A few days ago, I was attending an interesting CME that was focused on the rise of Diabetes in the US and the world. It was an interesting educational forum because of the ever decreasing age of Type II Diabetes (non-insulin dependent) that we see in medicine. When I was in medical school only a decade ago, Type II Diabetes was considered a condition that people generally only got when they were middle-aged or beyond. Young people with Diabetes were Type I (insulin dependent) almost by definition.
But in recent years, we have been seeing a steady decline in the age of the onset of Type II Diabetes. One ER colleague recently had a 12 year-old girl in the ER with a blood sugar of 850! She ended up being a new Type II diagnosis and did not have ketoacidosis which just shocked everyone involved in her case. Unfortunately cases like this though are becoming more and more common, with the age of onset being as low as 7 or 8 years of age in some cases.
What is Diabetes though and why are the demographics changing?
Diabetes is a condition where the body is unable to properly use sugar (glucose) due primarily to a problem with the hormone Insulin. Insulin is naturally produced in the pancreas and helps the body’s cells to absorb glucose from the bloodstream so that it can be used as an energy source.
To make a metaphor, it would be like saying that oil is sugar, but it can not be used by your car until it is first processed in a refinery (insulin). Without a proper refinery, all the oil in the world just sits around and cannot be used for fuel.
Type I Diabetes is where the person’s pancreas no longer makes Insulin and it is the least common form of Diabetes. Type II Diabetes though is where in the beginning of the course of disease, the body has trouble using the Insulin in its body. In fact, people with Type II often even have elevated levels of Insulin. Why do these people have trouble using the Insulin they already have? Because, amongst other things, they usually have increased amounts of fat tissue (they are overweight) and fat results in ever increasing degrees of resistance to insulin.
Even more concerning, endocrinologists state that at the time a person is diagnosed with Type II Diabetes, they have already burned 50% of the cells required to make Insulin naturally. That means it is only a matter of time before they will come to require Insulin on a daily basis to survive. This is not as much of a problem if a person is diagnosed at the age of 55, but when they are diagnosed with Type II at the age of 20, it is a definite problem with major medical consequences.
So one of the main factors that is contributing to the alarming rise of Diabetes in our society – particularly in younger people and even children – is increasing obesity. ASD reports that in 1962, statistics showed that the percentage of obesity in America’s population was at 13%. By 1980 it has risen to 15% — by 1994 to 23% — and by the year 2000 the obesity progression in America had reached an unprecedented 31%! Obesity is now the second most preventable cause of death after smoking.
Watching a movie like Super Size Me, the award winning documentary by Morgan Spurlock where he went on a McDonald’s only “diet” for 30 days and almost went into liver failure, we see how a small soft drink and small fries in the US is the biggest you can get in other countries. They don’t have a medium, large or super-size. When it comes even to breakfast cereals, you find that the sugar content is different in the US than say Australia. School cafeterias are being replaced by food plazas with McDonald’s, Pizza Hut and Taco Bell. We are too busy to cook at home anymore and so we now regularly eat out or order in. Kiplinger’s Magazine reported in 2000, that the average American eats out at least 4.2 meals per week.
One patient, who later got Diabetes, used to go everyday to her mailbox – which was about 20 feet away from her front door – by getting into her car, backing out of the garage, reaching into the mailbox and then driving back into the garage. Are we too lazy even to walk 20 feet to the mailbox? For those that have seen the animated movie Wall-E, the picture of the future of mankind is truly frightening.
For those that are fans of Jim Gaffigan, he once did a routine on Fast Food Delivery which was very funny, and at the same time so sad. He said, “I love delivery because it involves two of my favorite activities: eating and not moving”. Then he wondered aloud when it would come to the point where we would expect the delivery man to actually feed us as well because we would get too lazy to lift the food to our mouths. Let’s not get there.
I hope that something in this post will encourage you to start working on a better life for you and your children because to be honest, the medical resources aren’t there to handle a country where 30% of the population has Diabetes; even in a country as wealthy and blessed as the US. Let’s turn this boat around now before we run aground.