Diabetes: A Silent Killer

Contributed By Prashant K. Patel, MD, FACP

The epidemic of diabetes has taken the nation by storm. The rise in diabetes has paralleled the rise in obesity. It is on the rise not only in the United States but around the world. In the U.S. alone there are an estimated 25.8 million diabetics. An astounding one-third have yet to become aware of their diagnosis, and therefore receive no treatment.

The two primary types of diabetes are Type I and II, with Type II comprising 95 percent of the total diabetic population. Hence, it is timely to highlight the significance of this condition.

Traditionally, it has long been known that hypertension or high blood pressure can be present without symptoms, and its effects can be deadly. However, diabetes is not met with similar perception, although it too can be a killer disease.

Symptoms and Risk Factors
While the symptoms of diabetes include excessive thirst, urination, hunger, blurred vision, weight loss, fatigue, tingling/numbness in the hands or feet, dry skin, itching and a proclivity toward infections, most individuals are asymptomatic. Their risk, nevertheless, is greater than that of a non-diabetic for complications such as a heart attack or stroke, which can often be fatal.

We know today that diabetes is a cardiovascular equivalent. That is to say diabetics have a similar risk level for first-time cardiovascular events, such as a heart attack or stroke, as patients with known heart disease have for experiencing subsequent cardiac events. While most diabetics are asymptomatic at the time of diagnosis, others may present with their first heart attack at the time of diagnosis.

Criteria for screening

  1. Consider in all individuals at age 45 and subsequently every 3 years
  2. Consider at earlier age/more frequently in those who are overweight and have additional risk factor(s):
  • physical inactivity
  • immediate relative with diabetes
  • high-risk ethnic populations (Hispanic- , Native-, African-, Asian-Americans and Pacific Islanders)
  • history of gestational diabetes or after delivering a baby 9 pounds or heavier
  • hypertensive (blood pressure 140/90 or higher)
  • HDL cholesterol 35 mg/dL or below, and/or triglycerides 150 mg/dL or above
  • Polycystic Ovary Syndrome (PCOS) or acanthosis nigricans
  • previous testing resulting in impaired glucose tolerance (IGT) or impaired fasting glucose (IFG), also known as pre-diabetes
  • history of vascular disease

Prevention and Treatment
Not all is grim on the diabetes front. The wrong genes with the wrong habits bring on disease, but the wrong genes with the right habits can thwart off disease. The same is true for diabetes. A healthy lifestyle can prevent the onset of diabetes. With regular exercise and a diet high in protein and fiber and low in fat and carbohydrates, you can prevent diabetes altogether.

However, many patients require oral medications or injectable medications such as a novel group of incretin (hormone involved in glucose metabolism that is found in abnormally low concentrations in diabetics) based therapies or insulin. Some patients require four shots of insulin to manage their diabetes. Alternatively, novel therapies such as insulin pumps and the use of continuous glucose monitoring systems are utilized. A combination of these approaches and with a team-based approach can lead to prevention or a complication-free course of treatment for many individuals.

Dr. Prashant K. Patel is a diabetologist recognized for excellence in diabetes care by the American Diabetes Association and for excellence in heart/stroke care by the American Heart/Stroke Associations.

If you have concerns about diabetes or your risk for cardiovascular disease, you may make an appointment with him or his colleague, Dr. Vijay K. Juneja, at Cary Internal Medicine & The Diabetes Center, located at 103 Baines Ct., Cary, NC 27511.

For more information, visit www.caryinternalmedicine.com or call (919) 467-6125.

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