Dr. Stacie Bering: Digging deep into the two types of diabetes

Diabetes is not a fun disease. Just ask my mothers. Well, you can’t ask my mom because she’s been gone for 16 years, but my mother-in-law will tell you it’s no walk in the park. Her diabetes has robbed her of her sight and damaged her kidneys.

That’s not all diabetes can do. Three out of four people with diabetes die from heart disease or stroke. And since diabetics are often overweight, have high blood pressure and atherosclerosis (hardening of the arteries), they are at even higher risk for cardiovascular disease.

Diabetes can cause nerve damage, leading to a disease called peripheral neuropathy (PN). PN causes a loss of sensation. When it affects the feet, injuries can go unnoticed and turn into a major problem often complicated by infection. PN can cause excruciating pain.

Diabetes can affect how your gut works, because it affects the nerves for the gastrointestinal tract. If the nerves become damaged, the movement of food through the GI tract slows down. This is called gastroparesis, and it can cause symptoms like nausea, vomiting and loss of appetite, not to mention erratic blood sugar levels.

What is diabetes, anyway? Diabetes is a result of disordered metabolism — the way the body uses digested food for energy and growth. Most of the food we eat is broken down into glucose — the main source of energy that fuels our body. In order for glucose to get into the cells where our little energy factories reside, we need insulin, a hormone produced by the pancreas, an organ that hides behind the stomach.

When a person has diabetes, either the pancreas stops producing insulin (Type 1 diabetes) or the body’s cells don’t respond properly to the insulin, a condition called insulin resistance. This is the more common type of diabetes, known as Type 2 diabetes.

In both types, the result is too much glucose floating around in the blood, where it does us no good and causes lots of problems.

The two types of diabetes have different causes.

Type 1 diabetes is an autoimmune disease, like lupus or multiple sclerosis. The body’s immune system decides somehow that the cells in the pancreas that make insulin are the enemy and goes on a search and destroy mission.

Type 2 diabetes is by far the more common, accounting for 90 to 95 percent of diabetes, and it is becoming epidemic.

The risk of developing Type 2 diabetes increases with age and with weight. Eighty percent of Type 2 diabetics are overweight.

Family history is an important risk factor (can’t do much about that), and women who had diabetes during pregnancy are at increased risk for developing Type 2 diabetes later in life, especially if they are overweight.

Once you have diabetes, there is good evidence that tight control of blood glucose levels can decrease the risk of all those nasty complications of the disease. A large federal study showed that tight control of blood sugar levels reduces the risk of kidney, eye and nerve damage in both Type 1 and Type 2 diabetes.

The study defined tight control as blood glucose levels of 70 to 120 before meals and less than 180 after meals. The same study confirmed that tight control protected against cardiovascular disease in Type 1 diabetics.

Another study is addressing the issue in Type 2 diabetics, but we expect the results will be similar.

Forty-one million Americans have prediabetes, a condition where the blood sugar is higher than it should be but not high enough to be called diabetes. Even worse, one in 10 males and one in 25 females ages 12 to 19 have prediabetes. It’s a major risk factor for diabetes.

But it doesn’t have to become diabetes.

Just 30 minutes of moderate exercise a day and a 5 to 10 percent reduction in body weight is enough to reduce the risk of developing diabetes by 58 percent.

And you don’t want diabetes. Just ask my moms.