Public Health Problem

People with diabetes either don’t make enough insulin (type 1 diabetes) or can’t use insulin properly (type 2 diabetes). Insulin allows blood sugar (glucose) to enter cells, where it can be used for energy. When the body doesn’t have enough insulin or can’t use it effectively, blood sugar builds up in the blood. High blood sugar levels can lead to heart disease, stroke, blindness, kidney failure, and amputation of toes, feet, or legs.

Type 2 diabetes accounts for about 90% to 95% of all diagnosed cases of diabetes, and type 1 diabetes accounts for about 5%. The health and economic costs for both are enormous:

  • Diabetes was the seventh leading cause of death in the United States in 2013 (and may be underreported).
  • Diabetes is the leading cause of kidney failure, lower-limb amputations, and adult-onset blindness.
  • More than 20% of health care spending is for people with diagnosed diabetes.

People who have one or more of the following risk factors should talk to their doctor about getting their blood sugar tested:

  • Being overweight.
  • Being 45 years or older.
  • Having a family history of type 2 diabetes.
  • Being physically active less than 3 times a week.
  • Ever having gestational diabetes or giving birth to a baby who weighed more than 9 pounds.

Race and ethnicity are also factors: African Americans, Hispanics and Latinos, American Indians, Pacific Islanders, and some Asian Americans are at higher risk than whites.

Diabetes Complications

Diabetes complications and related conditions include the following:

  • Heart disease and stroke: People with diabetes are twice as likely to have heart disease or a stroke as people without diabetes—and at an earlier age.
  • Blindness and other eye problems: Diabetic retinopathy (damage to blood vessels in the retina), cataracts (clouding of the lens), and glaucoma (increase in fluid pressure in the eye) can all result in vision loss.
  • Kidney disease: High blood sugar levels can damage the kidneys long before a person has symptoms. Kidney damage can cause chronic kidney disease, which can lead to kidney failure.
  • Amputations: Diabetes damages blood vessels and nerves, particu-larly in the feet, and can lead to serious, hard-to-treat infections. Amputation is sometimes necessary to stop the spread of infection.

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