Diabetes is a Growing Epidemic: Are You at Risk?

Diabetes is an epidemic in the United States despite continued medical advances and prevention efforts. As of 2015, 30 million Americans had diabetes. Almost one-fourth of those are undiagnosed, according to the American Diabetes Association.

That means nearly 1 in 4 people in the U.S. is living with diabetes. About 95 percent of cases are Type 2. The remaining 5 percent are Type 1 diabetes cases that are usually diagnosed before age 40.

Unfortunately, the rates continue to rise. Experts predict that by 2050, more than 100 million Americans — or 1 in 3 people — will be living with diabetes.

Another 84 million Americans have prediabetes, a precursor to Type 2 diabetes — yet only 10 percent of them are aware of their condition. If no intervention occurs, there’s a 33 percent chance of prediabetes developing into full-blown Type 2 diabetes within five years. Already, the number of Americans with prediabetes is expected to hit 100 million by 2030.

If you have diabetes or are at risk for it, understanding the disease and working with your doctor can help you minimize complications or prevent it. Here’s what you need to know.

Recognizing the Signs and Symptoms of Diabetes
There are some telltale visual signs of Type 2 diabetes. Look in the mirror and ask yourself:

• Am I overweight or obese? Having a BMI of 30 or higher is a risk for developing Type 2 diabetes.
• Am I carrying some extra weight around my waist? Women with a waist circumference of 35 inches or more and men with a waist circumference of 40 inches or more are at risk.
• Do I have brown patches under my arms, on my face, or on the back of my neck? These patches may be acanthosis nigricans, a skin condition associated with insulin resistance and early diabetes.

Some risk factors are out of your control. Ask yourself:

• Am I over the age of 40? If you’re sedentary and over 40, your risk is even higher.
• Do I have a family history of diabetes? This is important. Between 50 and 75 percent of patients with Type 2 diabetes have a family member with diabetes.
• Does my ethnicity increase my risk? If you are of African, Hispanic, or Native American descent, your risk of diabetes increases two to six times.

Both Type 1 and Type 2 produce similar symptoms. Ask yourself:

• Are you thirstier or hungrier than usual?
• Have you unintentionally lost weight?
• Are you more tired than usual?
• Do you have worsening or blurred vision?
• Do you get a lot of infections or skin sores that are slow to heal?

Watching Out for Metabolic Syndrome: The Risk Factor without Symptoms
Metabolic syndrome is a combination of high blood pressure, high blood sugar, high triglycerides, unhealthy cholesterol levels, and extra fat around the waist.

It’s sometimes overlooked because it often doesn’t produce symptoms, but it plays a role in insulin resistance and increases the risk of developing Type 2 diabetes, even if your blood sugar is normal.

Doctors will diagnose someone as having metabolic syndrome if they have three of the following:

• Abdominal obesity/BMI 30 or higher
• Triglycerides higher than 150
• HDL (good cholesterol) below 40 or LDL (bad cholesterol) higher than 130
• Blood pressure higher than 130/80
• Fasting blood sugar higher than 100

Metabolic syndrome also triggers inflammation, raising the risk of cardiovascular disease even higher if you have Type 2 diabetes. As a proinflammatory state, it also indicates the presence of cardiovascular disease.

Getting Diagnosed with Diabetes
If you’re at risk for prediabetes or Type 2 diabetes, your doctor may order some lab tests. Here’s what they’re looking for:

• A fasting blood sugar higher than 100
• A random blood sugar higher than 140
• An A1C level between 5.7 and 6.4 (prediabetes) or 6.5 or higher (Type 2 diabetes)
• A triglycerides level higher than 150
• A triglyceride/HDL (good cholesterol) ratio higher than 3.5 (insulin resistance)
• Glucose tolerance test (GTT): higher than 140 (prediabetes) or higher than 200 (Type 2 diabetes)

Testing for Type 1 diabetes is a different process. If your doctor is concerned, you’ll probably go through a fasting glucose test. If your results are normal but you have symptoms and risk factors, an oral glucose-tolerance test may be ordered.

Once you’re diagnosed, your doctor may track your blood sugar levels using random blood sugar tests and A1C tests.

Treating Diabetes
Many options are available to control Type 2 diabetes and prediabetes. Your doctor will probably recommend that you change your diet, begin exercising, manage your weight, and quit smoking.

If lifestyle changes aren’t enough to maintain sugar levels, oral medication may be prescribed to help the body use insulin more efficiently and lower the liver’s production of blood sugar. And if the pancreas isn’t producing enough insulin, you may need insulin.

If you have Type 2 diabetes, talk with your doctor about taking additional medications, such as aspirin, a statin, or an ACE (angiotensin converting enzyme) inhibitor or ARB (angiotensin-receptor blocker).

Understanding How Diabetes Affects Your Wallet
Medical expenses for patients with diabetes are generally two to three times higher than patients without diabetes. In 2017, the average patient with diabetes spent about $16,750 on medical expenses, of which $9,600 was attributed directly to diabetes, according to the American Diabetes Association.

The expenses are going to keep increasing. Experts predict the $408 billion spent to treat diabetes in 2015 will jump 53 percent to $622 billion by 2030.

Preventing Complications Associated with Diabetes
Poorly controlled diabetes raises your risk for a long list of serious conditions, including cardiovascular disease, kidney disease, nerve damage, blindness, osteoporosis, Charcot foot, and infections including sepsis.

Moreover, recent studies have linked uncontrolled diabetes to Alzheimer’s disease. Working with your doctor can help keep your sugar levels in a healthy range and address complications as soon as signs and symptoms arise.

Preventing Diabetes
Even though genetics plays a large role in prediabetes and Type 2 diabetes, adopting these lifestyle changes can help offset your risk.

• Limit refined carbohydrates and sugar. If you need help cleaning up your diet, consult a dietitian.
• Get physical activity daily. Remember, talk with your doctor before beginning an exercise program.
• Manage your weight. Excess weight around the waist is a major contributor to prediabetes and Type 2 diabetes.
• Quit smoking. If you’re having a tough time quitting, talk with your doctor, as medications are available that can make the process easier.

If you’re concerned about diabetes, pay attention to early signs and symptoms, identify risk factors you may have, and work with your doctor to develop an aggressive intervention program.

Thomas Kurland, DO, is a primary care physician practicing in York, Pennsylvania, and is affiliated with MDVIP, the leader in personalized healthcare. He offers an annual wellness program that includes advanced screenings and tests to help detect, prevent, and/or treat diabetes, heart disease, and other serious conditions. To learn more, visit mdvip.com/ThomasKurlandDO.

This article reflects the medical opinion of Dr. Thomas Kurland, an MDVIP-affiliated internal medicine physician, and not necessarily the opinion of all physicians in the MDVIP national network.