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Diabetes - Are You at Risk?
By Dr. Wes Youngberg. Dr. Youngberg is a Clinical Preventionist & Nutrition Specialist and is part of the diabetes treatment team at the Seventh-day Adventist Clinic Wellness Center.

For every person in your family or in your neighborhood who knows they have diabetes, there is at least one other who has diabetes but does NOT know it yet! And for every one person who has diabetes there is an average of two more who have Impaired Glucose Tolerance (IGT) - a pre-diabetic condition where blood sugars are abnormally high after meals but do not yet reach diabetic levels. This means that on Guam, an estimated 60% of Chamorros have diabetes or IGT. Unfortunately most are not aware of their personal health risk.

There are three main types of diabetes: type 1, type 2, and Gestational (pregnancy related diabetes).

Type 1 diabetes is rare and represents about 5% of diabetics in the U.S. Type 1 diabetes is even less common on Guam and occurs when certain cells in our pancreas - the organ just under the liver that makes insulin - are destroyed either by a viral infection, chemical toxin, or as the result of the bodies own immune system attacking the insulin producing cells. This form of diabetes can occur at any age but typically is seen in younger individuals.

Type 2 diabetes is very common and represents over 95% of diabetes on Guam. While type 1 diabetes occurs because the pancreas no longer can produce insulin (the hormone necessary to transport sugar in the cells for energy production), type 2 diabetes occurs primarily because the bodies fat cells and muscle cells are insensitive to the insulin being produced. This results in a large compensatory production of insulin by the pancreas as the body attempts to force storage of the excess blood sugar. The insulin producing cells in the pancreas are called beta cells.

Gestational diabetes is diagnosed when a pregnant woman is found to have high blood sugars after drinking 100 grams of a sugar syrup. High blood sugars during pregnancy can be harmful to both the baby and the mother. Just like in type 2 diabetes, gestational diabetes occurs when weight gain, inadequate nutrients, stress, and lack of exercise results in increased resistance to insulin. Pregnant women are more susceptible because in addition to the regular risk factors they have an increase in pregnancy related hormones which further lower the cells' sensitivity to insulin. This resistance to insulin becomes so significant that even large amounts of their own bodies pancreatic insulin production is not able to keep blood sugars in check. All pregnant women who have any risk factors for diabetes should take this test under the supervision of their personal health care professional. Fortunately, women diagnosed with this condition can be effectively treated if they see their doctor and diabetes educator regularly.

All organs of the body must go through regular cycles of rest. Type 2 diabetes results after years and decades of pancreatic beta cell overwork. The stress placed on beta cells to constantly produce up to 100 times the normal level of insulin leads to fatigue and eventually failure of the beta cells. This excessive insulin helps for a time to keep the blood sugars down to borderline levels but also increases the persons risk for other health problems including high blood pressure, high cholesterol, heart attack and stroke.

The beta cells would not become fatigued if the bodies muscles were regularly exercised and excess body fat was gradually reduced. An excess of large fat cells causes a resistance to normal levels of insulin resulting in gradually increasing blood sugars. Inactive muscles simply do not need to store the excess sugar in the blood and therefore resist the effort of insulin to transport blood sugar into the muscle cells.

A few years ago an international Expert Committee sponsored by the American Diabetes Association established new standards for the diagnosis and classification of diabetes. Fasting blood sugars levels less than 140 mg/dl use to be considered normal. However now diabetes is diagnosed when fasting blood sugar levels tested before eating breakfast are equal to or greater than 126 mg/dl. Levels above 110 mg/dl are not quite diabetic levels but are considered abnormal and unhealthy. Interestingly, on Guam and other Pacific islands, fasting blood sugars greater than 90 mg/dl are associated with a much higher risk of developing diabetes and or heart disease. Individuals with mildly elevated blood sugars can ask their doctor about taking a Glucose Tolerance Test. This is the most accurate test for determining if an individual has diabetes and is the best way to detect diabetes before significant damage has been done to body organs.

The diagnostic standards were changed because of research that clearly showed a sharp rise in medical complications when blood sugars reached 126 mg/dl before breakfast. A similar risk was observed when blood sugars rose above 200 mg/dl two hours after meals. Typical complications of poorly controlled diabetes include: blindness and other eye problems, kidney damage, nerve damage to hands or feet, poor circulation of blood through the body, amputations of the feet or legs, and heart disease.

Fortunately, the risk of medical complications from diabetes is greatly decreased by regular visits with your family doctor and the assistance of a diabetes treatment team consisting of the primary care physician, clinical preventionists, educators, nutritionists and fitness professionals. The Wellness Center offers individual care and group classes designed to assist each person with diabetes to better understand their condition and also control their risk of health complications. For more information call 632-7522. You may also tune into 91.9FM from 5:00 to 6:00pm on Wednesdays when Dr. Youngberg discusses health issues and takes your phone calls.


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