Confronting a growing epidemic: diabetes

Exercise can help people manage diabetes. - Courtesy/MultiCare
Exercise can help people manage diabetes.
— image credit: Courtesy/MultiCare

The number of Americans diagnosed with diabetes continues to increase.

In the United States, the disease has become an epidemic with nearly 26 million children and adults afflicted. And recent estimates project that as many as 1 in 3 American adults will have diabetes in 2050 unless we can figure out how to slow the growth.

Much of the tremendous growth can be attributed to poor diet and lack of exercise. About 34 percent of the U.S. adult population is obese and more than one third of Americans are expected to develop diabetes over their lifetime, according to the American Diabetes Association.

Dr. Ronald Graf, an endocrinologist with MultiCare Health System, works with diabetic patients daily. Here he answers some questions about the disease.

What are the different types of diabetes?

Type 1 diabetes occurs when the pancreas cannot make insulin. Without insulin, sugar piles up in your blood vessels. People with type 1 diabetes must take insulin to help get the sugar into the cells. This type cannot be prevented. This has historically been called juvenile diabetes.

Type 2 diabetes occurs when the pancreas does not make enough insulin, the insulin does not work properly, or both. Being overweight makes type 2 diabetes more likely to occur. It can happen in a person of any age and the occurrence in children is increasing.

Gestational diabetes is a form of glucose intolerance that is diagnosed during pregnancy. It requires treatment to bring maternal blood glucose to normal levels and avoid complications in the infant.

Other types of diabetes result from specific genetic conditions (such as maturity-onset diabetes of youth), surgery, medications, infections, pancreatic disease, and other illnesses.

Do you see a lot of patients coming to you for help with diabetes?

The vast majority of the patients we see in our practice have diabetes. About 75 to 80 percent have type 1 or type 2 diabetes.

Do you see more cases now than a decade ago?

The incidence of diabetes is growing tremendously - unfortunately. There's already an enormous number of patients in the United States. It's probably increasing by another million patients a year.

How do you know if you have diabetes?

Maybe one-third of the people with diabetes are undiagnosed. When symptoms occur they include frequency of urination, excess thirst, weight loss, recurrent bladder or yeast infections and blurry vision. These are typical signs.

What do you do if you think you might have diabetes?

See your doctor. In folks with type 1 diabetes, the condition tends to occur quite abruptly. In those cases it's important to be seen by your health care provider as soon as possible. In folks with type 2 diabetes, they may have no symptoms for many years – maybe 10 to 15 years before diagnosis. Your health care provider should be monitoring your blood sugar, especially if you have risk factors.

Can we say definitively that diet plays a role in diabetes?

Diet is responsible for what the pancreas has to react to. If you overtax that poor little pancreas especially if there's a genetic predisposition for the pancreas to fail, then the result is an increase in the frequency of diabetes. Also, diabetes, especially, type 2 has a strong family connection.

How do the two types of diabetes break down in terms of percentages?

Type 2 is about 80 percent of patients. Type 1 is 10 or 15 percent.

How do you get more information about diabetes?

Patient should rely on their doctor as their primary source of education. They also should get referral to diabetes educator. And the American Diabetes Association has an excellent website at that can answer lots of questions.

Dr. Ronald Graf is an endocrinologist with MultiCare Health System.

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