More than 25 million people in the United States suffer from diabetes and it is estimated that at least 79 million more are pre-diabetic or have a predisposition to the disease. This is why it is indispensable to be educated about this medical condition that kills more than 200,000 people every year at a cost of approximately $174 billion.

Diabetes is a combination of metabolic disorders characterized by “a deficiency of the body to manage sugar in the blood due to the lack of various hormones, among them insulin,” says Dr. George Vargas, endocrinologist at Memorial Regional Hospital in Hollywood.

Patients who suffer this condition do not have adequate levels of insulin because their bodies are not producing it (Type 1) or they have become resistant to it (Type 2). Because most people initially show light symptoms, diagnosis is normally done by testing glucose in the plasma (blood) while fasting or by an oral test of glucose tolerance. The American Diabetes Association recommends the first because it is less expensive and is quick and easy to perform. Normal levels of blood sugar, measured in milligrams of glucose per deciliter (mg/dl), are between 60 and 99. Persons with levels between 99 and 125 are considered “pre-diabetic.” Those with values over 126 are diagnosed with the disease. In the case of an oral test, the patient must ingest a drink with a high content of glucose and have the content in the blood measured within two hours. Persons who present levels higher than 200 mg/dl are considered diabetic.

It is also common to perform the A1C test, which determines the levels of blood sugar in the last three months. This test measures the amount of glucose that has mixed with hemoglobin, part of the red cells that distribute oxygen in the body. Diabetic patients have levels of 6.5 percent or more and pre-diabetics are in the range from 5.7 to 6.4 percent.

Diabetes Type I

This type of diabetes, also known as juvenile diabetes or insulin-dependent, normally affects children and young adults under 21.

“It’s a process in which the immunologic system does not recognize the pancreatic cells and attacks them, causing them to stop producing insulin,” says Dr. Carmen Vanessa Villabona, endocrinologist at the Cleveland Clinic of Florida. “Yet nobody can live without this hormone, so patients arrive at the hospital very sick, vomiting, with nausea and abdominal pain, and then they are diagnosed.”

While this variant of the disease is rare and barely affects 5 percent of diabetics in the country, it has important implications because it cannot be treated simply by changing the diet and lifestyle. These patients require daily doses of the hormone to process the levels of glucose in their blood. It can be administered by subcutaneous injections or through an insulin pump, a portable gadget that works through a catheter placed under the patient’s skin to constantly measure the levels of sugar, sending the amount of insulin the body needs.

Another important difference between diabetes Type 1 and Type 2 is that it cannot be prevented and has no cure.

“We have not yet found a genetic predisposition that would allow us to predict it,” says Villabona, who adds that “we understand that it affects mostly Caucasian children and adolescents,” though it is not clear if it appears due to environmental or genetic factors.

Diabetes 1 is severe and serious. To make it worse, it is difficult to diagnose a chronic disease among children and adolescents.

“There are not only physical complications, such as the pain of pricking their skin to monitor their sugar, but there are also psychological implications of living with this disease the rest of their lives,” says Villabona, who emphasizes the need of family support to deal with diabetes. “Patients cannot face this disease by themselves. They need the help of their families, friends and even the school.”

Diabetes Type 2

This type, also known as adult-onset diabetes, occurs when the body creates a resistance to insulin. This is the most common form of diabetes in the United States and affects one in every 10 adults. The Centers of Disease Control and Prevention considers it, together with obesity, as the most important threat to the wellness of the country in the 21st Century.

Being overweight, a lack of exercise and diets with high content of carbohydrates are directly related to the development of this disease. The constant presence of sugar in the blood forces the pancreas to generate more insulin to help the body process it, but the cells become more and more resistant to its effects and require higher quantities of the hormone to function. Eventually, this over-activity damages or prompts the collapse of pancreatic cells, and the patient then has to depend exclusively on injected insulin.

“Diabetes Type 2 can be prevented,” Vargas says. “Nothing can be done about the genetic predisposition, but if the patient stays in the ideal weight and exercises, it will not develop.”

The disease also has genetic and ethnic components. For example, if someone has a diabetic father, the probability of suffering from the disease increases 50 percent, and this number jumps to 80 percent if both parents have it. Hispanics and African Americans also are more likely to develop diabetes Type 2 than persons of Caucasian origin. The American Diabetes Association’s numbers show that 11.8 percent of Hispanic adults and 12.6 percent of African Americans suffer from diabetes, as opposed to 7.1 percent of persons of Caucasian origin and 8.4 percent of Asian descendants.

“The studies indicate that we as Hispanics shouldn’t worry about Diabetes Type 1, because it is genetic and basically affects the [non-Hispanic] white population,” says Dr. Vargas. “Type 2 is much more frequent among us, to the point that two of every three Hispanics 60 and older have diabetes.”

Villabona says that “besides the genetic predisposition, we Hispanics face many cultural barriers that predispose us to this disease: we tend to have less access to health systems, visit doctors less frequently, and we favor a diet rich in carbohydrates, which is why there is a larger incidence of obesity.”

The age of the patient is also considered an important factor. Until recent times, this type of diabetes affected mostly adults or older people (40+ years old). However, the explosion in the obesity numbers is causing younger patients to be being diagnosed with the disease.

“The affected population is growingly younger and there are recent reports of children of school age who are developing diabetes Type 2,” says Villabona.

Diabetes Type 2 can be controlled in its first stage with diet and exercise. Some people also react favorably to an oral insulin treatment.

“If the patient loses weight, begins to exercise regularly and stays healthy, he can control the disease for many years,” says Vargas. In other cases, the disease continues to develop until the person requires daily injections or an insulin pump.

Pre-diabetics

At least 79 million of people in the United States are considered pre-diabetic, according to the American Diabetes Association. These are people who present higher than normal levels of glucose in the blood — between 99 and 125 mg/dl — but not high enough to be diagnosed with diabetes. In other words, they are one step away from developing the disease.

Being overweight, an inadequate diet and lack of exercise are the main problems this group faces.

“Pre-diabetics have an extremely high risk of developing diabetes in two or three years,” Villabona says. “The good news is that this condition can be reversed. The patient has a very good chance of returning to normal if they do the right thing.”

Patients diagnosed with this medical condition must lose weight, follow a diet low in fat and carbohydrates and raise their exercise level. In some cases, doctors can prescribe a dosage of Metformin, a medication recommended by the American Diabetes Association to prevent the disease from developing. However, “recent studies such as the Diabetes Prevention Program demonstrate that dieting and exercising regularly is much better to prevent diabetes than taking pills,” says Vargas.

Gestational Diabetes

Also known as pregnancy diabetes, this condition affects 18 percent of pregnant women in the United States. It is similar to diabetes Type 2 in the sense that the body generates a resistance to insulin, thus patients present high levels of sugar in the blood after 24 weeks of pregnancy.

While researchers have not yet found the cause of gestational diabetes, it has been determined that it happens when certain hormones generated by the placenta to encourage the development of the baby interfere with the insulin in the mother. This situation gets complicated with the gain of weight due to pregnancy, generating even a higher demand for insulin at a moment in which the body cannot process it.

Since it happens after the baby has been formed, the children of mothers with gestational diabetes do not present risks of congenital diseases that affect children of mothers who were diabetic before conceiving. However, to expose the fetus to high levels of glucose has consequences to health in long term, because babies tend to develop more adipose tissue or fat, increasing the probabilities of suffering from obesity and diabetes Type 2 later in life. Also, since they tend to be bigger and fatter than normal, some present lesions in their shoulders when passing through the vaginal channel during birth and can suffer from sugar lows during the first days of their life.

The treatment includes a diet low in carbohydrates and sugars, moderate exercise, regular monitoring of the glucose levels and, in some cases, insulin injections. The condition usually disappears after giving birth, but it increases the mother’s risk of developing diabetes Type 2.

In fact, “two of every three Hispanic mothers with gestational diabetes will develop diabetes in the future,” Vargas says. “Therefore, these patients must lose weight immediately after their pregnancy and begin exercising regularly. No use keeping those excess pounds that babies often leave as a gift.”