Type 2 on the rise

Type 2 diabetes is on the increase in the U.S. This rise can be controlled if more people pay attention to lifestyle choices. Americans eat too much and exercise too little. Some long-term damage to the body may already be occurring in prediabetes. This is especially true for the heart and circulatory system. In prediabetes, both the average and fasting blood sugars are above normal, but not quite in the range of diabetes. People with prediabetes are at high risk of developing type 2 diabetes. People with prediabetes can often put off getting type 2 diabetes by doing several things. They can make changes in their diet, exercise more, and lose weight. Some overweight people may also benefit from medicines to help prevent the development of type 2 diabetes.

What is diabetes?

Many people don't know what type 2 diabetes is or why healthcare providers are interested in their blood sugar levels. The hormone insulin is made by your pancreas. Insulin allows your body to use sugar and other food for energy. Blood sugar rises when you don't have enough insulin. It also rises when your body's cells can't use what is there.

In type 2 diabetes, your pancreas either does not make enough insulin or your body’s cells aren’t correctly using the insulin. This is called insulin resistance. When blood sugar goes up again and again, the risk for heart attack and stroke goes up by as much as 4 times. It also greatly raises the risk for kidney disease. You are also at risk for blindness, amputation because of poor circulation, and other problems.

Type 2 diabetes is often diagnosed later in life. But in an alarming trend, many teens are being diagnosed with it. This was almost unheard of 20 years ago. This is thought to be directly related to being extremely overweight, having a poor diet, and a lack of exercise. The American Diabetes Association (ADA) advises type 2 diabetes screening for children and teens who are overweight and have at least 2 of these risk factors:

• Family history of diabetes

• Being in a high-risk ethnic group

• Having signs of insulin resistance

It's always best to find diabetes before symptoms start. But watch for these symptoms:

• Severe tiredness (fatigue)

• Intense thirst

• Need to pee (urinate) often

• Sores that don't heal

• Weight loss when you aren’t trying to lose weight

• Tingling or numbness in your feet or hands

• On-and-off blurry vision

Adults ages 35 to 70 who are overweight or obese should get screened every 3 years. If you have other risk factors for diabetes, you may need screening tests more often. And all adults 45 years old and older should be screened for diabetes every 3 years. 

Risk factors

Risk factors for type 2 diabetes are:

• Being older than age 35

• Being overweight or obese. This means a body mass index of 25 or higher.

• Having parents or siblings who have diabetes

• High blood pressure (140/90 mmHg or higher in adults)

• HDL ("good') cholesterol of less than 35 mg/dL, a triglyceride level of 250 mg/dL or higher, or both

• Getting little exercise

• High-risk race or ethnicity. This includes African American, Alaska Native, Hispanic American, American Indian, Asian American, and Pacific Islander.

• Blood sugar test in the past that was high

• Having a history of gestational diabetes

• Having polycystic ovarian syndrome (PCOS)

• Having a history of heart disease

Diagnosing diabetes

The ADA now advises the A1C test to help diagnose prediabetes and diabetes. The A1C gives an average blood glucose level for the past 3 months. An A1C level of around 5% is considered normal. An A1C of 6.5% or above shows diabetes. A1C in prediabetes is generally between 5.7 and 6.4%.

The A1C test is not more accurate than the fasting plasma glucose test and the 2-hour oral glucose tolerance test. The difference is the AIC test doesn't require fasting. It can be measured at any time of the day.

Experts hope the ease of the A1C will result in more testing for people who are at risk for diabetes or prediabetes. This would help reduce the number of people with undiagnosed diabetes in the U.S.