Disease Prevention in Women (cont.)
Type II diabetes mellitus
Diabetes mellitus is a condition characterized by
elevated blood sugar levels ("hyperglycemia") due to impaired utilization of
insulin, decreased production
of insulin, or both.
Diabetes is the seventh leading cause of death in the United States. An
estimated 18% of all Americans over 65 have diabetes. Over ten million Americans
have been diagnosed with diabetes; and at least half as many more are thought to
have undiagnosed diabetes. Many more people have a condition that precedes
diabetes, referred to as prediabetes, characterized by sluggish metabolism of
sugar (glucose) to a lesser degree than is present in those with diabetes.
Diabetes is the leading cause of new cases of blindness in adults
aged 20-74 years, the leading cause of
chronic kidney failure, and the leading
cause of lower extremity amputations not related to injury. Individuals with diabetes are
2-4 times as likely to have a heart attack or stroke as are those without
diabetes.
Screening tests
Tests for diabetes mellitus:
- Fasting blood sugar (blood sugar test after at least
eight hours without
calories), normal level less than 100 mg/dl
- Pre-diabetes is characterized by a fasting blood sugar level of 100-125
mg/dl.
- Diabetes is characterized by a fasting glucose level greater than 126
mg/dl.
- 2 hour postprandial blood sugar (blood sugar test
two hours after a meal),
normal level less than 140mg/dl
Who to test and how often
Healthy subjects over 45 years of age should have fasting blood glucose level
checked every three years; however, adults at a higher than normal risk of
developing diabetes mellitus should be checked more frequently than every three
years.
Risk factors of diabetes include:
- excessive weight
- first-degree blood relative with adult onset diabetes
- certain ethnic groups such as African-Americans, Hispanics, certain Native
American groups, and some Asians
- delivery of a baby weighing more than 9 lbs or a
history of diabetes during pregnancy ("gestational diabetes")
- impaired glucose tolerance, currently or previously
- low HDL cholesterol (35 mg/dl or less) or elevated triglyceride level
(over 250 mg/dl)
Benefits of early detection
Diabetes mellitus commonly causes organ damage without symptoms until
extensive damage is present.
There is good evidence that curtailing total calorie intake (especially
intake of processed starches, sugar and sweets), regular exercise, and losing
excess weight can help prevent the development of diabetes mellitus. Control of
excessive weight usually leads to improved metabolism of sugar, often to normal
in those with impaired glucose tolerance.
There is good evidence that in patients with diabetes, controlling
hyperglycemia with
medications, diet, weight control, and regular exercise can slow the development
of all the complications of diabetes.
There is good evidence that even those with impaired
glucose tolerance can significantly improve their otherwise increased risk for
atherosclerotic disease
(including heart attacks and stroke) with appropriate changes in diet, physical activity,
and weight.
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