“The epidemic of obesity in the United States is fueling this trend. It’s estimated about 10% of obese children have signs that meet the diagnostic criteria for prediabetes.”

Denise Warren, RN, BSN  & Shelda L. Hudson, RN, BSN, PHN                                      (Both authors for National Center for Continuing Education, Inc)

Go to striveforgoodhealth.com and read on Part One Types of diabetes and what risk factors prone you to getting this disease.

The economic impact of diabetes remains a tremendous burden in the United States. The total economic encumbrance is more than $174 billion annually. The majority of the expenses, $116 billion, were for direct medical costs such as hospital care, emergency room visits, physician office visits and home health visits. The other $58 billion was attributed toward indirect costs such as disability, loss of workplace productivity and premature mortality. According to recent data published by the National Institute of Diabetes and Digestive and Kidney Diseases, most of the expenses associated with diabetes are for long-term complications, such as heart failure, renal failure, hypertension, amputation and blindness. In fact, medical expenses for people with diabetes are twice as high than for people without diabetes. Why not prevent getting it before you here by your doctor your with the diagnosis diabetes. Then you won’t be paying medical expenses twice as high like those who do with diabetes plus you’ll be helping the American economy with decreasing billions put out to expenses of diabetes.

Race and ethnicity also play a role as potential risk factors for diabetes. The most recent National Institutes of Health (NIH) surveys revealed Hispanic Americans and African Americans have a greater prevalence of diabetes than Caucasians (11.8% and 12.6% versus 7.1%). Asian Americans with diabetes make up about 8.4% of all diagnosed cases. Diabetes prevalence in American Indians and Alaska Native in the United States is over twice as high compared to Caucasians (16.1%).

Types of diabetes:

Type 1 diabetes

Historically, type 1 diabetes (T1DM) was labeled as insulin dependent diabetes or juvenile diabetes. The WHO and the American Diabetes Association changed the nomenclature due to the evolution of treatment options. The classification is now based on pathogenesis instead of the requirement of insulin therapy. Over 95% of people with T1DM develop the disease before the age of 25.

Type 1 Diabetes is considered an autoimmune disorder and occurs when the pancreas fails to produce insulin. During T1DM, the pancreatic beta cells are damaged or destroyed, which causes insulin to decline. This lack of insulin causes blood glucose levels to rise. During this state, known as hyperglycemia, glucose levels are elevated in the blood and the unutilized sugar is excreted in the urine. This accumulation of glucose in the bloodstream prevents it from going into the cells. This results in the body’s inability to convert the glucose into energy and eventually leads to the symptoms of T1DM.

Risk Factors for Type 1 Diabetes

The risk for developing T1DM can be calculated by measuring molecules, known as biomarkers, which reveal potential autoimmune reactions in the pancreas. Although the exact cause of the autoimmune response in T1DM is unknown, evidence suggests several risk factors, which may enhance the susceptibility for the disease.

Genetic Factors

Researchers have located certain genetic chromosomes and genes, which are related to T1DM. The majority of these genes are referred to as human leukocyte antigen (HLA) genes, they also are responsible for approximately half the genetic risk for T1DM.

Environmental Factors

Research published by the National Center for Biotechnology Information, U.S. National Library of Medicine revealed that the environment plays a role on the development and progression of T1DM.

Certain viruses have been linked to the onset of T1DM. Mumps, rubella and herpes viruses appear to increase the chance of autoimmunity, which precipitates T1DM in people with predisposed autoimmunity. How to prevent this is through rubella and mumps vaccines. There is a relationship between human enterovirus (HEV) infections and the induction of beta cell autoimmunity, which is strongly linked to T1DM. HEVs are small virus particles with more than 100 known different strains

One interesting study by Roivainen and Klingel investigated the link between day care exposure and the incidence of T1DM. Although communal places such as day care facilities, preschool and playgrounds strikes fear in many “germaphobe” parents, several well-designed case control studies have indicated that early social mixing, as in the case at day care, offers protective mechanisms against childhood diabetes. Researchers in these studies believe that exposure to infections in infancy help to strengthen immunoregulatory functions that have a protective effect against diabetes in children before the age of five. Another environmental factor concerning T1DM has to do with the so-called “hygiene hypothesis,” which proposes that T1DM incidence in most industrialized societies is less due to the reduced risk of parasites.

Type 2 diabetes mellitus (T2DM) occurs most frequently in adults over 40 years of age. Prior to being changed by the WHO, T2DM was previously known as adult-onset diabetes, insulin-insensitive diabetes and non-insulin dependant diabetes. In recent years there has been a dramatic increase in the incidence of T2DM. Recent statistics published by the CDC reported that over 285 million people currently have T2DM in the United States. In fact, T2DM is the most common non-communicable disease in the world.

T2DM is characterized by elevated levels of glucose in the blood. Insulin resistance is the primary contributor toward T2DM.

Insulin resistance is the primary contributor toward T2DM. During T1DM, the islet cells in the pancreas are destroyed resulting in the depletion of insulin. Conversely, during T2DM there may be a normal amount of circulating insulin in the body, however, the body’s muscles, fat and liver become resistant or do not use insulin effectively. This condition is called insulin resistance. Insulin resistance can begin in the components of the intercellular cascade, which connects the insulin receptors in the cell membranes. Unlike in the case with T1DM, at least initially, people with T2DM typically do not need insulin to survive.

In normal glucose regulation, insulin stimulates peripheral glucose uptake through the muscles and fat. At the same time, it inhibits glucose production in the liver. During this process, the gastrointestinal (GI) tract helps to transport the glucose into the body during digestion. Conversely, in an environment of impaired glucose tolerance, GI absorption of glucose aggravates already compromised glucose regulatory systems and overpowers the body’s other organs. Because the organs are overwhelmed, they are unable to excrete the surplus glucose, which results in hyperglycemia. T2DM also frequently causes hyperinsulinemia, which is characterized by excess insulin in the bloodstream. Also, during T2DM, the liver both overproduces and underuses glucose. Hyperglycemia causes injury to the beta cells in the pancreas, which makes it even more difficult for the pancreas to regulate the elevated levels of blood glucose. Over time, this process causes harm to blood vessels, nerves, eyes, kidneys and other organs of the body.

T2DM is a heterogeneous disease and can be attributed to a variety of causes. For example, many patients with T2DM are obese, and obesity alone often causes insulin resistance. The potential for developing T2DM increases certain genetic influences and environmental factors such as obesity, dietary factors, age, sedentary lifestyle, smoking and excessive alcohol consumption.

Genetic Factors

According to the National Diabetes Clearinghouse, genetics play a significant role in people with diabetes. Having certain inheritable genes can definitely increase susceptibility to T2DM. Current research has identified over 36 genes that have been associated with the development of T2DM. These genes influence insulin production rather than insulin resistance. One gene identified through research is known as the TCF7L2 gene. People with this gene have an 80% increased risk of developing T2DM compared to those who do not carry the gene. In fact, TCF7L2 is considered the most dominate gene related to the vulnerability of T2DM. Twin studies have also shown that if one identical twin has diabetes, the likelihood of the other twin contracting the disease is approximately 90%. One landmark study of identical twins revealed a 100% concordance rate for the disease.

The pathogenesis of genetic susceptibility is typically related to genetic irregularities related to glucose metabolism. Candidate genes involved in insulin secretion of beta cells play a role in these genetic abnormalities. Researchers have also linked genetic risk to mitochondrial genes and insulin receptor genes. One recent genome-wide association study by Morgan (2012) has recognized the mutation in the KCNQ1 gene, which is related to insulin secretion. The results of this study concluded that this specific gene played a significant role as a genetic risk factor for T2DM in Asian ethnic groups, who were the participants in the investigation.

Obesity

Obesity is one of the strongest risk factors related to insulin resistance and T2DM. According to research reported in The Journal of Clinical Endocrinology & Metabolism, obesity is present in the majority of patients with T2DM. In fact, obesity accounts for almost 85% of the overall risk of developing T2DM. In fact, obesity accounts for almost 85% of the overall risk of developing T2DM. Obesity can be attributed toward eating and lifestyle habits, genetics, or a combination of all three factors. However, one thing is certain – obesity is a major dilemma in the United States and it is been cited as one of the leading major health issues over the past couple decades. According to the U.S. CDC, over one third (35.7%) of adults in America are obese.

The statistics are frightening. According to recent government reports, childhood obesity has tripled over the past 30 years, partly due to the lack of activity. Less than 25% of high school students are engaged in the proper amount of moderate-intensity physical activity.

An abundance of visceral fat is directly associated with insulin resistance. This type of fat is characterized by intra-abdominal fat or “belly fat,” rather than subcutaneous fat or gynecoid “pear shaped” fat, which usually manifests in the thighs and gluteal regions of the body. The intraperitoneal fat drains to the liver and leads to excessive free fatty acid in the bloodstream. This process is one of the causes of insulin resistance.

“Most cases of colon cancer begin as small, noncancerous (benign) clumps of cells called adenomatous polyps. Over time some of these polyps become colon cancers.”

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“The cause of bone marrow failure is associated with three types of diseases, fanconi anemia (FA), dyskeratosis congenita, and aplastic anemia.”

Bone Marrow Failure In Children.”. Drug Information Online, Drugs.com. Thomson Reuters

This form of iron deficiency anemia is treated with changes in your diet and iron supplements.

If the underlying cause of iron deficiency is loss of blood — other than from menstruation — the source of the bleeding must be located and stopped. This may involve surgery.

• Rapid growth cycles (infancy, adolescence)

• Heavy menstrual bleeding or chronic blood loss from the GI tract

• Pregnancy

• Diets that contain insufficient iron (rare in the United States)

• Breastfed infants who have not started on solid food after six months of age

• Babies who are given cow’s milk prior to age 12 months

• Alcoholism 

                                                                                                          *Most often healthy red blood cells last between 90 and 120 days. Parts of your body then remove old blood cells. A hormone called erythropoietin (epo) made in your kidneys signals your bone marrow to make more red blood cells.To first diagnose the person with any anemia the following needs to be done to help the doctor in diagnostic tooling , which is tests to rule out and rule in what the actual problem isn’t or is. With the MD knowing the results of these tests it will guide the doctor knowing the correct diagnosis to use the best treatment to either cure or get the problem under control (Ex. What is curable is iron deficiency anemia but sickle cell anemia is not).*

 *Hemoglobin is the oxygen-carrying protein inside red blood cells. It gives red blood cells their red color. People with anemia do not have enough hemoglobin.  (Although many parts of the body help make red blood cells, most of the work is done in the bone marrow). Bone marrow is the soft tissue in the center of bones that helps form all blood cells.)*

The diagnosis tests that are usually done by a doctor are the following:                              

Physical exam. During a physical exam, your doctor may listen to your heart and your breathing. Your doctor may also place his or her hands on your abdomen to feel the size of your liver and spleen. He would look at the color of the skin and the eyes to look for paleness.

Blood Tests. Your doctor would do the basis blood tests being a CBC which is used to count the number of blood cells in a sample of your blood. For anemia, your doctor will be interested in the levels of the red blood cells contained in the blood particularly your hematocrit (the solids of the blood) and the hemoglobin (the liguid of your blood) in your bloodstream. If anemic both of these will be low and hematocrit below 7.0 down to 6.0 is critical.

Normal adult hematocrit values vary from one medical practice to another but are generally between 40 and 52 percent for men and 35 and 47 percent for women. Normal adult hemoglobin values are generally 14 to 18 grams per deciliter for men and 12 to 16 grams per deciliter for women.

****Additional testing maybe ordered as well; like the following to help determine what the person has with the what treatment to tell the MD is needed to help the individual get better.

This could be: . A test to determine the size and shape of your red blood cells. Some of your red blood cells may also be examined for unusual size, shape and color. Doing so can help pinpoint a diagnosis. For example, in iron deficiency anemia, red blood cells are smaller and paler in color than normal. In vitamin deficiency anemias, red blood cells are enlarged and fewer in number

If you receive a diagnosis of anemia, your doctor may order additional tests to determine the underlying cause. For example, iron deficiency anemia can result from chronic bleeding of ulcers, benign polyps in the colon, colon cancer, tumors or kidney problems.

Occasionally, it may be necessary to study a sample of your bone marrow to diagnose anemia (see diagram above showing you one area a bone marrow aspiration could be done; another common area is the the hip but the size of the needle in length and needle opening the same size basically).  This test common in inherited anemia’s and cancerous anemia’s.  REMEMBER the bone makes all our cells and if our bone marrow is affected by an anemia your bone marrow will be effected possibly but if a cancer especially a bone cancer the bone marrow will show decrease in normal cells and show cancerous cells replacing them if a bone marrow aspiration is done; not that iron deficiency anemia is cancerous but could show decrease of  normal cells.  Usually a bone marrow is done in helping to diagnose an anemia difficult to determine.****

Treatment for iron-deficiency anemia will depend on its cause and severity. Treatments may include dietary changes and supplements, medicines, and surgery.  Most importantly determination of the individual diagnosed with it to make changes and STICK to those changes in your diet with supplements, medicines the MD may need you to do.  It is up to the patient to  determine where they will go with properly treating themselves after the MD diagnoses it and treats it.  They need to make the changes not the doctor.  It is called being compliant in caring for yourself with you diagnosis or if lucky, preventing it from happening again. 

Severe iron-deficiency anemia may require a blood transfusion, iron injections, or intravenous (IV) iron therapy. Treatment may need to be done in a hospital.

The goals of treating iron-deficiency anemia are to treat its underlying cause and restore normal levels of red blood cells, hemoglobin, and iron.

“Loss of blood is the most common cause of anemia.”

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Anemia develops when you don’t have enough robust, healthy red blood cells to carry oxygen throughout your body. The blood cells may lack enough hemoglobin, the protein that gives blood its red color. Anemia affects one in 10 teen girls and women. It also develops in men and children and is linked to some illnesses.  Anemia is a condition that develops when your blood lacks enough healthy red blood cells or hemoglobin. Hemoglobin is a main part of red blood cells and binds oxygen. If you have too few or abnormal red blood cells, or your hemoglobin is abnormal or low, the cells in your body will not get enough oxygen. Symptoms of anemia — like fatigue — occur because organs aren’t getting what they need to function properly.

Anemia is the most common blood condition in the U.S. It affects about 3.5 million Americans. Women, young children, and people with chronic diseases are at increased risk of anemia.

There types of different anemia’s but today’s we’ll look more into is Iron deficiency anemia.

 Iron deficiency anemia is a common type of anemia — a condition in which blood lacks adequate healthy red blood cells. Red blood cells carry oxygen to the body’s tissues.

As the name implies, iron deficiency anemia is due to insufficient iron. Without enough iron, your body can’t produce enough of a substance in red blood cells that enables them to carry oxygen (hemoglobin). As a result, iron deficiency anemia may leave you tired and short of breath.

You can usually correct iron deficiency anemia with iron supplementation. Sometimes additional tests or treatments for iron deficiency anemia are necessary, especially if your doctor suspects that you’re bleeding internally.

Initially, iron deficiency anemia can be so mild that it goes unnoticed. But as the body becomes more deficient in iron and anemia worsens, the signs and symptoms intensify.

Iron deficiency anemia symptoms may include:

• Extreme fatigue, Pale skin, Weakness, Shortness of breath, Chest pain, Frequent infections

• Headache, Dizziness or lightheadedness, Cold hands and feet, Inflammation or soreness of your tongue, Brittle nails, and Fast heartbeat.

• Unusual cravings for non-nutritive substances, such as ice, dirt or starch.

• Poor appetite, especially in infants and children with iron deficiency anemia.

• An uncomfortable tingling or crawling feeling in your legs (restless legs syndrome).

Causes of iron deficiency anemia include:

• Blood loss. Blood contains iron within red blood cells. So if you lose blood, you lose some iron. Women with heavy periods are at risk of iron deficiency anemia because they lose blood during menstruation. Slow, chronic blood loss within the body — such as from a peptic ulcer, a hiatal hernia, a colon polyp or colorectal cancer — can cause iron deficiency anemia. Gastrointestinal bleeding can result from regular use of some over-the-counter pain relievers, especially aspirin.

• A lack of iron in your diet. Your body regularly gets iron from the foods you eat. If you consume too little iron, over time your body can become iron deficient. Examples of iron-rich foods include meat, eggs, leafy green vegetables and iron-fortified foods. For proper growth and development, infants and children need iron from their diet, too.

• An inability to absorb iron. Iron from food is absorbed into your bloodstream in your small intestine. An intestinal disorder, such as celiac disease, which affects your intestine’s ability to absorb nutrients from digested food, can lead to iron deficiency anemia. If part of your small intestine has been bypassed or removed surgically, that may affect your ability to absorb iron and other nutrients.

• Pregnancy. Without iron supplementation, iron deficiency anemia occurs in many pregnant women because their iron stores need to serve their own increased blood volume as well as be a source of hemoglobin for the growing fetus.

Those at risk for anemia:

Anemia is a common condition. It occurs in all age, racial, and ethnic groups. Both men and women can have anemia. However, women of childbearing age are at higher risk for the condition because of blood loss from menstruation.

Anemia can develop during pregnancy due to low levels of iron and folic acid (folate) and changes in the blood. During the first 6 months of pregnancy, the fluid portion of a woman’s blood (the plasma) increases faster than the number of red blood cells. This dilutes the blood and can lead to anemia.

During the first year of life, some babies are at risk for anemia because of iron deficiency. At-risk infants include those who are born too early and infants who are fed breast milk only or formula that isn’t fortified with iron. These infants can develop iron deficiency by 6 months of age.

Infants between 1 and 2 years of age also are at risk for anemia. They may not get enough iron in their diets, especially if they drink a lot of cow’s milk. Cow’s milk is low in the iron needed for growth.

Drinking too much cow’s milk may keep an infant or toddler from eating enough iron-rich foods or absorbing enough iron from foods.

Older adults also are at increased risk for anemia. Researchers continue to study how the condition affects older adults. Many of these people have other medical conditions as well.

Major Risk Factors for anemia:

• A diet that is low in iron, vitamins, or minerals

• Blood loss from surgery or an injury

• Long-term or serious illnesses, such as kidney disease, cancer, diabetes, rheumatoid arthritis, HIV/AIDS, inflammatory bowel disease (including Crohn’s disease), liver disease, heart failure, and thyroid disease

• Long-term infections

• A family history of inherited anemia, such as sickle cell anemia or thalassemia.

  Complications of Anemia

  Some people who have anemia may have arrhythmias. Arrhythmias are problems with the rate or rhythm of the heartbeat. Over time, arrhythmias can damage your heart and possibly lead to heart failure.

  Anemia also can damage other organs in your body because your blood can’t get enough oxygen to them.

  Anemia can weaken people who have cancer or HIV/AIDS. This can make their treatments not work as well.

  Anemia also can cause many other health problems. People who have kidney disease and anemia are more likely to have heart problems. With some types of anemia, too little fluid intake or too much loss of fluid in the blood and body can occur. Severe loss of fluid can be life threatening.

Stayed tune tomorrow for part 2 on Anemia on treatment and how a MD diagnoses what  treatment to use.

“How likely you are to develop osteoporosis ? — a condition that causes bones to become weak and brittle — depends on how much bone mass you attain by the time you reach age 30 and how rapidly you lose it after that.”

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Is life worth living?   It all depends on the liver.