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"You have Type 2 diabetes", the doctor says. And with those simple words, in a haze of shock and disbelief, your world turns upside down. Everything you have ever heard about diabetes, whether on T.V., the radio, or from relatives and friends flits briefly through your mind. And as often as not, you sit and cry, or feel numb and bewildered. And wonder how to cope with this disease, or if you can.
Living with diabetes means living with a chronic condition, one that doesn't go away, and acceptance can take years to acheive. In fact, studies have shown that the initial grieving process after diagnosis takes a full YEAR at least. And for some, the process will be ongoing, as they swing between acceptance and denial.
What is Type 2 diabetes? It is the most common form of diabetes, present in 90 - 95 % of patients diagnosed with diabetes. It is more common in adults over age 40, although the incidence in children and teens is increasing in recent years. Basically, a Type 2 diabetic makes some insulin, a hormone manufactured by the beta cells in the pancreas. The job of insulin is to transport glucose into cells. But in Type 2 diabetes, it is believed that *insulin resistance* makes this transport difficult, and glucose (blood sugar) levels stay high. Also, the older an individual is, the less insulin they make. A forty year old makes less insulin than a twenty year old, and a sixty year old even less. Insulin resistance, and possibly less insulin production, contribute to what is known as Type 2 diabetes.
There are risk factors for Type 2 diabetes. Family heredity is one, and studies have shown that certain ethnic groups are at risk for this form of diabetes: hispanics, African americans, native americans, and Asian and Pacific islanders. Having a family member with Type 2 diabetes increases the risk that you will also have it, and regular screening is recommended, especially if other risk factors are present.
Being overweight is another risk factor. Being overweight increases the insulin resistance in Type 2 diabetes, and often moderate weight loss can help the person use their own insulin more efficiently. In fact, diet therapy, using a diet prescribed by a registered dietitian, is a cornerstone of the treatment for Type 2 diabetes. But changing life-long dietary habits can be extremely difficult, and takes time. It can be one of the greatest challenges facing the person with Type 2 diabetes, since our eating patterns are often based on heritage, family traditions, and lifestyle.
A sedentary, inactive lifestyle, which is rampant in our society, is another risk factor for Type 2 diabetes. Along with healthy eating, increasing activity levels as recommended by a person's medical doctor is another cornerstone of treatment. Any physical activity that is enjoyable is encouraged for most people: swimming, walking, dancing, vigorous gardening, sports, golf. If a person is over 40, it is important to have a thorough check-up and discuss exercise with their doctor first before beginning a new exercise routine.
A woman who has had gestational diabetes (diabetes first diagnosed while pregnant) is also at risk for type 2 diabetes. Again, on-going screening is important at regular intervals.
A low HDL (high density lipoprotein level) and elevated triglyceride levels are also considered a risk factor with Type 2 diabetes.
Part of learning to live with Type 2 diabetes will involve overcoming the DENIAL that frequently follows the diagnosis. This is a normal part of the grieving process, and most people have to deal with this reaction in some form. Statements such as "Maybe it was the soda I had the night before the test," or "I feel fine, so maybe I don't really have it, or just a mild case," are commonly heard by health professionals. Other clients choose to take their medication, but not to follow diet or exercise recommendations, which is a form of denial of the seriousness of the disease.
Unfortunately, Type 2 diabetes may be symptomless for some individuals, even though blood sugar levels are high and causing damage to their body. This is why Type 2 diabetes at times has been referred to as the "silent disease". Others will experience the typical symptoms of elevated blood sugars: increased thirst, increased urination, blurred vision, fatigue, irritability, cuts/bruises that don't heal, or heal slowly, frequent infections, yet choose to ignore them. Denial can be strong.
Of course, learning about Type 2 diabetes, the treatments available for it, including some of the new medications that are on the market, and working with your doctor and diabetic educator as part of the "treatment team" to manage your diabetes are the best ways to deal with it. Type 2 diabetes won't go away, but it can be treated and well controlled, ensuring a longer, healthier life for the individual with it. The rewards are well worth it.
References:
1. American Diabetes Association: "Diabetes Facts and Figures" from
website at www.diabetes.org on 8/24/00
2. "American Diabetes Association Complete Guide to Diabetes", Cryer and
Childs, 1996
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