Building Healthy Communities through Medical-Religious Partnerships

7. Diabetes Mellitus

7 Diabetes Mellitus Data from the Centers for Disease Control and Prevention indicate that approximately 24 million Americans (nearly 8% of the U.S. population ) have diabetes mellitus, a condition defined by abnormally high levels of glucose (a natural sugar) in the blood. However, almost a quarter of these people do not know they have this serious medical condition. Among people 60 years of age and older, the prevalence is estimated at 25 percent having diabetes mellitus. The prevalence rates are even higher among African Americans and Hispanics and for all adults who are overweight. Besides those with diabetes, more than 55 million other Americans have “prediabetes ,” or evidence of problems controlling glucose levels that increases their risk of developing diabetes. There are two major types of diabetes mellitus. Type 1 diabetes, also known as insulin-dependent diabetes mellitus, juvenile diabetes, and brittle diabetes, accounts for approximately 10 percent of all cases. This type is most likely to affect those under 20 years of age, although it can occur at older ages. More common is type 2 diabetes mellitus, also referred to as non–insulin-dependent diabetes mellitus or adult-onset diabetes, generally found in individuals over 40 years of age. Type 2 diabetes accounts for approximately 90 percent of all cases. Although the majority of people with type 2 diabetes are overweight, even lean adults can be affected. Given the epidemic of obesity in the United States, it is now common to find children, adolescents, and adults less than 40 years of age with type 2 diabetes—a situation almost unheard of just a few decades ago. In persons with diabetes, high blood glucose (hyperglycemia) occurs diabetes mellitus 69 because there is a breakdown in the normal process of glucose being transported into the body’s cells. Insulin, a hormone produced by the pancreas, plays a critical role in the movement of glucose or sugar from the bloodstream into the cells. High levels of blood glucose result when the pancreas does not produce enough insulin (type 1 diabetes) or when the cells are resistant or unresponsive to insulin (type 2 diabetes). Type 1 diabetes usually develops rapidly, with individuals experiencing unexplained weight loss, frequent urination, and excessive thirst. Sometimes diabetic ketoacidosis, a potentially life-threatening condition with symptoms that include nausea, vomiting, slow respirations, and mental confusion, can be the presenting illness for persons with type 1 diabetes. Type 2 diabetes develops more gradually, and many individuals experience few or no symptoms for several years. Increased thirst and urination can be seen, along with visual disturbances or even fungal rashes of the feet or groin. Occasionally, individuals with type 2 diabetes develop ketoacidosis under certain circumstances, but the more serious problems associated with type 2 diabetes are its long-term complications. Who Is at Risk? It is important that people at high risk for developing diabetes have the appropriate screening tests. At least two screening tests separated by a few days or weeks must be abnormal to make and confirm the diagnosis of diabetes. (Sometimes diet, medications, or illness can lead to an elevated blood glucose measurement in those who do not have diabetes and therefore having a second test is a necessary step in diagnosis.) The two most common tests are the fasting glucose and oral glucose tolerance tests. For the fasting glucose test, the patient fasts overnight for at least ten hours, blood is drawn and tested the next morning, and the glucose value over 126 mg/dl is consistent with a diagnosis of diabetes. For an oral glucose tolerance test, the same procedure as for a fasting glucose test is initially followed. But in addition, after the first blood is drawn, the patient drinks a sugary mixture and has a second blood sample drawn two hours later. If the fasting blood glucose is over 126 mg/dl or if the blood glucose two hours later is over 200 mg/dl, a diagnosis of diabetes can be made. Persons at risk for developing diabetes include everyone over 45 years 70 suggested topics for congregational programs of age, those with a family member who has diabetes, Asian Americans, African Americans, Hispanics, Native Americans, Pacific Islanders, people who are overweight or obese, women with previous gestational diabetes (or diabetes diagnosed while pregnant) or with babies born weighing more than nine pounds, and women with a diagnosis of polycystic ovarian disease. People who are at risk for diabetes...