12 Facts About Diabetes Mellitus

iStock/mthipsorn
iStock/mthipsorn

Thirty million Americans—about 9 percent of the country's population—are living with diabetes mellitus, or simply diabetes. This chronic condition is characterized by sustained high blood sugar levels. In many patients, symptoms can be managed with insulin injections and lifestyle changes, but in others, the complications can be deadly. Here's what you need to know about diabetes mellitus.

1. There are three types of diabetes.

In healthy people, the pancreas produces enough of the hormone insulin to metabolize sugars into glucose and move the glucose into cells, where it's used for energy.

But people with type 2 diabetes—the most common form of the disease, accounting for about 95 percent of cases—either can't produce enough insulin to transport the sugars, or their cells have become insulin-resistant. The result is a buildup of glucose in the blood (a.k.a. high blood sugar or hyperglycemia). Type 2 diabetes typically develops in adults.

Type 1 diabetes, also known as juvenile diabetes, makes up the remaining 5 percent of chronic cases and most often develops in children and young adults. With this condition, the initial problem isn’t blood sugar levels, but insulin production: The pancreas can’t make enough insulin to process even normal amounts of glucose. The sugar builds up as a result, leading to dangerous concentrations in the bloodstream.

The third form, gestational diabetes, only afflicts pregnant people who weren’t diabetic before their pregnancy. The mother's blood glucose levels usually spike around the 24th week of pregnancy, but with a healthy diet, exercise, and insulin shots in some cases, diabetes symptoms usually can be managed. Blood sugar levels tend to return to normal in patients following their pregnancies.

2. The mellitus in diabetes mellitus means "honey sweet."

Around 3000 years ago, ancient Egyptians described a condition with diabetes-like symptoms, though it wasn't called diabetes yet. It took a few hundred years before the Greek physician Araetus of Cappodocia came up with the name diabetes based on the Greek word for "passing through" (as in passing a lot of urine, a common diabetes symptom). English doctor Thomas Willis tacked on the word mellitus, meaning "honey sweet," in 1675, building on previous physicians' observations that diabetic patients had sweet urine. Finally, in 1776, another English physician named Matthew Dobson confirmed that both the blood and urine of diabetes patients were made sweeter by high levels of glucose in their blood.

3. The cause of one type of diabetes is well understood; the other, not so much.

A person’s lifestyle is a key predictor of developing type 2 diabetes. Factors like being overweight or obese, consuming a high-calorie diet, smoking, and seldom exercising contribute to the risk. Foods and drinks that are high in sugar—soda, candy, ice cream, dessert— may contribute to hyperglycemia, but any food that’s high in calories, even if it's not sweet, can raise blood sugar levels.

In contrast to these well-established factors, medical experts aren’t entirely sure what causes type 1 diabetes. We do know that type 1 is an autoimmune disease that develops when the body attacks and damages insulin-producing cells in the pancreas. Some scientists think that environmental factors, like viruses, may trigger this immune response.

4. Family history also plays a role in diabetes risk.

If a parent or sibling has type 2 diabetes, you are predisposed to developing pre-diabetes and type 2 diabetes. Lifestyle habits explain some of these incidences, since family members may share similar diets and exercise habits. Genetics also play a role, but just because one close relative has diabetes does not mean you're destined to. Research conducted on identical twins, which share identical genes, showed that the pairs have discordant risk. Among twins in which one has type 1 diabetes, the other has only a 50 percent chance of developing it; for type 2, the risk for the second twin is 75 percent at most.

5. Racial minorities are at a higher risk for developing diabetes.

Many racial minority groups in the U.S. have a higher chance of developing type 2 diabetes. Black Americans, Latino Americans, Native Americans, Pacific Islanders, and some groups of Asian Americans are more likely to have pre-diabetes and type 2 diabetes than white Americans. This can be partly explained by the fact that some of these groups also have higher rates of obesity, which is one of the primary risk factors of type 2 diabetes. Socioeconomics may also play a role: One study shows that people with diabetes living in poverty are less likely to visit diabetes clinics and receive proper testing than their middle-income counterparts. According to another study, diabetic people without health insurance have higher blood sugar, blood pressure, and cholesterol rates than insured diabetics. Genetics, on the other hand, don’t appear to contribute to these trends.

6. Diabetes is one of the world's deadliest diseases.

With proper management, people with diabetes can live long, comfortable lives. But if the disease isn’t treated, it can have dire consequences. Diabetics make up the majority of people who develop chronic kidney disease, have adult-onset blindness, and need lower-limb amputations. In the most serious cases, diabetes leads to death. The condition is one of the deadliest diseases in the world, killing more people than breast cancer and AIDS combined.

7. Millions of Americans are pre-diabetic.

According to the CDC, 84 million adults living in the U.S. are pre-diabetic: Their blood sugar is higher than what’s considered safe, but hasn't yet reached diabetic level. In pre-diabetic patients, blood glucose levels after eight hours of fasting fall between 100 and 125 milligrams per deciliter, and diabetic levels are anything above that. People with pre-diabetes are not just at a greater risk for type 2 diabetes, but also for heart disease and stroke. Fortunately, people who are diagnosed with pre-diabetes can take steps to eat a healthier diet, increase physical activity, and test their blood glucose level several times a day to control the condition. In some cases, doctors will prescribe drugs like metformin that make the body more receptive to the insulin it produces.

8. After climbing for decades, rates of diabetes incidence are declining.

In the U.S., the rate of new diagnoses skyrocketed 382 percent between 1988 and 2014. Globally, 108 million people had diabetes in 1980, but by 2014 that number was 422 million.

But thanks to nationwide education and prevention efforts, the trend has reversed in the U.S., according to the CDC. Since peaking in 2009, the number of new diabetes cases in America has dropped by 35 percent. In that same timeframe, the number of people living with diagnosed diabetes in the U.S. has plateaued, suggesting people with the condition are living longer.

9. The first successful treatment for type 1 diabetes occurred in 1922.

Prior to the 20th century, type 1 diabetes was usually fatal. Diabetic ketoacidosis—a toxic buildup of chemicals called ketones, which arise when the body can no longer use glucose and instead breaks down other tissues for energy—killed most patients within a year or two of diagnosis. In searching for way to save children with juvenile (type 1) diabetes, Canadian physician Frederick Banting and medical student Charles Best built on the work of earlier researchers, who had demonstrated that removing the pancreas from a dog immediately caused diabetes symptoms in the animal. Banting and Best extracted insulin from dog pancreases in University of Toronto professor J.J.R. Macleod's lab. After injecting the insulin back into dogs whose pancreases had been removed, they realized the hormone regulated blood sugar levels. On January 11, 1922, they administered insulin to a human patient, and further refined the extract to reduce side effects. In 1923, Banting and Macleod received the Nobel Prize in Medicine for their work.

10. A pioneering physicist discovered the difference between type and and type 1 diabetes.

In the 1950s, physicist Rosalyn Yalow and her research partner Solomon Berson developed a method for measuring minute amounts of substances in blood. Inspired by Yalow's husband's struggle with diabetes, Yalow focused her research on insulin. Their "radioimmunoassay" technology revealed that some diabetes patients were still able to produce their own insulin, leading them to create two separate categories for the disease: “insulin-dependent” (type 1) and “non-insulin-dependent” (type 2). Prior to that discovery in 1959, there was no distinction between the two types. In 1977, Yalow won the 1977 Nobel Prize in Medicine for the radioimmunoassay, one of only 12 female Nobel laureates in medicine.

11. Making one insulin dose once required tons of pig parts.

Insulin is relatively easy to make today. Most of what's used in injections comes from a special non-disease-producing laboratory strain of E. coli bacteria that's been genetically modified to produce insulin, but that wasn't always the case. Until about 40 years ago, 2 tons of pig pancreases were required to produce just 8 ounces of pure insulin. The pig parts were typically recycled from pork farms.

12. A quarter of diabetes patients don’t know they have it.

The symptoms of type 2 diabetes can develop for years before patients think to ask their doctor about them. These include frequent urination, unexplained thirst, numbness in the extremities, dry skin, blurry vision, fatigue, and sores that are slow to heal—signs that may not be a cause for concern on their own, but together can indicate a more serious problem. Patients with type 1 diabetes may also experience nausea, vomiting, and stomach pain.

While serious, the symptoms of diabetes are sometimes easy to overlook. That’s why 25 percent of people with the illness, 7.2 million in the U.S., are undiagnosed. And that number doesn’t even cover the majority of people with pre-diabetes who aren’t aware they’re on their way to becoming diabetic.

What You Should Know About Necrotizing Fasciitis, the 'Flesh-Eating' Infection

DragonImages/iStock via Getty Images
DragonImages/iStock via Getty Images

You’ve likely stumbled across one of several recent news stories describing cases of necrotizing fasciitis, or “flesh-eating bacteria.” The condition can follow exposure to certain bacteria in public beaches, pools, or rivers. This July, a man in Okaloosa County, Florida with a compromised immune system died after going into local waters. Just two weeks before, a 12-year-old girl was diagnosed with necrotizing fasciitis after scraping her foot in Pompano Beach, Florida. The stories and their disturbing imagery spread on social media, inviting questions over the condition and how it can be avoided.

According to the Centers for Disease Control and Prevention, necrotizing fasciitis can be caused by different strains of bacteria, with group A Streptococcus (strep) being the most common. When group A strep enters the body through a break in the skin like a cut or burn, a serious and rapidly spreading infection can develop. People will have a high fever, severe pain at the site of exposure, and eventual tissue destruction, which gives the condition its name. Necrotizing is to cause the death of tissue, while fasciitis is inflammation of the fascia, or tissue under the skin.

Because necrotizing fasciitis spreads so quickly, it’s crucial for people to seek medical attention immediately if they see early symptoms: rapid swelling and redness that spreads from a cut or burn, fever, and severe pain. Doctors can diagnose the infection using tissue biopsies, blood work, or imaging of the infected site, though they’ll almost always initiate treatment immediately. IV antibiotics, surgery to excise dead tissue, and blood transfusions are all used in an attempt to resolve the infection.

Even with care, necrotizing fasciitis can lead to complications like organ failure or sepsis. An estimated one in three people who are diagnosed with the condition die.

Fortunately, the condition is extremely rare in the United States, with an estimated 700 to 1200 cases confirmed each year. The CDC acknowledges, however, that the number is likely an low estimate.

Because group A strep can be found in water, the CDC advises people to avoid going into public waters with any kind of open wound. This applies to both public beaches and rivers as well as swimming pools or hot tubs. Chlorination is no guarantee against group A strep. Any cut or other wound should always be cleaned with soap and water. It’s especially important that people with compromised immune systems from illness, diabetes, cancer, or another conditions be exceedingly careful.

Rising ocean temperatures may make necrotizing fasciitis more common, unfortunately. A recent study in the Annals of Internal Medicine suggested that warmer water temperatures in Delaware Bay has allowed another kind of bacteria, Vibrio vulnificus, to flourish, resulting in five cases of necrotizing fasciitis in 2017 and 2018. Previously, only one case had been confirmed since 2008. Florida is also known to harbor group A strep in seawater.

But, owing to its rarity, necrotizing fasciitis should not overly concern people with healthy immune systems and unbroken skin. If you suffer a cut with a reddened area accompanied by severe pain and fever, however, seek medical evaluation right away.

Pioneering Heart Surgeon René Favaloro Is Being Honored With a Google Doodle

Dr. René Favaloro (left) pictured with colleague Dr. Mason Sones.
Dr. René Favaloro (left) pictured with colleague Dr. Mason Sones.
The Cleveland Clinic Center for Medical Art & Photography, Wikimedia Commons // CC BY 4.0

Argentinian heart surgeon René Favaloro is the subject of today’s Google Doodle, which features a sketched portrait of the doctor along with an anatomical heart and several medical tools, The Independent reports.

The renowned doctor was born on this day in 1923 in La Plata, the capital of Argentina’s Buenos Aires province, and pursued a degree in medicine at La Plata University. After 12 years as a doctor in La Pampa, where he established the area’s first mobile blood bank, trained nurses, and built his own operating room, Favaloro relocated to the U.S. to specialize in thoracic surgery at the Cleveland Clinic.

In 1967, Favaloro performed coronary bypass surgery on a 51-year-old woman whose right coronary artery was blocked, restricting blood flow to her heart. Coronary bypass surgery involves taking a healthy vein from elsewhere in the body (in this case, Favaloro borrowed from the patient’s leg, but you can also use a vein from the arm or chest), and using it to channel the blood from the artery to the heart, bypassing the blockage. According to the Mayo Clinic, it doesn’t cure whatever heart disease that caused the blocked artery, but it can relieve symptoms like chest pain and shortness of breath, and it gives patients time to make other lifestyle changes to further manage their disease.

Favaloro wasn’t keen on being called the “father” of coronary bypass surgery, but his work brought the procedure to the forefront of the clinical field. He moved back to Argentina in 1971 and launched the Favaloro Foundation to train surgeons and treat a variety of patients from diverse economic backgrounds.

Favaloro died by suicide on July 29, 2000, at the age of 77, by a gunshot wound to the chest. His wife had died several years prior, and his foundation had fallen deeply into debt, which Argentinian hospitals and medical centers declined to help pay, The New York Times reported at the time.

“As a surgeon, Dr. Favaloro will be remembered for his ingenuity and imagination,” his colleague Dr. Denton A. Cooley wrote in a tribute shortly after Favaloro’s death. “But as a man ... he will be remembered for his compassion and selflessness.” Today would have been his 96th birthday.

[h/t The Independent]

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