By Dr. Ewa Arnold, Grace Cottage Family Health

Over one million Americans are newly diagnosed with diabetes each year. Could you be one of them? Should you be screened? Are there things you can do to prevent diabetes?

November has been designated as National Diabetes Awareness Month to shine a spotlight on this disease and ways to diagnose, prevent, and manage it.

First, why does it matter? Diabetes is the eighth most common cause of death in the U.S. It’s also associated with a number of health complications, including heart disease, blindness, kidney failure, and lower extremity amputations.

Next, here’s a reminder of some basic facts about this disease.

Diabetes is often linked to obesity and inactivity, but it can also be influenced by genetics. I’ll talk more about this in the information below.

It’s important to know the difference between the two main types of diabetes–Type 1 and Type 2.

Type 1 Diabetes is a chronic, lifelong autoimmune disease which currently has no cure. It occurs when the immune system mistakenly attacks and destroys insulin-producing cells in the pancreas. It is not linked to lifestyle factors. Type 1 Diabetes is often diagnosed in childhood, but it can also develop later in life.

You may be born with a predisposition for Type 1 Diabetes, but research indicates that something must trigger it, perhaps a virus, before it becomes apparent. While having a first degree relative (parent or sibling) with Type 1 Diabetes increases your chances of developing the disease, 85% of cases occur sporadically without a known family history.

Type 1 Diabetes leads to a lack of insulin production. Therefore, the cornerstone of treatment is lifelong insulin replacement therapy. A consistent carbohydrate diet and regular physical activity can help make blood sugars easier to control.

Type 2 Diabetes is NOT an autoimmune disease. It occurs as result of genetic and environmental/ lifestyle factors. These include family history, as well as obesity, inactivity, and aging.

In Type 2 Diabetes, peripheral tissues such as muscles, liver, and fatty tissue become less sensitive to insulin, requiring more of it to maintain a normal blood sugar. Over time, the pancreas fails to compensate, leading to loss of insulin-producing pancreatic cells. Type 2 Diabetes is a progressive disease.

Now, should you be screened? How do you know if you are at risk?

The classic symptoms at onset of Type 1 Diabetes are excessive thirst, excessive urination, increased hunger, weight loss, fatigue, and blurred vision. These symptoms usually develop over days or weeks. Children and adolescents will generally present with more acute and severe symptoms, while adults may have a more subtle onset.

At onset of Type 2 Diabetes, most people are asymptomatic, so complications may begin years before clinical recognition.

Because of that, the American Diabetes Association (ADA) recommends that all adults, even those without obvious risk factors, be screened starting at age 35 and repeated every 3 years.

For adults who are overweight or obese with additional risk factors, such as family history, high risk race/ ethnicity (diabetes is more prevalent for American Indian, Alaska Native, Black, and Hispanic populations), and/or those with a history of cardiovascular disease, hypertension, high cholesterol, and Polycystic ovary syndrome (PCOS), screening should be considered earlier and more frequently.

Screening is performed with bloodwork, either by checking an HbA1C test, fasting plasma glucose, or a 2-hour oral glucose tolerance test.

Screening may lead to a diagnosis of pre-diabetes. In this condition, blood sugars are elevated above normal levels but do not yet meet thresholds for diabetes. This should be considered a warning sign, as it may progress to diabetes and increase risk of cardiovascular disease, kidney damage, and eye damage.

The good news is that pre-diabetes is potentially reversible, with the risk of progression to diabetes reduced. Studies show that lifestyle changes such as modest weight loss (at least 7% of baseline) and participating in 150 minutes of moderate-intensity physical activity per week can significantly decrease the progression to diabetes.

If you have already been diagnosed with diabetes, you will have received advice from your medical provider about how best to manage it. Good control of your blood sugars substantially reduces the risk of developing complications such as kidney disease, eye issues, and nerve damage.

For Type 1 diabetics, that means insulin therapy.

For Type 2 diabetics, a multi-approach is warranted, combining intense lifestyle modifications (healthy nutrition, regular physical activity, weight management, and smoking cessation). It may be helpful to work with a nutritionist or diabetes educator.  In most cases, lifestyle modifications with oral and non-insulin injectable agents is sufficient. Over time, about one third of Type 2 diabetics require insulin therapy to maintain normal blood sugars.

Remember, you’re in control of your health. First, you need a diagnosis. If you are over age 35 and have not yet talked with a provider, take care of yourself and make an appointment for a screening today.