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Wall Street Journal Article - Millions don't know they are diabetic

Posted on May 20 2009
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Experts know these people exist -- even if they don't know themselves -- by extrapolating from big government health surveys that include blood tests. A surprising number of adults have elevated blood-sugar levels that meet the criteria for diabetes but have never had symptoms or ignored them. The numbers would no doubt be higher if they included children, since Type 2 diabetes is being found at ages as young as 4.

The danger of undiagnosed diabetes is that, left untreated, it raises the risk of heart disease and stroke and can escalate into blindness, kidney failure, loss of limbs and death.

Yet fear of such complications is a key reason it often goes undiagnosed. "Many people know of elderly relatives who died or had these complications, and they don't get it checked out because they're terrified," says Robin Goland, co-director of the Naomi Berrie Diabetes Center at Columbia University Medical Center in New York. "But it doesn't have to be that way. We know how to manage it."

Some people fail to get tested because Type 2 diabetes is often associated with being overweight and sedentary. "People think it's their fault, but that's not true," Dr. Goland says. Roughly 20% of the people with Type 2 diabetes are thin, and 75% of obese people never get it.

The biggest risk factor is a family history. The more relatives you have with the disease, the higher your own risk is. Being overweight seems to activate the genetic predisposition in many cases, but not always. "People with a lot of genetic loading can get it at a younger age and a lower body weight," Dr. Goland says.

Diabetes is technically an imbalance between sugar, or glucose, and insulin. When the body ingests glucose, the pancreas secretes insulin to convert it into energy. With diabetes, the body doesn't get enough insulin, either because the pancreas can't make it (Type 1) or because the body becomes resistant to the insulin (Type 2). With Type 2, the pancreas churns out ever more insulin, but it has little effect, leaving too much glucose in the blood stream. Eventually, the insulin-making beta cells in the pancreas may give out.

The first symptoms -- including fatigue, excessive thirst and frequent urination -- often don't appear until the excess sugar has been damaging blood vessels for 10 years or more.

"I felt absolutely fine," says Charles Gallagher, an attorney in Jersey City, N.J., and his doctor agreed. But his father and 10 of his 11 aunts and uncles had "sugar," as it was often called in years past, and his daughter, an endocrinologist, persuaded him to check further. He was diagnosed with diabetes at the Naomi Berrie center in November at age 63. He has since lost 15 pounds and lowered his blood sugar considerably.

Standard physical exams often include a blood-glucose test, but experts say doctors at times don't take the results seriously enough. "They'll tell patients, 'Oh, your blood sugar is a little high. We'll check it again next year,' " says R. Paul Robertson, president for medicine and science of the American Diabetes Association. "That's the wrong thing to say. You want to make the diagnosis as soon as possible."

A fasting-glucose level below 100 milligrams per deciliter is normal. From 100 to 125 mg/dl is considered "prediabetes," and above 125 is diabetes. Some experts think "prediabetes" should be dubbed full diabetes so that patients pay attention sooner. Some also recommend that a different test, the hemoglobin A1C, be used for screening, since the results are more clear-cut.

Treating elevated blood sugar isn't as draconian as some people fear. In one study, 58% of subjects with prediabetes were able to prevent Type 2 diabetes by cutting down on carbohydrates, which reduces the glucose the body has to handle, and adding exercise, which helps insulin work more efficiently. For those who need more help, many medications are available.

"Losing just a little weight, and exercising just a little more can make a huge difference," Dr. Goland says. "People can still eat in restaurants and eat foods they love, in moderation, with diabetes. They just can't ignore it."

Last changed: May 20 2009 at 8:46 AM