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Diabetes is one of those conditions that must be treated for life, and requires lifestyle shifts and constant monitoring. Diabetics are in for the long haul, no matter which of the two major types of diabetes they are living with. Both type-1 and type-2 diabetes are associated with elevated glucose levels in the blood and an inability of the cells to take up sugars which have the energy they need to perform the tasks they have to perform every day. A third type of diabetes, gestational diabetes, develops only during pregnancy and occurs more often in African Americans, American Indians, Hispanic Americans, and among women with a family history of diabetes. Women who have had gestational diabetes also have a 20 to 50 percent chance of developing type-2 diabetes within 5 to 10 years.

All forms of diabetes present a serious problem to sufferers, in that they increase the risk of heart attack, stroke, eye disease, and kidney failure. Symptoms of elevated blood sugar include light-headedness, confusion, weakness, and if untreated, seizures, coma, and death. Insulin is a hormone produced by the pancreas that stimulates uptake of glucose or sugar, the body’s food, into cells. Unregulated glucose in the blood can lead to a hospital room emergency.

Type-1 (juvenile) diabetes is a genetic disease that usually occurs in childhood, but can also happen in adults, normally those under age 40. It is thought to be an immune system disorder, and is related to a deficiency of insulin production caused by an autoimmune attack on pancreatic ²-cell islets; daily insulin shots are required for survival. Type-1 diabetes is a lifelong condition that needs to be treated for life, and at this time it is not preventable. However, it is actually fairly uncommon – only 10% of people who have diabetes have type-1. Those dealing with type-1 diabetes treat it with insulin therapy, meal planning (carbohydrates need to be carefully balanced), regular exercise (because activity lowers the amount of sugar in the blood), and careful monitoring of overall health. This last because diabetes alters the body’s immune system and decreases the body’s ability to fight infection. Foot injuries in particular have to be watched, since diabetes causes damage to the blood vessels and nerves, which can result in a decreased ability to sense trauma or pressure on the foot. An unnoticed foot injury can lead to severe infection and, if untreated, amputation.

For those who have type-2 diabetes or “adult onset diabetes” (about 90% of those with diabetes – 10% have type-1 or gestational) insulin shots are not necessarily required for treatment. Ten million Americans have impaired glucose tolerance, putting them at risk for the development of type-2 diabetes. From 2000 to 2010 the prevalence of type-2 diabetes is projected to increase by 46%, from 151 million to 221 million world-wide. And calling the disease “adult onset” is fast becoming a misnomer, since more and more children and young adults are diagnosed with type-2 diabetes each year. According to The Children’s Hospital of Philadelphia, type-2 diabetes in children has risen dramatically since 1994, when less than 5 percent of new childhood diabetes cases were type-2. By 1999, type-2 diabetes accounted for 8 to 45 percent of new childhood diabetes cases, depending on geographic location. That’s because type-2 is closely linked to lifestyle, most especially obesity and a sedentary lifestyle, and is associated with resistance to insulin at the cell level and/or impaired insulin secretion.

The growing prevalence of type-2 diabetes over the last 20 years has led to terms such as “diabesity” (obesity plus diabetes) and “metabolic syndrome” (abdominal fat, insulin resistance, increased lipids, and hypertension). Once again, we see a modern disease caused by modern living, in this case, a bad diet. Massive doses of fats and sugars that are part of our everyday food leads to diabetes because large doses of sugar in the blood lead to a spike in insulin release. High fat diets add to the problems, as fat-filled cells release fats into the blood stream, triggering insulin release, leading to insulin resistance and eventual diabetes.

It’s not only the US that is seeing a rise in type-2 diabetes – there are dramatic increases occurring in developing nations as well. For instance, on the Pacific island of Nauru, where 40 years ago diabetes was virtually unknown, now 40% of the adult population has diabetes. The prevalence of diabetes in Chinese ranges from 2% in China to 15% to ethnic Chinese in Mauritius, showing how when ethnic Chinese move from their native country to other cultures they have a corresponding increase in diabetes. These changes in rates of diabetes in countries where they previously did not exist have been directly correlated with the introduction of Western diets, specifically with the arrival of American fast food restaurants like McDonalds and Wendy’s.

In fact, A. Hauber (an economist from Bear Stearns International) and E. Gale (a doctor at the University of Bristol in England) (showing an unusual collaboration between the world of finance and that of medicine and science) wrote in 2006 that, “There are two dimensions to each new treatment for diabetes. The first is the impact it will have upon glucose control, measured in terms such as clinical trial outcomes, risk vs benefit, patient satisfaction and cost. The other dimension, rarely considered in clinical journals, is that of the market place. Diabetes has been a major driver of the worldwide pharmaceutical market over the past 10 years, and this sector has grown at an annual rate of just below 20%, from US$3.8 billion in 1995 to US$17.8 billion in 2005. Growth in the diabetes market remained at a solid double-digit level even when growth of the world pharmacy market slowed from 11% in 2002 to 5% in 2005. Diabetes is common-and rapidly becoming more so-and current therapies are only partially effective in controlling glucose levels and preventing late complications. It is therefore expected to remain one of the most attractive growth areas in the global pharmaceutical market. This was not always the case, for 10 years ago the market in diabetes was limited to insulin, sulfonylureas and metformin, medications that were well established, largely generic and relatively inexpensive. In contrast, the past decade has seen the introduction of a wide range of new therapies that have varied in their clinical and commercial success but have invariably been more expensive than the previously available options.”

originally posted 9.17.10

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Physician, professor, researcher, writer, filmmaker