Diabetes. We hear about it all the time as a risk factor for a lot of bad things, including making us more vulnerable to severe complications of COVID-19. According to the CDC, 34.2 million Americans—that’s 1 in 10—have diabetes. For people over 65, it is 1 in 4. Another 88 million have prediabetes. It’s the seventh leading cause of death in the United States. And yet, many people don’t clearly understand what it is, what it does, and how serious the disease can be. They may not even know they have it.
Diabetes is the result of too much glucose, or sugar, in your bloodstream. Our bodies need glucose to function at peak levels. Cells use it for energy. Brain cells use it to process information. When you eat, food is broken down into sugar, and your pancreas releases insulin to help that blood sugar get into your cells. If your body can’t make enough insulin, or can’t use it properly, blood sugar will get too high and will cause health problems.
Type 1 diabetes, also called diabetes mellitus, is caused when a body’s immune system attacks insulin-producing cells (beta cells) in the pancreas, destroying their ability to function. This type is usually diagnosed in childhood, although it can happen at any age, and there is no known way to prevent it. People with Type 1 must take insulin every day to survive.
Type 2 diabetes develops more slowly than Type 1, often over many years. Insulin production works normally, but the body can’t use it well, and blood sugar gets too high. It’s usually diagnosed in people middle-aged or older, but more young people are developing it than in the past.
Approximately 90 to 95 percent of Americans with diabetes have Type 2. Unfortunately, this type is really easy to ignore until it becomes a serious problem.
“Both the risk and the fact that they have it are easy to ignore,” says Dr. Arthi Thirumalai, an endocrinologist at UW Medicine. “Like a lot of silent killers, they’re not symptomatic until it’s really advanced. Diabetes can be chipping away at their health and they don’t realize it. It’s a very unrelenting disease process.”
If untreated, Type 2 diabetes is extremely toxic to nerves and blood vessels, causing serious damage to your body over time. The leading cause of death for diabetes patients is heart disease. Other problems include:
- Diabetic neuropathy—nerve damage—in different parts of the body; in the feet, it can cause infections and difficulty walking.
- Eye damage leading to low vision or blindness.
- Diabetic kidney disease, which can develop into life-threatening kidney failure.
- Dental problems, such as dry mouth, infections, or gum disease.
- Erectile dysfunction, loss of interest in sex, and bladder leaks.
It’s also been described as a risk factor for a more serious outcome if a patient contracts COVID-19. Dr. Thirumalai, a clinician, researcher and professor, says the reason is less clear than with other diseases.
“We’re not sure why with COVID, but think it’s due to an overlap of other disease issues—such as obesity, presence of heart disease, and increased age—that are risks for both. Younger people with well-controlled diabetes have a closer risk level (from COVID) to people who don’t have diabetes.”
For diabetes itself, risk factors for developing Type 2 include obesity, lack of exercise, family history, history of gestational diabetes during pregnancy, sleep apnea, and age.
In the last 20 years, according to the CDC, the number of adults diagnosed with diabetes has more than doubled, due to an aging and more obese population.
Medical costs for people with diabetes are twice as high as for people who don’t have diabetes.
Quality of life may be severely impacted. Instead of enjoying retirement, older adults with Type 2 may lose their sight, need lower leg amputations, or suffer debilitating nerve pain.
The tragedy is that there are lifestyle choices that can make a huge difference in both the number of cases and the severity of diabetes in individuals. Of course, because they involve eating well and getting exercise, doctors have trouble getting patients to try them, or stick with them.
“Lifestyle changes are the pillars of diabetes management that we rely on,” says Dr. Thirumalai. “If you don’t have a healthy diet and exercise regimen, you’ll need higher doses of medication.”
Dr. Thirumalai has tried to motivate people by explaining serious outcomes. “Two big ones that seem to resonate are neuropathic pain, which can be very incapacitating to quality of life, and dialysis. I also used to try to motivate them with being able to avoid getting insulin injections. Still works for some people.”
Many people with Type 2 diabetes do need medication to manage their disease. Metformin, an oral medication, is the most common one to use first, but there are other options if necessary. It’s not recommended that patients rely solely on medication, but it’s essential to treat the disease to prevent further damage.
The interesting—even exciting—thing about Type 2 diabetes is that, with some work, it can be reversed. Losing about 10 percent of body weight, for most people, may bring blood sugar levels into the normal range. If ongoing attention to diet and exercise keeps the level there, then the patient would no longer have the disease.
The best advice is to pay attention to your health and learn about the risks, especially if you are overweight or have a family history of diabetes. Remember, symptoms for Type 2 won’t show up until damage has begun. Work with your primary care provider to recognize and address problems before they get out of control. With this disease, you have the chance to take charge.
“I’d love, as an endocrinologist, for people not to need my services,” says Dr. Thirumalai. “People need to have a healthy lifestyle and regular medical care to try to prevent those issues.”
Priscilla Charlie Hinckley has been a writer and producer in Seattle television and video for 35 years, with a primary interest in stories covering health and medicine, women’s and children’s issues, social justice, and education. She enjoys taking a lighthearted approach to serious topics.