Susan Blatt, MD

As more Americans are overweight, it appears that more people are also developing diabetes.  Diabetes is caused by a decrease in insulin production, which results in increased sugar in the body.  When diabetes occurs in older adults it is usually referred to as type 2 diabetes.

Children who develop diabetes usually have type 1.  Their bodies make no insulin and they must take insulin shots.  Most type 2 diabetics make some insulin, but not enough to keep the blood sugar in normal range. 

Risk factors for type 2 diabetes include being overweight, lack of exercise, and having a family history of diabetes. Diagnosis is by finding elevated blood sugar levels.  There may be no symptoms at the beginning.   Eventually it usually causes increased urination, and increased thirst.

Lifestyle changes may slow the progress of diabetes.  These include losing weight, eating a diet low in sweets, and getting regular vigorous exercise. Often treatment begins with one or two medications.  The first medication encourages more insulin production by the pancreas and the other makes the body use insulin more effectively.  Insulin injections may be necessary to bring blood sugar levels down to normal.  Patients monitor their blood sugar at home and get blood tests every few weeks.  Medications for diabetes often need to be increased or change.

Many people who have diabetes also have elevated cholesterol and triglycerides.  Medication for cholesterol is relatively easy to take and usually is successful. High blood pressure is often part of the picture of diabetic patients.  Many patients require two or three medications to get their blood pressure into an acceptable range. 

There are long range effects of diabetes.  Patients may have vision problems resulting in blindness.  Kidney problems may develop, resulting in the need for dialysis.  There may be circulation problems in the legs resulting in amputation.  There is also an increased risk of heart attack or stroke.  All of these worrisome problems are best prevented by keeping blood sugar, blood pressure, and cholesterol in normal range.

All of the effects of diabetes are made worse by smoking, so the most important lifestyle change for diabetic adults is to stop smoking. Although it may be discouraging to deal with many health related problems at the same time, many patients can work with their doctor and gradually make lifestyle changes and use medication to bring all of their problems under control.  It is very important to do this, in order to improve the quality of life.

There is information on the Internet about diabetes.  The American Diabetic Association, at www.diabetes.org provides valuable information about the illness.  There is also excellent, up-to-date information at the site provided by the American Academy of Family Physicians (familydoctor.org)