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Diagnosing Diabetes A routine blood glucose test, especially a “fast- ing” level, can screen for a problem. Other tests include the blood test HbA1c and/or an oral glu- cose tolerance test, which involves ingesting a spe- cific amount of glucose and then monitoring the blood sugar response for several hours.
52 MILITARY OFFICER FEBRUARY 2017 Diabetes
The seventh-leading cause of death, diabetes aff ects 25 percent of Americans over 65, and its consequences consume 20 percent of health care spending. By Rear Adm. Joyce Johnson, D.O.
As the food we eat is digested and absorbed, the level of glucose (sugar) in our blood rises. Simply ex- plained, this increase usually triggers the pancreas to release insulin, which helps transport sugar into cells (to be used for energy), thereby lowering blood sugar. This cycle keeps levels of blood sugar rela- tively constant throughout the day. How- ever, in people with diabetes, the insulin response doesn’t occur, and blood sugar levels remain high. Type 1 diabetes, also known as insulin- dependent diabetes or juvenile diabetes, most commonly begins in childhood or early adulthood. However, especially in those with a genetic predisposition, diabe- tes often follows a viral infection that can provoke an autoimmune response, which in turn can destroy insulin-producing cells in the pancreas. People with Type 1 diabetes must take insulin because their bodies can’t produce it, and they must monitor their blood sugar level during the day and adjust their insulin dose accordingly. About 5 to 10 percent of those with diabetes have Type 1. Type 2 diabetes, most common in adults, occurs when the body isn’t able to prop- erly use the insulin it produces or when an inadequate amount of insulin is produced. Type 2 diabetes is more common in people who are overweight and don’t exercise; healthy habits can help prevent it. It gener- ally develops slowly and can be signaled by frequent urination, with consequent exces- sive thirst. Weight loss (despite a hearty
appetite) and lack of energy, resulting from the body’s inability to properly use glucose from digested food, also can be signs of Type 2 diabetes. Treatment relies on diet and exercise, often with oral medications. These medications can increase the body’s own insulin production; increase the ability of peripheral tissues to use insulin; or de- crease the absorption of glucose in the gas- trointestinal tract. Some people with Type 2 diabetes also require insulin injections. Management of diabetes involves diet,
physical activity, and long-term monitoring of hemoglobin A1c (HbA1c) to indirectly measure the “average” blood sugar levels over time. In the past, “diet” generally meant avoiding sugar, but today there are various approaches to the diabetic diet, in- cluding monitoring the glycemic index of foods (i.e., how quickly a specifi c food will increase blood sugar) or the glycemic load (how much a specifi c quantity of a specifi c food will increase blood sugar levels). Controlling blood glucose is critical to minimize the long-term complications of diabetes, which can aff ect the eyes, ears, kidneys, heart, gastrointestinal system, skin (including feet), peripheral arteries, sexual function, and nervous system. Am- putations, especially of the foot, are com- mon in late-stage diabetes.
MO
— Rear Adm. Joyce Johnson, USPHS (Ret), D.O., M.A., is a health care consultant in Chevy Chase, Md. Find more health and wellness resources at
moaa.org/wellness. For submission information, see page 4.
PHOTO: STEVE BARRETT
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