Disease Prevention in Women (cont.)

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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 include:

  • 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; and
  • two 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; and
  • 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.

Medically Reviewed by a Doctor on 4/28/2014

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