American Diabetes Awareness Month 2021
What is Diabetes Awareness Month?
American Diabetes Awareness Month (or simply Diabetes Month) is an annual campaign throughout the month of November in the USA to bring awareness to the growing prevalence of diabetes, the health risks associated with it, raise funds for research into the condition, and support people living with it.
The country’s leading diabetes organisation, the American Diabetes Association (ADA), encourages people to ‘take the risk test’, especially those at risk such as overweight people and certain ethnicities (see Facts and Figures below). In addition, it encourages people to learn the facts, become an advocate and donate. The ADA trademarked “American Diabetes Month” in 1997.
As a Type 1 diabetic myself I take a particular interest in this campaign.
Diabetes Facts, Figures and Statistics
Diabetes is one of the fastest growing, preventable medical conditions in the world.
According to the International Diabetes Federation (IDF), at 31 million the US has one of the highest prevalence of diabetes in the world (see table below).
Recent research by the Diabetes Research Institute published in 2020 also points to some alarming statistics. Among the US population overall the prevalence of diagnosed and undiagnosed people with the condition for 2018 were (crude estimates):
- 34.2 million people of all ages—or 10.5% of the US population—had diabetes
- 34.1 million adults aged 18 years or older—or 13.0% of all US adults—had diabetes
- 7.3 million adults aged 18 years or older who met laboratory criteria for diabetes were not aware of or did not report having diabetes (undiagnosed diabetes). This number represents 2.8% of all US adults and 21.4% of all US adults with diabetes
- The percentage of adults with diabetes increased with age, reaching 26.8% among those aged 65 years or older
Diabetes also affects different ethnic groups differently. The prevalence of diagnosed diabetes was highest among American Indians/Alaska Natives (14.7%), people of Hispanic origin (12.5%), and non-Hispanic blacks (11.7%), followed by non-Hispanic Asians (9.2%) and non-Hispanic whites (7.5%).
The condition also causes many deaths:
- In 2017, diabetes was the seventh leading cause of death in the United States. This finding is based on 83,564 death certificates in which diabetes was listed as the underlying cause of death (crude rate, 25.7 per 100,000 persons)
- In 2017, there were 270,702 death certificates with diabetes listed as the underlying or contributing cause of death (crude rate, 83.1 per 100,000 persons)
And the costs are astronomical!
- The total direct and indirect estimated costs of diagnosed diabetes in the United States in 2017 was $327 billion
- Total direct estimated costs of diagnosed diabetes increased from $188 billion in 2012 to $237 billion in 2017 (2017 dollars); total indirect costs increased from $73 billion to $90 billion in the same period (2017 dollars)
- Between 2012 and 2017, excess medical costs per person associated with diabetes increased from $8,417 to $9,601 (2017 dollars)
For the individual, the American Diabetes Association states that people with diagnosed diabetes incur average medical expenditures of $16,752 per year, of which about $9,601 is attributed to diabetes. On average, people with diagnosed diabetes have medical expenditures approximately 2.3 times higher than what expenditures would be in the absence of diabetes.
While diabetes used to be associated with the ever-growing waistline of Western and developed nation countries major health associations including the World Health Organisation now see it as a global problem, especially one affecting middle to lower income countries.
To quote the International Diabetes Federation:
- Approximately 463 million adults (20-79 years) were living with diabetes; by 2045 this will rise to 700 million
- The proportion of people with Type 2 diabetes is increasing in most countries
- 79% of adults with diabetes were living in low- and middle-income countries
- 1 in 5 of the people who are above 65 years old have diabetes
- 1 in 2 (232 million) people with diabetes were undiagnosed
- Diabetes caused 4.2 million deaths
- Diabetes caused at least USD 760 billion dollars in health expenditure in 2019 – 10% of total spending on adults
- More than 1.1 million children and adolescents are living with Type 1 diabetes
- More than 20 million live births (1 in 6 live births) are affected by diabetes during pregnancy
- 374 million people are at increased risk of developing Type 2 diabetes
The Federation also lists and projects the top 10 countries (in millions) with the highest number of people with diabetes:
Most countries with the highest percentage figures are island nations. In 2019 these were:
What is Diabetes?
Diabetes is a condition where the body can’t naturally control the amount of glucose (sugar) in the blood. Blood sugar levels rise and in turn cause medical complications.
Glucose is the main source of energy we need to function (run, walk and go about our daily lives). It is produced by the food we eat mostly through carbohydrates like bread, pasta, rice, potato, sweets and chocolate.
However, to be used as energy glucose needs to pass through the digestive system and enter the body’s muscles and cells via the bloodstream. This transition of insulin from the blood to the cells is enabled by a hormone called insulin which is produced by the pancreas.
If the pancreas doesn’t produce enough insulin or we become resistant to it, glucose will remain in the blood and cause blood sugar levels to rise.
The body’s inefficient use of insulin, a resistance to it or when the pancreas has packed up altogether is the cause of diabetes and it can cause serious health problems as we discuss below.
What are the Symptoms of Diabetes?
Symptoms of diabetes are typically:
- Weight loss
- Urinating often
- Itchy private parts
- Cuts and wounds taking a long time to heal
- Blurred vision
I recall I had many of these symptoms when I was diagnosed. I was working in Southeast Asia at the time but given the hotter climate thought little of feeling thirsty despite drinking water like it was going out of fashion. I was terribly tired for two or three weeks and would just want to go to sleep in the afternoon.
I went to the doctor and to my surprise had lost heaps of weight too: down from my usual fighting weight of around 170lbs to a mere 150lbs.
Note: having these symptoms does not mean you are necessarily diabetic. If you’re concerned, you should see a doctor.
How to Test for Diabetes?
Testing for diabetes is straightforward and typically involves a blood or urine test. What they test for is different in each case:
- C-peptide: finds out how much insulin your body is producing
- Fasting Plasma Glucose Test: this is the finger pricking test you see diabetics do on a daily basis. Also called a ‘fasting blood sugar test’ it requires the patient not to eat for 8-10 hours prior
- GAD Antibodies Test: to discover whether someone has either Type 1 diabetes or Latent Autoimmune Diabetes of Adulthood (LADA)
- Oral Glucose Tolerance Test: can help diagnose instances of diabetes mellitus or insulin resistance
To complicate things slightly more you’ll see two measurements used with blood glucose test results:
- MMOL/L or millimoles per litre: international standard and used in the UK
- MG/DL or milligrams per decilitre: used in USA, Germany and elsewhere
The American Diabetes Association recommends target blood glucose levels as follows:
|Normal for person without diabetes||70–99 mg/dl (3.9–5.5 mmol/L)|
|Official ADA recommendation for someone with diabetes||80–130 mg/dl (4.4–7.2 mmol/L)|
|1 to 2 hours after meals|
|Normal for person without diabetes||Less than 140 mg/dl (7.8 mmol/L)|
|Official ADA recommendation for someone with diabetes||Less than 180 mg/dl (10.0 mmol/L)|
|Normal for person without diabetes||Less than 5.7%|
|Official ADA recommendation for someone with diabetes||Less than 7.0%|
Types of Diabetes
There are in fact several types of diabetes. However, there are two main types which cover 98% of people with the condition. How diabetics manage their diabetes depends on which type they have.
Type 1 Diabetes
Type 1 diabetes is what’s known as an auto-immune disease: the body attacks and destroys the cells in your body that make insulin. In effect, your pancreas has packed up.
Type 1 diabetes is also typically inherited from parents (my father is Type 1 as well) though there are instances, albeit less common, where there is no family history of it.
As the pancreas has stopped working Type 1 diabetics need to inject insulin several times a day to literally stay alive. Not injecting insulin would mean constantly high blood sugar levels which would have disastrous effects on health (see below).
How often you inject and what type of insulin you inject will depend on the way the insulin is administered.
There are two types of insulin:
- Basal: also known as background insulin, basal insulin is long acting and works for approximately 12-24 hours to counteract the natural production of sugar your body makes. One or two injections are required every day
- Bolus: an injection taken with every meal to counteract the carbohydrates eaten. Three or more injections are required per day
There are two methods of administration. Type 1 diabetics use one or the other, not both:
- Insulin pen: a pre-filled insulin cartridge in a pen-like dispenser (see image below). Note the pens are different: the orange is the bolus, the green is the basal
- Insulin pump: a little machine the size of a computer mouse attached to the body via an adhesive patch. The pump dispenses the same insulin the whole time: at a specified rate per hour for the basal throughout the day, and with each meal for the bolus (you need to press a few buttons yourself to do this). It consists of the pump, a reservoir of insulin and an infusion set. When the reservoir runs out or the adhesive patch loses its stickiness you prepare a new one and reattach it to the body
How much insulin you inject depends on the type and quantity of food we eat, your resistance to insulin, and the amount of exercise you do: more carbs = more insulin, less carbs = less insulin, but one’s resistance to insulin varies from person to person.
I, personally, use a pump which is a fantastic piece of kit.
Type 1 diabetics are also often prescribed statins.
Managing Type 1 diabetes can be complicated and it takes time getting to grips with. There is nothing you can’t eat but you should eat and drink in moderation and of course do regular exercise.
‘Going low’, when the blood sugar level drops below 4 mmol/l (72 mg/dl) and you start to feel light-headed, is a common occurrence for Type 1 diabetics (see hypoglycaemia below) as is being ‘too high’ (see hyperglycaemia). Keeping within the ranges in the table above are important.
Exercise rapidly brings down the sugar level and is a common cause of people going low as well, especially unplanned exercise.
Once you’ve got to grips with it though, I know from personal experience and the health experts will confirm this, if you manage the condition properly there is little you can’t do.
For example, I’ve completed an Ironman triathlon, ridden 100-mile bike rides, completed half-ironman and Olympic distance triathlons, and done a 5km Swimathon (raising perhaps £3,000 for Diabetes UK in the process). You’re most welcome to follow me on Twitter as Type1Rob or visit my website Diabetes and Exercise (a shameless plug I admit but I’m not terribly active on there).
Another Type 1 chap I know, virtually at least, is Roddy Riddle. He’s completed various Ironman triathlons, the Marathon des Sables, and walked across the North Pole to name a few of his achievements.
My point is to illustrate that having Type 1 diabetes shouldn’t hold you back from doing what you enjoy. You’ll find many famous people with diabetes. Just take precautions, prepare properly and you’ll be fine (I have blood glucose testing meters at home, the office, in the car and my sports bag along with a supply of dextrose tablets).
Type 2 Diabetes
Type 2 diabetes is by far the most common type and affects 90% of all diabetics. It is typically caused by a poor diet, lack of exercise or advancing age though some ethnic groups are particularly susceptible. The pancreas still works with Type 2s but the body has become resistant to the insulin it produces.
You’re more likely to have Type 2 if you:
- Are overweight or obese
- Have an immediate family member with type 2 diabetes
- Are over age 45
- Are physically inactive
- Have ever had gestational diabetes, which is diabetes during pregnancy
- Have given birth to a baby weighing more than 9 pounds
- Are African American, Alaska Native, American Indian, Asian American, Hispanic/Latino, Native Hawaiian or Pacific Islander
- Have polycystic ovarian syndrome
- Have a lot of belly fat
Symptoms are very similar to those of Type 1.
While many Type 2 diabetics will be prescribed metformin a few also need insulin but an improvement in lifestyle and diet are the best medicines. Some people may also go into remission. Diabetes UK say this is most likely to happen nearer the time of diagnosis and is strongly linked to weight loss but there is still no cure for the disease as the condition can always return.
Medical Problems Associated with Diabetes
Diabetes affects people physically but also mentally given the lifestyle changes they often have to make.
According to Diabetes.co.uk, diabetes is currently the fifth most common reason for death in the world:
- Around 1 in 8 people between 20 and 79 years old have their death attributed to diabetes and it is expected to rise
- The life expectancy on average now is reduced by:
- More than 20 years for people with Type 1 diabetes
- Up to 10 years for people with Type 2 diabetes
To quote the Diabetes Research Institute again. In 2016, a total of 16 million emergency department visits were reported with diabetes as any listed diagnosis among adults aged 18 years or older, including:
- 224,000 for hyperglycaemic crisis (9.7 per 1,000 adults with diabetes)
- 235,000 for hypoglycaemia (10.2 per 1,000 adults with diabetes)
Hypoglycaemia is especially common in people with Type 1. Also known as a ‘hypo’ or ‘going low’ it is caused when the blood sugar level drops below 4 mmol/l (72 mg/dl). Symptoms include having zero energy, feeling anxious, light-headed, hungry, irritated (more than usual!), and getting sweaty or clammy hands.
In the most part you can deal with these symptoms yourself by consuming fast-acting sugar like fruit juice, dextrose tablets or a sugary snack but it’ll take 10-15 minutes to work so sit down and just relax! As soon as you feel better take a more long-lasting carbohydrate like a piece of toast or a meal.
In the worst cases you could appear as though you are drunk, you could collapse or become unconscious in which case you need immediate medical attention either with a shot of glucagon or by calling the emergency services.
Hypos tend to happen after missing a meal, giving yourself too much insulin, unplanned exercise or boozing on an empty stomach.
Type 1 diabetics only have three year driving licenses as well after which it needs renewing and a medical questionnaire completing telling the authorities of any hospitalisation or regular hypos. Clearly, we don’t want people going low at the wheel.
Type 1 diabetics also need an annual eye test to identify diabetic background retinopathy, and a foot test to test for blood circulation problems and sensitivity.
Hyperglycaemia is when sugar levels rise too high. What is too high? Well, it varies from person to person but we take 7 mmol/l (126 mg/ml) as a guide before a meal and above 8.5 mmol/l (153 mg/dl) two hours after we’re fairly close.
Symptoms include thirst, frequent urinating, tiredness, stomach pain, feeling sick or breath that smells like pear drops.
It is generally caused by missing an insulin dose, not taking enough insulin, overeating, being stressed, having a fever or cold, or lack of exercise.
Being ‘high’ once in a while won’t cause interminable damage but if it occurs regularly or your blood sugar is over 20-30mmol/l then there is cause for immediate concern in the form of Diabetic Keto Acidosis (DKA) or more long-term effects such as damage to the eyes, nerves, kidneys, heart and blood vessels and more.
If you’re Type 1, immediate treatment for a simple high blood sugar level can be given with a dose of insulin. If you’re feeling really unwell or if it happens regularly you’ll need to change your insulin regime, diet, exercise routine and speak to a doctor.
Diabetic Keto Acidosis (DKA)
Diabetic Keto Acidosis or DKA is a serious complication that affects Type 1s and some Type 2s, and can result in coma or even death if not treated quickly.
It is caused by a build up of ketones in the blood that quickly become acidic.
Other Medical Problems
We’ve already noted the number of deaths attributed to diabetes but what are the medical conditions commonly associated with it?
Diabetics are likely to be diagnosed with more medical problems than the average man or woman but many are preventable. These include stroke, heart disease, kidney disease, nerve damage, eye problems, dental disease, and foot problems.
Rather than list details of each the Diabetes Research Association tells us some headline figures.
In 2016, a total of 7.8 million hospital discharges were reported with diabetes as any listed diagnosis among US adults aged 18 years or older (339.0 per 1,000 adults with diabetes). These discharges included:
- 1.7 million for major cardiovascular diseases (75.3 per 1,000 adults with diabetes), including:
- 438,000 for ischemic heart disease (18.9 per 1,000 adults with diabetes)
- 313,000 for stroke (13.6 per 1,000 adults with diabetes)
- 130,000 for a lower-extremity amputation (5.6 per 1,000 adults with diabetes)
- 209,000 for hyperglycaemic crisis (9.1 per 1,000 adults with diabetes)
- 57,000 for hypoglycaemia (2.5 per 1,000 adults with diabetes)
Among US adults aged 18 years or older with diagnosed diabetes, crude estimates for 2013–2016 were:
- 37.0% had chronic kidney disease (stages 1–4), of which over half (52.5%) had moderate to severe chronic kidney disease (stage 3 or 4)
- 24.9% with moderate to severe chronic kidney disease (stage 3 or 4) were aware of their kidney disease
Diabetes is also the leading cause of new cases of blindness among adults aged 18–64 years. Among US adults aged 18 years or older with diagnosed diabetes, crude data for 2018 indicated 11.7% reported vision disability, including blindness.