A representative of Boston Mayor Thomas M. Menino said yesterday that the mayor hopes that his newly diagnosed diabetes provides a "teachable moment" for those who aren't aware or informed enough about this common and serious disease. Currently, about 25 million Americans have diabetes, with millions more at risk or undiagnosed. To assess your own knowledge of diabetes, take this brief quiz that covers some basic facts--and frequent misconceptions:
1. True or false?:
The difference between Type I and Type II diabetes is that kids get type I and need insulin, while adults get type II and take pills.
2. The way you first know you have diabetes is:
a) You are very thirsty, urinate a lot, and have blurry vision.
b) You go into a sudden coma.
c) You don't feel anything--it shows up on a blood test.
d) Any of the above.
3. Every adult with diabetes needs to see all of these specialists regularly except:
a) A dietician
b) An endocrinologist specializing in diabetes
c) An ophthalmologist (eye doctor)
d) A podiatrist (foot doctor)
4. Uncontrolled blood sugar can cause:
a) Skin infections
c) Erectile dysfunction
d) Any of the above
5. True or false?:
Once you are on insulin, you can never get off it.
1. False. Type I diabetes is an autoimmune disorder in which the pancreas fails to produce insulin. All Type I diabetics need insulin. It usually starts in early childhood, and used to be called "juvenile diabetes." Type I is relatively uncommon (only 5% of diabetics have Type I). But here's where things get confusing: Because of the increased incidence of obesity in children, lots of kids also now get Type II diabetes. And, while many adults with Type II diabetes--in which the pancreas makes insulin but the body doesn't react to it effectively--can control their sugar with pills, or even diet alone, many also need insulin.
2. d: Sometimes people with Type II diabetes have no symptoms at all, and find out they're diabetic on a routine blood test, or while being treated for another illness (such as seems to have been the case with Mayor Menino). Elevated blood sugar can cause frequent urination, dehydration, thirst, and blurry vision. Rarely, very high blood sugars can cause loss of consciousness--a diabetic coma. This kind of emergency is more likely to occur in Type I diabetics, but can happen to Type II diabetics as well. Currently, the U.S. Preventive Services Task Force only recommends routine diabetes screening for asymptomatic people with elevated blood pressure (because of the additive risk of cardiovascular disease in people with both conditions). Pregnant women are also routinely screened for gestational diabetes with a glucose tolerance test. Because the incidence of diabetes is rising, and it's estimated that millions of Americans have either "pre-diabetes" or undiagnosed diabetes, more aggressive screening is being considered, and has been urged by many advocacy groups.
3. b. Every diabetic should have counseling with a dietician. Proper diet can help regulate blood sugar and, in some cases, reduce or even eliminate the need for medication. Annual visits to an ophthalmologist and a podiatrist are also recommended for diabetics. Damage to blood vessels in the back of the eye from diabetes (diabetic retinopathy) can be treated, if caught early. If not treated, these changes can lead to blindness. Diabetics are prone to skin infections, especially in the legs and feet. Often, decreased nerve function caused by diabetes means that a person doesn't even feel a small cut or ingrown toenail which can lead to severe infections and even amputation. A primary care doctor, especially one who works with a team including a diabetes nurse and a dietician, can manage Type II diabetes very well. Some patients may prefer to see an endocrinologist specializing in diabetes, or go to a diabetes center, but this is not always necessary.
4. d. Diabetes affects virtually every body part from head to toe. A good summary is here.
5. False. With diet, weight loss, and exercise, Type II diabetics may decrease and even eliminate their need for insulin--sometimes their need for pills as well. A recent study showed that weight loss surgery can be a particularly effective treatment for diabetes, with many patients no longer needing insulin after surgery.
The best "treatment" for diabetes, though, is not to develop it in the first place. While Type II diabetes isn't always preventable, a federally funded program involving over 3000 people showed that even modest weight loss and exercise can delay or defer the onset of the disease.
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