What You Need To Know About Diabetes

Photographed by Ruby Yeh.
Across the globe, the rate of diabetes has skyrocketed — quadrupled, in fact — in the last few decades. As of 2012, over 9% of the U.S. population has diabetes — and more than 8.1 million people who have it don't know it, according to the American Diabetes Association. We spoke with Dorothy Fink, MD, an endocrinologist at NYU Langone Medical Center, to find out what you need to know about the condition, including its main warning signs.
What's the difference between type 1 and type 2 diabetes?
To understand the two diseases, you have to first understand what's supposed to happen. After eating — if you're healthy — your digestive system will break down food into basic sugars (a.k.a. glucose) that it can use as fuel. In order for it to do that, though, your pancreas has to release the hormone insulin, which acts like a key for each of your cells, unlocking them so the glucose can enter and be used for fuel. But in both type 1 and type 2 diabetes, there is a kink in this system. Dr. Fink explains that type 1 diabetes is caused by an autoimmune response, which means that antibodies from a patient's own immune system start to attack the pancreas, damaging it and preventing it from producing insulin. Without the insulin, the body's cells can't use the glucose, so it builds up in the blood, causing the "high blood sugar" that can be dangerous. People with type 1 usually have to rely on insulin injections to make sure their bodies can regulate their blood sugar and their cells get the fuel they need. Patients with type 2 diabetes, on the other hand, can still make insulin, but their bodies have become resistant to the hormone, so it isn't as effective at moving the glucose into the cells. Over time, people with type 2 may also stop making enough insulin, eventually becoming dependent on insulin medication, just like a patient with type 1 diabetes, Dr. Fink says. Type 2 diabetes is far more common than type 1, which is usually diagnosed in childhood or adolescence (though it can be diagnosed in adults, as well).
What are the early signs of diabetes?
The symptoms of type 1 tend to come on suddenly, and may include irritability and mood changes, increased thirst and urination, fatigue and extreme hunger. With type 2, however, the symptoms are more gradual. "It’s not like someone wakes up one day and they’re a full-blown diabetes patient," explains Dr. Fink. "The sad reality is that [it develops over time and] it's silent." However, once someone has developed type 2, Dr. Fink says the signs can be similar to type 1: intense thirst, peeing a lot more (including getting up to go during the night), feeling fatigued, and possibly, blurred vision. These symptoms, particularly the need to pee, can also be signs of many other less serious issues, too, so you should definitely see your doctor, who can do tests to find out what's really going on.

What about prediabetes?
"Patients with both type 1 and type 2 diabetes are going to have a state before they get to true diabetes when the pancreas isn’t working as well as it should be," Dr. Fink explains. But when we're talking about "prediabetes," we're talking about type 2 diabetes. A prediabetes diagnosis means that your blood sugar is elevated, but not yet high enough to warrant a full-blown type 2 diagnosis. Insulin resistance can actually be reversed with lifestyle changes, like diet and exercise, if caught during prediabetes, making it a critical window for changing your habits. There are a lot of complicated factors that contribute to your risk for insulin resistance, but you're more likely to develop prediabetes (and diabetes) if you're overweight, have a family history of the disease, have polycystic ovarian syndrome (PCOS), or come from certain ethnic backgrounds (Asian- and African-Americans are most at-risk). While the rise in diabetes is related to the obesity epidemic, we also know that weight alone isn't necessarily a reliable predictor of problems on an individual level. No matter how heavy you are, the thing to remember is that it's lifestyle that matters most: "If you're addicted to processed carbohydrates, eat everything on the run, sit at a desk all day, never exercise, and have a family history of diabetes, those are all major factors to take into account," Dr. Fink says. It's important to check with your doctor about your risk for diabetes, get your blood-glucose levels checked regularly (this is often a routine part of an annual check-up), and if necessary, make those lifestyle changes everyone's always talking about. "It's easier to think of food and exercise as medicine than it is to take medicine," Dr. Fink says. And it's better to start thinking of those things as medicine sooner rather than later.

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