For the Newly Diagnosed

What is diabetes • What are the different types of diabetes • Type 1 diabetes • Type 2 diabetes • Gestational diabetes • What is the scope and impact of diabetes • Who gets diabetes • How is diabetes managed • What Is the status of diabetes research • What will the future bring

An estimated 16 million people in the United States have diabetes mellitus--a serious, lifelong condition. About half of these people do not know they have diabetes and are not under care for the disorder. Each year, about 798,000 people are diagnosed with diabetes.

Although diabetes occurs most often in older adults, it is one of the most common chronic disorders in children in the United States. About 123,000 children and teenagers age 19 and younger have diabetes.

Diabetes is a disorder of metabolism--the way our bodies use digested food for growth and energy. Most of the food we eat is broken down by the digestive juices into a simple sugar called glucose. Glucose is the main source of fuel for the body.

After digestion, the glucose passes into our bloodstream where it is available for body cells to use for growth and energy. For the glucose to get into the cells, insulin must be present. Insulin is a hormone produced by the pancreas, a large gland behind the stomach. When we eat, the pancreas is supposed to automatically produce the right amount of insulin to move the glucose from our blood into our cells. In people with diabetes, however, the pancreas either produces little or no insulin, or the body cells do not respond to the insulin that is produced. As a result, glucose builds up in the blood, overflows into the urine, and passes out of the body. Thus, the body loses its main source of fuel even though the blood contains large amounts of glucose.

The three main types of diabetes are:

• Type 1 diabetes
• Type 2 diabetes
• Gestational diabetes.

Type 1 diabetes (once known as insulin-dependent diabetes mellitus or juvenile diabetes) is considered an autoimmune disease. An autoimmune disease results when the body's system for fighting infection (the immune system) turns against a part of the body. In diabetes, the immune system attacks the insulin-producing beta cells in the pancreas and destroys them. The pancreas then produces little or no insulin.

Someone with type 1 diabetes needs daily injections of insulin to live. At present, scientists do not know exactly what causes the body's immune system to attack the beta cells, but they believe that both genetic factors and viruses are involved. Type 1 diabetes accounts for about five to 10 percent of diagnosed diabetes in the United States.

Type 1 diabetes develops most often in children and young adults, but the disorder can appear at any age. Symptoms of type 1 diabetes usually develop over a short period, although beta cell destruction can begin years earlier. Symptoms include increased thirst and urination, constant hunger, weight loss, blurred vision, and extreme tiredness. If not diagnosed and treated with insulin, a person can lapse into a life-threatening coma.

The most common form of diabetes is type 2 diabetes (once known as noninsulin-dependent diabetes mellitus or NIDDM). About 90 to 95 percent of people with diabetes have type 2 diabetes. This form of diabetes usually develops in adults over the age of 40 and is most common among adults over age 55. About 80 percent of people with type 2 diabetes are overweight.

In type 2 diabetes, the pancreas usually produces insulin, but for some reason, the body cannot use the insulin effectively. The end result is the same as for type 1 diabetes--an unhealthy buildup of glucose in the blood and an inability of the body to make efficient use of its main source of fuel.

The symptoms of type 2 diabetes develop gradually and are not as noticeable as in type 1 diabetes. Symptoms include feeling tired or ill, frequent urination (especially at night), unusual thirst, weight loss, blurred vision, frequent infections, and slow healing of sores.

Gestational diabetes develops or is discovered during pregnancy. This type usually disappears when the pregnancy is over, but women who have had gestational diabetes have a greater risk of developing type 2 diabetes later in their lives.

Diabetes is widely recognized as one of the leading causes of death and disability in the United States. According to death certificate data, diabetes contributed to the deaths of more than 193,140 persons in 1996.

Diabetes is associated with long-term complications that affect almost every major part of the body. It contributes to blindness, heart disease, strokes, kidney failure, amputations, and nerve damage. Uncontrolled diabetes can complicate pregnancy, and birth defects are more common in babies born to women with diabetes.

Diabetes cost the United States $98 billion in 1997. Indirect costs, including disability payments, time lost from work, and premature death, totaled $54 billion; medical costs for diabetes care, including hospitalizations, medical care, and treatment supplies, totaled $44 billion.

Diabetes is not contagious. People cannot "catch" it from each other. However, certain factors can increase one's risk of developing diabetes. People who have family members with diabetes (especially type 2 diabetes ), who are overweight, or who are African American, Hispanic, or Native American are all at greater risk of developing diabetes.

Type 1 diabetes occurs equally among males and females, but is more common in whites than in nonwhites. Data from the World Health Organization's Multinational Project for Childhood Diabetes indicate that type 1 diabetes is rare in most Asian, African, and American Indian populations. On the other hand, some northern European countries, including Finland and Sweden, have high rates of type 1 diabetes. The reasons for these differences are not known.

Type 2 diabetes is more common in older people, especially older women who are overweight, and occurs more often among African Americans, Hispanics, and American Indians. Compared with non-Hispanic whites, diabetes rates are about 60 percent higher in African Americans and 110 to 120 percent higher in Mexican Americans and Puerto Ricans. American Indians have the highest rates of diabetes in the world. Among Pima Indians living in the United States, for example, half of all adults have type 2 diabetes. The prevalence of diabetes is likely to increase because older people, Hispanics, and other minority groups make up the fastest growing segments of the U.S. population.

Before the discovery of insulin in 1921, all people with type 1 diabetes died within a few years after the appearance of the disease. Although insulin is not considered a cure for diabetes, its discovery was the first major breakthrough in diabetes treatment.

Today, daily injections of insulin are the basic therapy for type 1 diabetes. Insulin injections must be balanced with meals and daily activities, and glucose levels must be closely monitored through frequent b

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