The Medical Minute: The truth about diabetes

You don’t notice it, at first. You might feel thirsty all the time, or maybe your vision is blurry.

Then your doctor says the word “diabetes.”

How could this have happened? Like 38.4 million people in the U.S. ― 11.6% of the population ― you have elevated blood sugar, a dangerous condition that can damage your internal organs and cause a litany of sobering health conditions from heart disease to blindness.

Worse, in today’s body-image obsessed, blame-game society, some diagnosed with the most common form of the illness, Type 2 diabetes, can feel as though their condition is self-inflicted. They think they’ve condemned themselves through poor dietary choices, to a life of depending on injections and drugs to survive.

But that isn’t true, says Dr. David Bradley, an endocrinologist who leads the diabetes program at Penn State Health Milton S. Hershey Medical Center. Despite the stigma, the cause of diabetes for many people isn’t necessarily within their control. And for the majority of patients, diabetes is completely reversible ― now more than ever with the advent of drugs that not only lower blood sugar but facilitate weight loss.

Here, Bradley discusses some of the truths about diabetes.

What is diabetes?

Simply put, the natural mechanisms that produce and direct sugar in the blood stream aren’t working properly.

There are two types:

• Type 1 diabetes is an underlying autoimmune disease that causes the body to attacks cells that produce insulin – the hormone that regulates blood sugar levels. Often, people who develop Type 1 diabetes have a family history of the disease.
• The majority of people with Type 2 diabetes, which represents most of the cases, are overweight or obese. In addition to affecting the pancreas’s ability to produce insulin, Type 2 diabetes creates what doctors call insulin resistance. Your pancreas secretes the hormone, but something prevents muscles from taking up the sugar they need. Insulin resistance also blocks messages to the liver, which continues to put out too much sugar that the muscles aren’t absorbing.

What symptoms are there for diabetes? Are the symptoms different between Type 1 and Type 2?

Symptoms of Type 1 include increased thirst, increased urination, weight loss and abdominal pain. Left unchecked, patients can develop what’s called diabetic ketoacidosis, where acids called ketones build up in the blood. That brings on nausea and vomiting, and it can be life-threatening.

Symptoms for Type 2 can be insidious. Many patients don’t realize they have it at first because the symptoms aren’t as striking at Type 1. “Oftentimes, when I see someone, they’ve had diabetes for five to 10 years, and they didn’t realize it,” Bradley said.

Some patients will feel thirstier than usual or find that they’re urinating more often. Blurry vision is another sign that their blood sugars may be high.

Five to 10 years seems like a long time. What if I just ignore it?

Big mistake. Diabetes can cause cardiovascular disease ― that includes stroke, heart failure and coronary disease (a build-up of plaque in the arteries that limits blood flow to the heart). “Cardiovascular disease is the number 1 cause of mortality in patients with diabetes,” Bradley said.

My doctor says I’m prediabetic. I have nothing to worry about until diabetes actually sets in, right?

“Most people think of prediabetes as a benign condition,” Bradley said. “Even having prediabetes can increase the risk of having cardiovascular disease.”

Can diabetes be cured?

“Currently, Type 1 diabetes is irreversible,” Bradley said. Immunotherapy is available, but it doesn’t completely stop the autoimmune process ― it only delays its onset.

You can treat diabetes by creating a plan with your doctor that includes practices like taking insulin, controlling your diet and monitoring your blood sugar.

But Type 2 can be reversed. And you have options ― all of which involve losing weight.

• Gastric bypass surgery, or surgery that alters the way your body channels food, can cause patients to lose a lot of weight. As a result, their hormone levels adjust and often ― 80% to 90% of the time ― their diabetes goes into remission. That said, roughly half of those patients gain weight, and diabetes returns within ten years.
• Lifestyle changes – “There’s lots of evidence that you can reverse Type 2 diabetes with changes like a lower calorie diet and increased exercise,” Bradley said.
• Medication – Three once-weekly, injectable drugs are working wonders for many diabetic patients. Decades ago, doctors discovered a hormone secreted by human intestines that affects blood sugar levels, but also crosses into the brain and suppresses appetite. Usually, this hormone is quickly deactivated once it enters the bloodstream. But drugs such as dulaglutide, or Trulicity; semaglutide, or Ozempic; and tirzepatide, or Mounjaro, use a more resistant version of the hormone. The hormone suppresses patients’ appetites and they start to lose weight. “I tell my patients if we’re able to accomplish a reduction in the risk or reverse diabetes without using a medication, that’s preferable, as medication has side effects,” Bradley said.

Who should get tested for diabetes?

Most medical institutions don’t recommend screening for Type 1 diabetes, but that could change soon. Doctors already commonly check for antibodies that indicate the disease.

Everyone should be tested for Type 2 diabetes at age 35, and every three years after that ― and more often if they are obese, have a family history of the disease and lead a sedentary lifestyle. Doctors also recommend annual screening for women who develop gestational diabetes during pregnancy.

Why do you see diabetes in all the news and medical literature these days? Are there more cases of it?

The number of people with diabetes has increased steadily since the 1970s, nearly quadrupling between 1980 and 2014.

“It tracks very closely to the obesity epidemic,” Bradley said.

Food trends seem to affect it. An increase in the availability of food, especially processed foods containing high-fructose corn syrup, have had a large impact on the rising rates of Type 2 diabetes. Socioeconomic factors play into it, as well. “A lot of the food that is more affordable tends to be the worst type of food for people,” Bradley said.

At the same time, some patients feel shame over their situation.

“The reality is diabetes is a hard condition to live with,” Bradley said. “You don’t have to feel guilty about being obese or having diabetes. These are oftentimes circumstances that are out of our control.

“I would tell people who don’t have diabetes and think it’s easy, try and live in their shoes for a while.”

Related content:

• The Medical Minute: Diabetes diagnosis demands close eye on vision
• The Medical Minute: Controlling diabetes apart from blood sugar levels
  

The Medical Minute is a weekly health news feature produced by Penn State Health. Articles feature the expertise of faculty, physicians and staff, and are designed to offer timely, relevant health information of interest to a broad audience.

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