaled $44 billion.

Q: Who gets diabetes?
A: There are 17 million people or 5.9% of the U.S. population who have diabetes. While an estimated 11.5 million have been diagnosed, 5.5 million people are not aware that they have the disease. Type 1 diabetes occurs equally among males and females, but is more common in whites than in nonwhites. Type 2 diabetes is more common in older people, especially older women who are overweight, and occurs more often among African Americans, Hispanics, and American Indians. The prevalence of diabetes is likely to increase because older people, Hispanics, and other minority groups make up the fastest growing segments of the U.S. population.

Q: What are the complications of diabetes?
A: With its complications, diabetes is the seventh leading cause of death in the United States. Diabetes is the leading cause of new blindness in people 20-74 years of age. Ten to twenty-one percent of all people with diabetes develop kidney disease. People with diabetes are 2-4 times more likely to have heart disease. About 60%-70% of people with diabetes have mild to severe forms of diabetic nerve damage, which, in severe forms, can lead to lower limb amputations.

Q: How is diabetes managed?
A: Daily injections of insulin are the basic therapy for Type 1 diabetes. Insulin injections must be balanced with meals and daily activities, and glucose levels must be closely monitored through frequent blood glucose testing. Diet, exercise, and blood testing for glucose are also the basis for management of Type 2 diabetes. In addition, some people with Type 2 diabetes take oral drugs or insulin to lower their blood glucose levels.

People with diabetes must take responsibility for their day-to-day care. Much of the daily care involves trying to keep blood glucose levels from going too low or too high. When blood glucose levels drop too low, the condition is known as hypoglycemia. On the other hand, a person can become very ill if blood glucose levels rise too high, a condition known as hyperglycemia. Hypoglycemia and hyperglycemia, which can occur in people with Type 1 diabetes or Type 2 diabetes, are both potentially life-threatening emergencies. The goal of diabetes management is to keep blood glucose levels as close as possible to the normal (nondiabetic) range.

Q: What are the DCCT and the UKPDS?
A: A 10-year study, called the Diabetes Control and Complications Trial (DCCT), was completed in 1993 and included 1,441 people with Type 1 diabetes. The study compared the effect of two treatment approaches - intensive management and standard management - on the development and progression of eye, kidney, and nerve complications of diabetes. Researchers found that study participants who maintained lower levels of blood glucose through intensive management had significantly lower rates of these complications. Another 10-year study called the United Kingdom Prospective Diabetes Study (UKPDS) studied patients with Type 2 diabetes and had similar findings - improved glycemic status as measured by A1C values translates into reductions in risk for getting diabetes complications.