WHO GETS DIABETES? | Added: 11, August 2017



Do type 1 and type 2 diabetes run in families?

According to the American Diabetes Association and research on genetics, type 1 diabetes does seem to have a genetic component. In other words, a person’s particular genetic makeup means that he or she is more likely to develop type 1 diabetes, especially under certain conditions. Research also indicates that many people with type 2 diabetes have a genetic predisposition to the disease-more so than a person with type 1 diabetes. The risk of developing diabetes is also based on such factors as aging; whether the person has an inactive lifestyle; and/or if he/she becomes overweight or obese. (For more about genetics and diabetes, see the chapter “Other Types of Diabetes.”)

What are some statistical chances of getting diabetes within families?

Like most data in science, the statistics about a person’s chance of developing type 1 or type 2 diabetes is often dependent on the research study. For example, one organization states that if a brother, sister, son, or daughter has diabetes, the chance of an immediate relation contracting type 1 diabetes is 10 percent; if the mother has type 1, the chance is 2 percent, and if the father does, 6 percent. For type 2, if a brother or sister has type 2, the chances of a relation’s having type 2 diabetes is 25 percent; a mother or father having it gives a chance of 12 percent; both the mother and father, the chance is 50 percent; and if an identical twin has type 2 diabetes, the chance is 90 percent.

But not everyone agrees. Still another group, the Harvard School of Public Health, states that if a parent, sister, son, or daughter has type 1 diabetes, the risk of an immediate relation developing type 1 diabetes is 10 to 20 times that of the general population, with the risk going from one in 100 to one in ten depending on which family member has diabetes and when he or she developed it. In addition, their studies indicate that if a mother has diabetes, the risk of a child developing type 1 diabetes is lower than if the father has the disease (around 10 percent chance of getting type 1 diabetes if the father has it). But if the mother has type 1 diabetes and is age 25 or younger when the child is born, the risk is reduced by 4 percent; if the mother is over age 25, the risk drops to one in 100, or around the same as the average American. Thus, statistics and chances of developing type 1 and type 2 are extremely dependent on the conditions surrounding the person who develops the disease-and especially the scientific group or study!

Which ethnic, racial, or cultural groups are more prone to type 1 and type 2 diabetes in the United States?

There is a difference among groups who seem to be more prone to type 1 and type 2 diabetes. In particular, it is thought that white people of northern European heritage are more prone to type 1 diabetes than members of other ethnic and racial groups. Other groups also have their share of diabetes diagnoses. According to the American Diabetes Association, the following ethnic, racial, or cultural groups in the United States have various percentages of diagnosed diabetes:

Ethnic or racial backgrounds: 7.6% of non-Hispanic whites; 9.0% of Asian Americans; 12.8% of Hispanics; 13.2% of non-Hispanic blacks; 15.9% of American Indians or Alaskan Natives.

Asian Americans: 4.4% of Chinese; 11.3% of Filipinos; 13% of Asian Indians; 8.8% of other Asian Americans.

Hispanic background (adults): 8.5% of Central and South Americans; 9.3% of Cubans; 13.9% of Mexican Americans; 14.8% of Puerto Ricans.

Which countries have the most cases of diabetes, and which have the highest rates as a percentage of the countries’ overall population?

Many organizations present various numbers and results concerning diabetes around the world. And no matter which organizations find what results, the underlying message is clear: Diabetes is very prevalent all over the world. For example, according to the International Diabetes Federation, China, India, and the United States have the most cases of diabetes. Several islands in the Pacific Ocean have the most rates of prevalence, or in other words, the highest rates of diabetes cases as a percentage of the country’s overall population. For instance, around 37.5 percent of the population of Tokelau (northeast of Fiji) has diabetes; Saudi Arabia, Qatar, Kuwait, and Micronesia all have higher-thanaverage rates of diabetes cases. In addition, Southeast Asia has nearly one-fifth (20 percent) of the global diabetes cases (and it is estimated that almost 50 percent of the population has not been formally diagnosed). Many of these countries are growing, and the availability and consumption of foods has changed (including more imported foods being eaten). As a result, many researchers believe diabetes is prevalent in these countries because of a growing obesity problem.

Of course, as with all statistics, other organizations find different results in their studies. For example, the World Health Organization notes that in 2014, half of adults around the world with diabetes lived in five countries: China, India, the United States, Brazil, and Indonesia, and noted that the rates doubled for men in India and China between the years 1980 to 2014. They also found that northwestern Europe has the lowest rates of diabetes among both women and men, with age-adjusted prevalence lower than 4 percent for women and around 5 to 6 percent for men in Switzerland, Austria, Denmark, Belgium, and the Netherlands.

A map of the world showing the prevalence of diabetes by country, according to a World Health Organization 2012 study.

Why is it sometimes difficult for health care professionals to treat a person who has diabetes?

For health care professionals (and even friends and family who try to help a person with the disease), it is often difficult to help a person with diabetes. The difficulty is not because of the disease itself, but because so many people are in denial and unwilling to accept that they have diabetes. Often, it is because there can be few symptoms, so the person does not believe the risks from diabetes actually exist. Other times, they don’t have (or don’t know how to find) the support they need to cope with the disease, both physically and emotionally. And still others are not willing to-or cannot without help-make lifestyle changes to manage their diabetes. (For suggestions on coping and getting help for diabetes, see the chapter “Coping with Diabetes,” and for those with and without access to the Internet and apps, see the chapter “Resources, Websites, and Apps.”)

Who should be tested for diabetes?

Everyone should be tested for diabetes, especially if there are any symptoms of the disease or if someone in the family has diabetes-no matter what age. Overall, the American Diabetes Association recommends that all adults be tested beginning at age 45.

DIABETES IN INFANTS AND CHILDREN

Can a baby have type 1 diabetes?

According to the most recent data, children under the age of three can have type 1 diabetes. Although no one agrees on the actual numbers, some research suggests that less than 1 percent of all children less than a year old develop type 1 diabetes; another statistic states that less than 2 percent of children under three years develop type 1 diabetes. The most recent data also suggests that there is a significant upward trend of type 1 diabetes at such young ages for some unknown reason. There may be several reasons, including and especially that there is a better understanding of the disease in infants (and therefore more diagnoses).

Why is it often a challenge to diagnose and treat an infant who may have type 1 diabetes?

There are several reasons that it is difficult to diagnose and treat a young infant who has diabetes. Initially, babies do not often have the “classic diabetic” early symptoms and signs of the disease. If they are diagnosed with type 1 diabetes, it is often a challenge to set up a therapeutic treatment for the infant (especially in terms of insulin dosage as the child grows), including if the mother is breastfeeding. Managing the child’s diabetes is also difficult because the child is growing and developing and is not able to take care of his or her needs. Thus, the parents, and often other members of the family, must be involved in the baby’s treatment. And finally, there is the psychological impact of how diabetes affects not only the child but also the child’s family, as the daily work of managing the disease is often difficult.

What is the youngest child known to develop type 2 diabetes?

As of this writing, and according to a study presented at the 2015 meeting of the European Association for the Study of Diabetes, the youngest child to develop type 2 diabetes was a three-and-a-half-year-old Hispanic female from Texas. Her initial symptoms were excessive urination and thirst, but her other medical history showed virtually nothing. In addition, although both parents were reported to be obese, there was no history of diabetes. But the child was in the top 5 percent of children her age in weight and height, putting her in the body mass index (BMI) obesity range (for more about BMI, see the chapter “Diabetes and Obesity”). Her blood tests also showed a high HbA1c level (also seen as A1C or A1c) but negative for antibodies that would mean she would have had type 1 diabetes. After treatment for six months with metformin (a common type 2 diabetes drug) at various levels and a change in diet and lifestyle, the girl had normal blood glucose levels and a “normal” HbA1c level. She stopped taking metformin. According to most researchers, this was a good sign. It may mean that type 2 diabetes is reversible in many young children-as long as they are diagnosed early and with certain modifications in eating, exercise, and lifestyle.

What is hyperinsulinism (hyperinsulinemia) in a newborn baby?

Hyperinsulinism (hyperinsulinemia) is just as the term implies-an excessive amount of insulin in the bloodstream. There are various types of hyperinsulinism, including congenital hyperinsulinism, a rare condition in which there is severe, persistent hypoglycemia in a newborn baby. In the United States, it is estimated that one in 50,000 newborns is affected by hyperinsulinemia, with symptoms ranging from sweating and lethargic behavior to irritability, jitteriness, and respiratory distress, all of which can mimic other conditions, which is why it is often difficult to diagnose.

Why is diabetes thought to be one of the most common chronic illnesses of young people?

According to several organizations that specialize in diabetes, diabetes is one of the most common chronic illnesses of young people. This is because it is estimated that 5 percent of all new diabetes cases are type 1, and most of those affected are children and adolescents. It is also estimated that more than 18,000 people under age 20 are diagnosed with type 1 diabetes each year. The numbers are also high in terms of type 2 diabetes-with estimates of more than 5,000 new cases of type 2 diabetes in young people each year. At this writing, these figures are often translated as meaning that one of every 350 children has diabetes, although some recent studies show this trend may be slowing.

What are the challenges of treating a toddler (one to three years old) who has type 1 diabetes?

The challenges associated with treating a toddler ages one to three who has type 1 diabetes is similar to that of an infant less than a year old. In addition, as children get older, they tend to refuse to eat certain foods, meaning there is a chance of hypoglycemia. Discipline and temper tantrums are also known to be issues at the toddler stage, possibly making it difficult for the parent to measure the child’s blood glucose levels. The best way to overcome such challenges is for the parent or guardian to better understand the disease (through education) and to get the overall support of a diabetes team and the child’s health care professional.

One challenge of having a toddler with diabetes is getting them to eat foods low in sugars.

What are some challenges of preschool and early school-aged children (three to seven years old) to school-aged children (eight to 12 years old) who have type 1 diabetes?

A child (ages three to seven) with type 1 diabetes still needs help managing injections and blood glucose readings. But in many cases, children in this age group are ready to participate in certain activities that will help them manage their diabetes. In particular, many parents ask their child to participate in the testing and keeping records of the child’s glucose measurements, along with helping to make meals for the child. These responsibilities often make a child gain confidence in helping to manage diabetes.

For school-aged children (ages eight to twelve) with type 1 diabetes, the challenges are somewhat different, especially if they have been diagnosed with the disease at a later age. If the child has had diabetes for a while, the tasks include continuing to manage blood glucose levels with injections and maintaining nutritional balance. For those who are diagnosed at an older age, the challenge becomes learning to cope with not only a different way of eating but also taking medication each day. There is also the psychological challenge of managing the disease every day, dealing with their peers’ understanding (and misunderstanding) of diabetes, and realizing the disease will not go away.

Why is it often difficult for children (ages six to twelve) with type 1 diabetes while at school?

One of the most difficult challenges for children ages six to twelve with diabetes-type 1 or type 2-is managing their blood glucose levels while they attend school. Younger children’s challenges at school include assistance in administering insulin (including if the child uses an insulin pump) and supervision in managing glucose levels. For older children, school becomes more of a challenge as they increase their activities while keeping their glucose under control. In addition, there are often problems stemming from peers, many who may not understand diabetes and what challenges it entails.

DIABETES AND TEENS THROUGH YOUNG ADULTS

Has type 2 diabetes increased in teens and young adults?

Yes, according to most diabetes research, type 2 diabetes, which usually develops in adulthood past age 40, has become increasingly common in children and teenagers. Some studies also indicate that along with this rise in type 2 diabetes cases is an increased number of teenagers and young adults who are also obese. Although one study indicated that a rise in obesity was slowing down, there are still enough teens and young adults who are at risk to become obese and develop type 2 diabetes to prompt concern.

What are some challenges faced by parents or guardians of adolescents and young adults with diabetes?

The parents or guardians of adolescents and young adults with diabetes can face several challenges. One of the biggest challenges is in helping a young person gain the independence and confidence he or she will need in the future-without too much parental involvement that may alienate the young person. Parents must also realize that the young person (especially an adolescent) will need help now and then with the management and decision making of diabetes (for example, with insulin adjustments and eating habits).

Psychologically, peer pressure may be hard on a young person with diabetes. In such cases, parents need to be understanding, give guidance, and even obtain counseling if necessary to help the young person. Plus, it is good to know that parents and the young person are not alone. There are others who can help a young person with diabetes, including teachers, health care professionals, dietitians, and diabetes educators.

Why is a Diabetes Medical Management Plan (DMMP) important to a student with diabetes?

A Diabetes Medical Management Plan (DMMP) consists of the medical orders or diabetes care plan developed by the student’s personal diabetes health care team. The main reason for having such a plan is that every student who has diabetes needs different methods of treatment. Because of this, a student’s doctor orders for school care need to be specifically designed for that student. According to the American Diabetes Association, along with the National Diabetes Education Program (under the National Institutes of Health), there is now a DMMP that can be customized for every student who has diabetes, whether it be type 1 or type 2. (To obtain this template, visit the American Diabetes Association website at http://www.diabetes.org/living-with-diabetes/parents-andkids/diabetes-care-at-school/written-care-plans/diabetes-medical-management.html.)

What are some ways to help adolescents and young adults with diabetes eat right-especially at school?

There are several ways to help adolescents and young adults with diabetes cope with eating right, especially while they’re at school. According to the National Institute of Diabetes and Digestive and Kidney Diseases (under the National Institutes of Health), several approaches will help a student plan meals and take care of his or her blood glucose levels during school. The following lists some of those ways (for more about diet and diabetes, see the chapter “Diabetes and Eating”):

Carbohydrate (carb) counting-This is a popular meal-planning approach for children and adolescents with diabetes. It involves calculating the number of grams of carbohydrates (also called carbs), or choices of carbohydrate, eaten at meals or snacks.

It can be hard to keep an active teen away from high-carb foods like French fries and sodas. They also need to know about other sources of carbs that seem unlikely, including sandwich wraps, raisins, smoothies, bagels, and bananas.

Changing-carb-intake meal plan-This is a method of meal planning used by students who take multiple daily insulin injections or have an insulin pump. Students who use this method do not have to eat the same amount of carbs at every meal or snack, but they must adjust their insulin doses (with either rapid- or short-acting insulin) to cover the amount of carbs they consume (they often use this method in conjunction with a basal/bolus insulin plan; for more about basal and bolus insulin treatments, see the chapter “Taking Charge of Diabetes”).

Consistent-carb-intake meal plan-This is a meal plan in which students aim for a set amount of carbohydrates at each meal and snack but do not adjust their mealtime insulin for the amount of carbohydrate intake. These students follow a traditional or fixed insulin-dose plan.

Overall, these methods can be used in conjunction with the student’s Diabetes Medical Management Plan (DMMP; see above) developed by the student’s personal diabetes health care team.

DIABETES AND MIDDLE-AGED ADULTS

What is the average life expectancy of a person with type 1 diabetes?

According to a study conducted in 2012, men with type 1 diabetes had an average life expectancy of about 66 years versus 77 years among men without it. Women with type 1 diabetes had an average life expectancy of about 68 years compared with around 81 years for those without type 1 diabetes. Of course, these are merely statistics, as many men and women with type 1 diabetes live well into their eighties, nineties, and even past the century mark.

What study connected type 2 diabetes with female puberty?

In research conducted in 2013, scientists studied more than 15,000 middle-aged women from eight countries in Europe, asking when the women started their periods. On the basis of their statistics, they determined that women who began menstruating between the ages of 8 and 11 years had a 70 percent greater chance of developing type 2 diabetes in adulthood than those who started their periods at the average age of 13. When the women’s BMI (body mass index; for more about BMI, see the chapter “Diabetes and Obesity”) was taken out of the equation, only about 42 percent had a greater risk of developing type 2 diabetes if they began menstruating at an early age. Although the researchers believe that early puberty in women somehow affects the women’s diabetes risk (no matter what the weight), it seems this study also does not factor in lifestyles or medical histories-thus the results are highly debated.

What percentage of adults develop type 1 diabetes?

Although type 1 diabetes is commonly diagnosed in childhood, around 25 percent of people with type 1 diabetes are diagnosed as adults, some even into their nineties. If an adult develops type 1 diabetes, the symptoms usually occur suddenly and are similar to those symptoms in children who develop the disease. These include weight loss, nausea, constant thirst, and urination. (For more about type 1 diabetes in adults, see the chapter “Type 1 Diabetes.”)

Does type 2 diabetes occur suddenly in middle-aged adults?

No, a person develops type 2 diabetes gradually over a number of years-at middle age or any age. Internally, it usually begins when muscle and other cells in the body stop responding to insulin. The reason it seems to occur more often in middle-aged adults is that it develops gradually and because more middle-aged people develop problems with weight gain, blood pressure, and other conditions that can lead to type 2 diabetes.

What is the average age a person is diagnosed with type 2 diabetes?

According to the Centers for Disease Control and Prevention (CDC), there were a total of 1.7 million new total diabetes cases in 2012 (the latest data available). In addition, adults (both male and female) ages 45 to 64 were the most-diagnosed age group for type 2 diabetes.

How does type 2 diabetes affect the life expectancy of a person with the disease?

According to several studies, type 2 diabetes cuts about eight and a half to ten years off the life of the average 50-year-old person (male and female) compared with a 50-yearold without the disease. (These numbers often differ for type 2 diabetes because of gender, how healthy the person is before the diagnosis, and lifestyle differences, such as smoking, blood pressure, etc.) Of course, these are merely statistics, as many men and women with type 2 diabetes live well into their eighties, nineties, and beyond.

Is there a connection between diabetes and the metabolic syndrome?

Many health care professionals believe there is a definite connection between diabetes (especially type 2) and what is called the metabolic syndrome. This condition is found mostly in adults, usually beginning at middle age. The syndrome includes several symptoms, including large waist measurement, abnormal blood fats, elevated blood pressure, and glucose intolerance-all of which usually start to appear in middle age. (For more about the metabolic syndrome, see the chapter “Prediabetes and Type 2 Diabetes.”)

DIABETES AND SENIORS

How does a person’s response to diabetes change as he or she ages?

As people with diabetes age, their bodies change along with their response to diabetes. For example, sometimes the method of monitoring blood glucose levels or administering insulin must change as a person gets older, especially if he or she is having difficulty with cognitive function. For some older people, aging with diabetes may mean a new routine, such as changing from using a syringe for insulin injections to an insulin pen. Or it can mean a major lifestyle change, such as engaging in more physical activity to keep blood glucose levels under control.

Why is it often difficult to determine how aging affects a person with diabetes?

There is one major reason why researchers and health care professionals find it difficult to determine how aging affects a person with diabetes: We don’t have enough data (such as a good cross-section of older people who have had the disease for very long) to understand what happens. It is true that insulin has been available for less than a century. But, as of this writing, few elderly people have been on insulin long enough for scientists to collect long-term data of how older people live with diabetes. There is a positive aspect even though there is less data about aging and diabetes. Managing diabetes has changed since the mid-twentieth century, with more technology and medications to treat diabetes no matter at what stage of life-and there is also a better understanding of the disease.

Some older people might require additional assistance with monitoring their glucose levels or taking their medications.

Do menopausal women have more type 1 or type 2 diabetes?

In general, most statistics show that most menopausal women who develop diabetes have type 2. This is because many menopausal women tend to gain weight after their childbearing years. The more a woman weighs, the more risk for developing type 2 diabetes, especially if it runs in her family.

How is menopause connected to diabetes in women?

If a woman is menopausal, she faces challenges even if she does not have diabetes, and if she does, bodily changes complicate the illness, especially its management. Bodily changes occur because two major hormones-estrogen and progesterone-are not stable. (In fact, a higher level of estrogen usually improves insulin sensitivity, while higher levels of progesterone cause resistance.) According to the Mayo Clinic, the following lists several possible effects on a woman’s body that can increase the risk of diabetes (for those who do not have the disease or are prediabetic) or exacerbate the problems associated with a menopausal woman who has diabetes:

Gaining weight-If a menopausal woman gains weight during the transition and after menopause, she may also cause an increase in blood glucose levels. This could increase the need for insulin or oral diabetes medications.

Blood glucose level changes-The two major female hormones, estrogen and progesterone, both affect how a woman’s cells respond to the natural insulin in her body. After menopause, the levels of these hormones change and thus can cause fluctuations in the woman’s blood glucose levels. This may also cause changes in how her body responds to glucose and insulin, which in turn can lead to a higher risk of dia betes and its complications.

What is menopause in women?

In women, menopause is the cessation of ovulation and menstrual periods; after the period has stopped completely, the woman is considered to be post-menopausal. The supply of follicles in the ovaries is depleted, increasing the amount of follicle-stimulating hormone (FSH), while decreasing the amount of estrogen and progesterone. The process may take one to two years and usually occurs between the ages of 45 and 55, with the average age in the United States being 51 to 52. The few years preceding the final menstrual period are known as perimenopause.

Infections of the urinary and reproductive tracts-Because of the fluctuations in blood glucose levels after menopause-especially the high glucose levels-a woman can more easily develop urinary and vaginal infections. In fact, the drop in estrogen levels in a menopausal woman allows bacteria and yeast to thrive in the urinary tract and vagina, increasing the risk of infections.

Sleep problems-Many women experience trouble sleeping after menopause, most often because of hot flashes and night sweats. Because of the lack of sleep, along with the stresses associated with having hot flashes and night sweats, many women with diabetes find it more difficult to manage their blood glucose levels. Even women who do not have diabetes can be affected by lack of sleep, as the stress causes blood glucose levels to rise.

Is there an osteoporosis–menopause connection in women?

Yes, there is often thought to be a connection between osteoporosis (see sidebar) and menopause in women. In particular, after a woman reaches menopause, and if she has a more sedentary lifestyle, she is at increased risk for osteoporosis. There is also an increased risk of the disease if the woman is thin or has a small frame, if she has a family history of the disease, or if she takes certain medications or has certain illnesses that leach or stop the absorption of calcium in the body. In women after menopause, osteoporosis is called primary type 1 or post-menopausal osteoporosis; after age 75, it is often called primary type 2 or senile osteoporosis.

Can type 1 and/or type 2 diabetes affect a menopausal woman’s bone density?

Yes, there seems to be a connection between menopause in a woman with type 1 diabetes and lower bone density, but no one is sure why. Some researchers believe that it may be because insulin, which is deficient in women with type 1 diabetes, may help promote bone growth and strength. Others believe cytokines (substances produced in many cells of the body’s immune system that have an effect on other cells) may play a role not only in the development of type 1 diabetes but also in osteoporosis.

What is osteoporosis?

Osteoporosis (from the Greek, meaning “porous bones”) is a disease in which a person’s bone-mineral density decreases because of the lack of certain elements in the body, including calcium and vitamin D. This causes the bone to break down and increases the risk of fractures and breaks, usually in older adults (female and male) and especially in post-menopausal women. (For more on osteoporosis and diabetes, see the chapter “How Diabetes Affects Bones, Joints, Muscles, Teeth, and Skin,” and for more about vitamins and minerals, see the chapter “Diabetes and Nutrition.”)

There is one additional statistic that researchers are examining: Although women with type 1 diabetes are at a higher risk overall for osteoporosis, the risk seems to be even more pronounced for overweight women with type 2 diabetes. It is thought that increased body weight can reduce the risk of osteoporosis, but it also increases the risk of type 2 diabetes. But studies have shown that although bone density increased in women with type 2 diabetes, fractures also increased.

Some suggest that people with type 1 diabetes also experience more fractures-and that these may be due to an increased number of falls because of poor vision and nerve damage caused by the disease. Others suggest that diabetes may damage bone structure and quality, causing a decrease in bone density.

How many Americans over age 60 are thought to have insulin resistance?

It is estimated that 40 percent of Americans over age 60 have some insulin resistance. This means that the cells in the body become less sensitive to the hormone and need larger amounts of insulin to metabolize certain compounds in the body, such as proteins, fats, and carbohydrates. And it is not only people with diabetes who are affected by insulin resistance. It also can affect those who suffer from obesity and hypertension and those with impaired glucose tolerance. (For more about insulin resistance, see the chapters “Introduction to Diabetes” and “Prediabetes and Type 2 Diabetes.”)

Can older people’s sense of taste and smell affect their eating habits-and their diabetes?

Yes, older people (with or without diabetes) do not have as keen a sense of smell or taste as when they were young-and these factors may affect their eating habits. In general, it is thought that a person’s sense of smell peaks between ages 30 and 60. After 60, a person’s ability to smell and taste declines. With further aging, especially over age 80, people lose even more of their sense of smell and their ability to discriminate between smells (medically called olfactory impairment). Research has shown that more than 75 percent of people over 80 have some decline in smell.

Overall, the reason for a decline usually has to do with the normal aging process, drug use (possibly including some medications associated with diabetes), infections (especially upper respiratory), changes in the mouth (such as dentures or tooth loss), and even the reduction of saliva. Thus, because smell and taste are so intertwined with a person’s perception of foods and eating habits, a large proportion of elderly people who lose their smell don’t eat well and become nutrient deficient, and for older people with diabetes, this can be a problem, as it may cause them to eat poorly, which can affect their ability to control blood glucose levels. (For more about diabetes, smell, and taste, see the chapter “Diabetes and Inside the Human Body.”)

Osteoporosis is a disease in which bone density decreases, making fractures and breaks more likely.

What are some other eating challenges that can affect an older person with diabetes?

Seniors with diabetes face many challenges, especially taking in enough nutrients to stay healthy. This can be for a multitude of reasons, including a loss of appetite (from medications or illness), problems with chewing and swallowing (difficulty with dentures or lack of teeth), and a need to reduce the intake of fats and sugars that are associated with certain chronic conditions (sugars and fats provide energy but also add weight that can lead to other diseases). All these conditions can (and often do) create problems with an older person’s blood glucose levels.

Is there a connection between complications from diabetes and dementia?

Although more studies need to be conducted, according to research published in 2015 in the Endocrine Society’s Journal of Clinical Endocrinology & Metabolism, people who have diabetes and experience high rates of complications are more likely to develop dementia as they age than people who have fewer diabetic complications. In particular, the researchers noted that when blood glucose levels remain high because of uncontrolled diabetes, complications such as blindness, kidney failure, and decreased blood flow in the extremities can occur. These complications, in turn, seem to be connected with the development of dementia as the person ages. (For more about dementia-including Alzheimer’s disease-see the chapter “How Diabetes Affects the Nervous System.”)

What are peripheral neuropathy and orthostatic hypertension, often complications of diabetes and aging?

Peripheral neuropathy is nerve damage affecting the long nerves that run from the spine to the arms, legs, and hands. Orthostatic hypertension is a form of autonomic (occurs unconsciously) neuropathy that affects a person’s balance. Both are often complications of type 1 and type 2 diabetes and the aging process. (For more about peripheral and autonomic neuropathies, see the chapter “How Diabetes Affects the Nervous System.”)

One possible complication of diabetes is peripheral neuropathy, which affects the nerves leading to extremities such as the feet, but it can also affect hands, arms, legs, facial muscles, and internal organs.

Who are some famous historical figures who have had diabetes?

Many historical figures have had diabetes-some with complications that greatly affected their lives and even their decisions over time. The following are only a few examples:

American Thomas Edison (1847–1931), inventor and businessman, managed to produce a prolific amount of patents while suffering from diabetes (this was before insulin was introduced)-including the phonograph, motion-picture camera, and the long-lasting, practical lightbulb.

George R. Minot (1885–1950) received the Nobel Prize (with two others) for studies in anemia. He was also diagnosed with diabetes in 1921 and was one of the first patients to be treated with the “new drug” insulin by Banning and Best (see above for more information). He had developed complications from diabetes by 1940, had a serious stroke in 1947, and died in 1950.

Who are some famous authors who have had or have diabetes?

The list of famous people who have had diabetes is long-and authors are among them. They include some of the following famous writers:

American writer Ernest Hemingway (1899–1961) had diabetes, but some researchers suggest that Hemingway may have had hemochromatosis (also called “bronze diabetes”). This disease-also known as iron overload-along with other health problems such as depression, diabetes, and alcoholism, probably contributed to his suicide in 1961. (For more about bronze diabetes, see the chapter “Other Types of Diabetes.”)

English writer H.G. Wells (1866–1946), often called the “father of science fiction,” was diagnosed with “mild diabetes” in his early 60s. He was instrumental in helping fund a diabetes center, and because of public response, Wells further involved himself in diabetes education by advocating an association specifically for diabetes charity (for research and awareness of the disease) in 1934. The result was the Diabetic Association, which developed into the British Diabetic Association in 1954 and was renamed Diabetes UK in 2000.

Novelist Anne Rice (1941–), most famous for her vampire novels, was diagnosed with type 1 diabetes in 1998. At the time of diagnosis, her blood sugar was around 800, and her health was fragile. If her husband had not called 911, the diabetic coma she was experiencing might have been fatal. After losing and then gaining more weight, Rice underwent gastric bypass surgery, losing 100 pounds (45.3 kilograms) and is in better control of her diabetes.

Who are some famous contemporary people who have made special contributions to their field of interest-and who have diabetes?

U.S. Supreme Court Justice Sonia Sotomayor is one of many luminaries in America who struggle with diabetes but manage to lead productive lives anyway.

Many famous people in various fields of interest have had or have diabetes. The following are only a few examples:

U.S. Supreme Court Justice Sonia Sotomayor (1954–) is the first person with type 1 diabetes ever to serve on the high court. Sotomayor was diagnosed with type 1 at age seven after fainting in church and always being extremely thirsty and urinating a great deal. She still takes insulin and is an advocate of diabetes education.

Nicole Johnson Baker (1974–), a former Miss America (1999) and Miss Virginia (1998), became the first Miss America with diabetes (type 1) and the first contestant to publicize an insulin pump. She is also an advocate of diabetes awareness and education and helps others understand how to cope with the disease.

Cynthia Ice (1959–2008) was an accessibility expert at IBM, specializing in Lotus Notes. She was diagnosed with type 1 diabetes at age seven and lost her eyesight to diabetic retinopathy in her twenties. Even though she lost her eyesight, she was instrumental in making certain programs accessible to the blind and disabled (among other computer-oriented contributions) in order to help them find employment and connect with the world.

Who are some famous musicians who have had or have diabetes?

Many musicians have had or have diabetes. The following lists only a few of them:

Blues singer and bass player B. B. King (1925–2015) was called “The King of Blues.” He was diagnosed with type 2 diabetes 20 years before his death and became an advocate of diabetes education, as he had watched both of his parents suffer from complications of the disease when he was a child. He died at age 89 from complications of diabetes.

American guitarist, singer, and songwriter Jerry Garcia (1942–1995) was a rock musician with the Grateful Dead. Later in life, Garcia was sometimes ill because of type 2 diabetes and in 1986 went into a diabetic coma that nearly cost him his life. Although his overall health improved somewhat after that, he still struggled with drug addictions. In 1995 he died of a heart attack while staying at a California drug-rehabilitation facility.

American singing great Ella Fitzgerald (1917–1996), known as the “First Lady of Song,” was one of many people’s favorite singers, and she pushed herself to exhaustion in her performing years. By the 1980s, Fitzgerald was having serious health problems. She had heart surgery in 1986 and was diagnosed with diabetes. Eventually, the diabetes left her blind, and she had to have both legs amputated in 1994. Never fully recovering from her surgery, she died in 1996.

American jazz musician Dizzy Gillespie (1917–1993) pioneered the 1940s movement that changed the shape of traditional jazz into bebop. Gillespie was hospitalized in 1992 with uncontrolled diabetes and an intestinal blockage, which required surgery. He died in 1993 of pancreatic cancer.

Country singer Johnny Cash (1932–2003), called the “Man in Black,” was considered one of the most influential musicians of the twentieth century. Cash was diagnosed with type 2 diabetes in his fifties and eventually died of complications from diabetes.

Pop singer and actress Patti LaBelle (1944–). Patti LaBelle is her stage name; she was born Patricia Louise Holt-Edwards. She has type 2 diabetes, but it was not until she passed out onstage during a concert that she finally took charge of her health. (She was diagnosed in 1995.) The disease is also in her family, as her mother died of type 2 diabetic complications at age 58.

American rock-’n’-roll singer Bret Michaels (1963–), known for his work as lead singer for the band Poison, was diagnosed with type 1 diabetes when he was six years old. After an onstage collapse because of a low blood glucose level and rumors about drug use, he finally went public about his disease. Since then, he has become more active in diabetes education.

Who are some famous politicians who have had or have diabetes?

Many well-known politicians have had or have diabetes. The following lists only a few of those people:

American politician Fiorello LaGuardia (1882–1947), the former (and 99th) New York City mayor and namesake of LaGuardia Airport in New York, was a diabetic.

Mikhail Gorbachev (1931–) was the general secretary of the Soviet Union from 1985– 1991 and a Nobel Peace Prize winner (1990). He was also instrumental, along with U.S. President Ronald Reagan in ending the Cold War between the United States and the Soviet Union. In 2014 he was diagnosed with “an acute form” of diabetes.

Yuri Andropov (1914–1984) was the general secretary of the Communist Party of the Soviet Union from November 1982 until his death 15 months later. Toward the end of his life, he had several health problems, including hypertension and diabetes, which were connected to chronic kidney deficiency. He eventually died from toxicity in his blood (mainly due to renal failure he had experienced the year before).

Who is Theresa May?

In 2016, after the United Kingdom voted to leave the European Union and Prime Minister David Cameron resigned, Theresa May, 59 at that time, became Britain’s 76th prime minister. She is also thought to be one of the first major world leaders with type 1 diabetes. May was diagnosed with diabetes later in life, seeking medical attention in 2012 for sudden weight loss, fatigue, and thirst. At first, she was misdiagnosed with type 2 diabetes, but then she was surprised to learn she had actually developed type 1. (Like many people, she assumed that at her age, she would not get the disease, but it can develop at any age; for more about adults and type 1 diabetes, see the chapter “Type 1 Diabetes.”) Since that time, she has been open about her diabetes, indicating that she has been able to effectively manage her condition and her responsibilities as prime minister. According to several reports, she does admit that she has to be a little more careful about what she eats and has to take injections, but that situation, she has said, is something that millions of people have. In fact, many people who have type 1 (and type 2) diabetes look to May as an example of what can be accomplished as long as they manage their diabetes sensibly.

Who are some famous sports personalities who have had or have diabetes?

Many famous sports personalities have had or have diabetes, including the following:

Tennis legend Billie Jean King (1943–), a six-time Wimbledon champion and four-time U.S. Open champion, was diagnosed with type 2 diabetes in 2007. She has attributed her developing the disease to a fluctuating weight and sometimes unhealthful eating habits while on the tennis circuit.

American professional baseball player Jack Roosevelt “Jackie” Robinson (1919– 1972) was the first African American to play Major League Baseball in the modern era. After his retirement in 1957, Robinson was diagnosed with diabetes (after complaining of numerous ailments). Although he took insulin, the medication did not stop Robinson’s physical deterioration from the disease. Complications from heart disease and diabetes weakened Robinson and made him almost blind by middle age. He died of a heart attack in 1972.

Ty Cobb (1886–1961), the baseball legend, considered one of the best baseball players of all time, had type 1 diabetes while he played for the Detroit Tigers and the Philadelphia Athletics. After he retired, he became overweight and along with diabetes had high blood pressure, both contributing to heart and kidney damage. He died in 1961 from cancer, complications of diabetes, and heart disease.

English rugby player Chris Pennell (1987–) was diagnosed with type 1 diabetes when he was 19 years old. He has become an advocate for diabetes education, especially for young people who may develop the disease.

American race-car driver Charles Newton “Charlie” Kimball (1985–) was the first licensed driver with diabetes in the history of IndyCar racing (he competes in the IndyCar Series).

How does Ryan Reed cope with racing and his diabetes?

In 2011, Ryan Reed (1993–), a stock-car racing driver who competes on NASCAR’s Xfinity Series circuit, was diagnosed with type 1 diabetes at age 17. Told he would be unable to race again, Reed found a way of treating his diabetes and racing. To do this, he installed a drink system in his race car, along with a blood glucose monitor. The monitor communicates with a wireless device attached to Reed’s stomach (for more about monitors, see the chapter “Taking Charge of Diabetes”), with the readout on the car’s dashboard, allowing him to keep track of his blood glucose levels. If he needs adjustment, Reed receives the necessary insulin (or whatever he needs) during his pit stops. He is one of two professional race-car drivers who have diabetes and has become a diabetes advocate, starting his own nonprofit foundation called Ryan’s Mission.

Who are some movie and television personalities with diabetes?

Many movie and television personalities-from about 1900 to the present-have or have had diabetes. Some of the more famous actors and actresses include the following:

Mary Jane “Mae” West (1893–1980), nicknamed “Diamond Lil,” was a popular actress, singer, and comedian in the 1940s and 1950s. She suffered from diabetes (type unknown) for 15 years before her death at age 87 (she had had a stroke that was thought to be a complication of her diabetes).

Talk-show host Larry King (1933–) had a major heart attack in 1987, after which he gave up smoking and changed his lifestyle. But even with the changes-and probably owing to a family history of the disease-he was diagnosed with type 2 diabetes in 1998.

Actress Mary Tyler Moore (1936– 2017) was diagnosed with type 1 diabetes after being hospitalized with a miscarriage-when a blood test revealed a blood glucose level of 750. She was put on insulin therapy in her early thirties (while she was in the early years of The Mary Tyler Moore Show). After that, she became a major spokesperson for the disease, serving as the international chairman of the JDRF (formerly Juvenile Diabetes Research Foundation) for several years.

The late actress Mary Tyler Moore (shown here in 2001) struggled with type 1 diabetes for much of her life. She spent many years educating people about the disease as a spokeswoman.

Actor Tom Hanks (1956–) reported once that he had elevated blood glucose levels for years before he was definitely diagnosed with diabetes. He may have developed the disease because of yo-yo dieting to fill certain roles in his movies (for example, he gained 30 pounds (13.6 kilograms) and lost 50 pounds (22.7 kilograms) for A League of Their Own and Cast Away, respectively, among other roles that required weight changes). He made his diagnosis public in 2013 and has since spoken candidly about his disease in several interviews.

DIABETES’ EFFECTS ON ANIMALS

Do all animals experience diabetes?

No, not all animals get diabetes. Those that do include pigs, apes, sheep, cats, dogs, and horses. In particular, all mammals produce insulin and will develop what humans often refer to as diabetes (high blood glucose levels) if the beta cells in their pancreases are removed. But in the case of animals that can develop diabetes-type problems, there are various classifications, usually depending on the species. For example, veterinarians divide dog (canine) diabetes into insulin-deficiency diabetes and insulin-resistance diabetes, which are somewhat similar to human type 1 and type 2 diabetes, respectively. In addition, female dogs can develop a canine form of gestational diabetes; other dogs can develop a form of autoimmune diabetes that is similar to a human’s latent autoimmune diabetes in adults (LADA). Even cats are not immune, often developing feline diabetes that is similar to a human’s type 2 diabetes.

How do some dogs-and cats-help humans who have diabetes?

One of the more amazing talents of some animals-especially dogs and some cats-is knowing when their owner is experiencing a diabetic event. These “therapy dogs” (and some cats) often alert a person with diabetes that he or she will soon experience a diabetic episode. The reason for the ability is thought to be a dog’s powerful ability to smell: Many people with diabetes have a certain smell when blood glucose levels are too high.

Dogs can be trained to recognize when their owners are having a diabetic event; they can then alert others to the emergency.

Can cats develop diabetes?

Yes, cats can develop diabetes. As with humans, diabetes is a common disease in cats, in which the cat’s body does not produce or does not use insulin properly (similar to human type 2 diabetes). The insulin in cats is also produced in the pancreas and, as with humans, is responsible for regulating the flow of glucose from the bloodstream and to various cells in the body. Also similar to humans, the classic signs of diabetes in cats are increased (and often ravenous) appetite, weight loss, increased thirst, and increased urination. And as of this writing, there are treatments but no cure for feline diabetes.

Feline diabetes is generally divided into two types: insulin-dependent diabetes mellitus (IDDM) and non-insulin-dependent (NIDDM) diabetes mellitus. Statistically, half to three-quarters of diabetic cats have IDDM, which requires injections of insulin as soon as the disease is diagnosed. The rest have NIDDM and can be treated with oral medications and diet, and some cats (especially if the diabetes is a result of being obese) may not need insulin months or years after the diagnoses once the obesity is controlled. But if obesity or some other connected disorder is not a factor, the diabetes will probably not go away, and such cats will often eventually require insulin injections to control the disease. Without treatment, a cat with diabetes will have a shorter lifespan. In addition, other related disorders will cause the cat to become progressively weaker, including from diabetic neuropathy; several fatal conditions may develop, including ketoacidosis.

What are some risk factors associated with diabetes in cats?

The risk factors for diabetes in cats are very similar to human diabetes risk factors. According to the Cornell University Feline Health Center, risk factors for cats include obesity (the biggest risk and most often in older cats), age, gender (male cats are more commonly afflicted than females), chronic pancreatitis, medications (such as corticosteroids), and concurrent disease or infections.

Can dogs develop diabetes?

Yes, as with most animals that develop the disease, diabetes in a dog is a disorder of carbohydrate, protein, and fat metabolism (how the body digests and uses food, mainly for energy) caused by an absolute or relative insulin deficiency. The process of metabolism is largely dependent on a sufficient amount of insulin in the body-and if a dog is deficient, it may develop diabetes. There are several symptoms of the disease, including weight loss, increase in urination, a change in appetite (eating more or eating less), drinking more water, fruity-smelling breath, dehydration, lethargy, and often urinary tract infections.

How do smaller and larger animals differ when it comes to diabetes?

Besides cats and dogs, many other small animals-mammals, mostly-can develop their own forms of diabetes. But there are differences. For example, ferrets develop insulinoma, or the opposite of what is common in humans with diabetes (lack of insulin). Afflicted ferrets have too much insulin because their beta cells are out of control, causing blood glucose levels to drop too low (hypoglycemia), which often causes nodules to form on the pancreas. Symptoms can often be inactivity (most healthy ferrets are active unless they are asleep), vomiting, drooling, and loss of appetite and weight. Larger animals, on the other hand, are less apt to develop diabetes than smaller animals, but diabetes has been reported in cattle, pigs, sheep, horses, and bison.

Why are dolphins of interest to diabetes researchers?

Researchers are interested in the bottlenose dolphin as that animal can have what could be called type 2 diabetes but with a big difference. Bottlenose dolphins can turn their type of diabetes “on and off” in a process that helps them keep enough glucose in their bodies even though they eat sugar-sparse diets (mostly high-protein fish and little sugar). The researchers believe this on-and-off process may have to do with the animals’ brains. Humans have relatively large brains as compared with their size, and dolphins are second only to humans in the ratio of brain to body size. In humans, it takes a great deal of sugar (glucose) to keep the brain functioning. Thus, researchers believe dolphins may have evolved their on-and-off diabetic-like states as an adaptation to maintain glucose for their bigger brains. This is only a theory, so more studies are needed.

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