Type 2 Diabetes

What Increases My Risk of Diabetes?

Diabetes is a disease rising in prevalence. About 1 in 3 Americans are at risk for developing type 2 diabetes, and many don’t even know it.

The chances that you know somebody with diabetes is likely very high; it could even run in your family.

For this reason, many people are concerned about diabetes risk factors and are interested in doing things to reduce their risk.

What is diabetes?

Diabetes mellitus, or diabetes, is a disease affecting the pancreas and its ability to produce the hormone insulin. More specifically, the beta cells of the pancreas are responsible for producing insulin. Diabetes occurs when:

  • the beta cells of the pancreas are destroyed

  • when the beta cells don’t produce enough insulin to keep blood sugar levels regulated

  • or when the body doesn’t respond to insulin effectively.

Insulin helps blood glucose (blood sugar) enter our cells, where it’s used as fuel to support all of the body’s functions.

Without enough insulin, sugar remains in the bloodstream and can become dangerously high. Having high blood sugar over a prolonged period of time is detrimental to health.

Our bodies make sugar, and we also obtain it from certain foods we eat, such as carbohydrates.

High blood sugar damages arteries and blood vessels. It also damages nerves and can result in loss of sensation in limbs, which can lead to severe wounds and amputations.

There are different types of diabetes, including type 1, type 2, and gestational diabetes.

Risk factors for type 1 diabetes

Type 1 diabetes is the rarest of the types of diabetes, affecting about 2-5% of the world’s population and about 1 in 300 American adults before the age of 18. Type 1 usually occurs before age 18, which is why it’s also referred to as juvenile diabetes.

Type 1 diabetes is an autoimmune disease. The body mistakenly views the beta cells of the pancreas as invaders, and it works to destroy them. People with type 1 diabetes have little to no beta-cell function left and must inject insulin in order to live a healthy life.

Symptoms of type 1 diabetes include:

  • Unintentional weight loss

  • Increased hunger and thirst

  • Frequent urination/new bedwetting

  • Irritability

  • Blurred vision

The risk factors for type 1 diabetes aren’t as well-understood as the other types of diabetes. Risk factors for developing type 1 diabetes include:

  • Family history: people with a parent or sibling with type 1 diabetes are more likely to develop it than people without a family history.

  • Genetics: certain genes tend to indicate an increased risk of type 1 diabetes.

  • Geography: incidence of type 1 diabetes tends to increase as the distance from the equator increases.

  • Age: the first peak of diagnosis tends to occur between ages 4-7, and again between ages 10-14.

Type 1.5 diabetes, or latent autoimmune disease in adults (LADA), is a presentation of diabetes sharing characteristics of both type 1 and type 2 diabetes.

It is often mistaken for type 2 diabetes because, unlike type 1 diabetes, which typically affects people in their adolescent years, LADA tends to occur later in life.

People with LADA usually have at least one of the antibodies that people with type 1 diabetes have. This means that their body is attacking the beta cells of the pancreas.

This process happens more gradually; people with diabetes often start with the same medications for type 2, but these start to lose their effectiveness. People with LADA usually end up needing to take insulin to manage their blood sugars.

Risk factors for prediabetes and type 2 diabetes

Type 2 diabetes is much different than type 1. It can occur in adolescence but is more common in older adults. Unlike type 1 diabetes, it isn’t an autoimmune disease.

Type 2 diabetes occurs when the pancreas stops producing enough insulin, or the body doesn’t respond to insulin the way it should. When the body doesn’t use insulin effectively, it’s called insulin resistance.

Prediabetes is the condition when blood sugar levels are elevated, but not enough to be diagnosed as diabetes.

Having prediabetes is a significant risk factor for developing type 2 diabetes later on. Prediabetes is diagnosed when fasting blood sugars are between 100-125 mg/dL and/or a hemoglobin A1c (longer-term blood sugar test) is 5.7-6.4%.

Diabetes is diagnosed when fasting blood sugars are 126 mg/dL or higher, and/or the hemoglobin A1c is 6.5% or higher. Risk factors for both prediabetes and type 2 diabetes are similar and include:

  • Weight: people who are considered overweight or obese according to their body mass index (BMI).

  • Age: people 45 and older are at increased risk.

  • Family history of diabetes

  • Race/ethnicity: diabetes tends to affect certain races more than others. At-risk races include African American, Alaska Native, American Indian, Asian American, Hispanic/Latino, Native Hawaiian, or Pacific Islander.

  • High blood pressure: if your blood pressure is higher than 120/80, you may be at increased risk.

    Altered lipid levels: low levels of HDL “good” cholesterol and high levels of LDL “bad” cholesterol are risk factors, as well as high triglycerides (blood fat).

  • Pregnancy history: women with a history of gestational diabetes (GDM) or gave birth to a baby 9 pounds or heavier are at increased risk.

  • Physical activity: people who aren’t regularly active or who have a sedentary lifestyle are at increased risk.

  • Smoking status: Smokers are 30-40% more likely to develop type 2 diabetes than nonsmokers.

  • Health history: those with a history of heart attack or stroke have a higher likelihood of developing type 2 diabetes.

  • Acanthosis nigricans: dark, velvety patches of skin are a sign of insulin resistance and are a risk factor for developing diabetes. These patches of skin usually occur around the neck or armpits.

Risk factors for gestational diabetes

Gestational diabetes (GDM) affects women during pregnancy. It occurs in women without a previous history of diabetes.

The drastic shift in hormones during pregnancy can trigger insulin resistance, resulting in higher blood sugars. It typically goes away after pregnancy.

Pregnant women without a previous history of GDM are screened for this condition between 24 and 28 weeks of pregnancy. Those with a history of GDM are screened earlier. Having GDM is a risk factor for developing type 2 diabetes later in life, so women should continue to have their blood sugar checked periodically after pregnancy.

Screening for GDM involves a glucose tolerance test. A drink with sugar is given to the pregnant woman, and her blood sugar is tested one hour after.

If it’s high, she’ll do a 3-hour glucose tolerance test, with her blood sugars being measured once every hour for three hours after drinking a sugary drink. GDM will be diagnosed based on the results of the glucose tolerance test.

Risk factors for developing GDM include:

  • Being at a higher weight when becoming pregnant.

  • Being African-American, Asian, Hispanic, or Native American

  • Having a history of prediabetes or GDM

  • Having high blood pressure or other medical problems

  • Having given birth to a large baby weighing 9 pounds or more

  • Having given birth to a stillborn baby or one with birth defects

  • Being over the age of 25

Tips to reduce the risk of diabetes

Type 2 diabetes is a preventable disease, as many of the risk factors are related to lifestyle habits.

Diabetes Prevention Programs through the CDC can help those at high risk of developing diabetes to improve their blood sugars. These programs are offered both in-person and online.

While factors such as genetics, family history, and ethnicity can’t be changed, several lifestyle habits can help reduce the risk of developing diabetes, such as:

  • Getting screened for blood sugar problems: People diagnosed with prediabetes are more likely to develop diabetes later in life. Making healthy lifestyle changes after receiving a prediabetes diagnosis can help reverse this process and normalize blood sugars.

    The American Diabetes Association recommends screening all people over the age of 45, regardless of other risk factors, and repeating the screening every three years.

  • Being physically active: Aiming for at least 30 minutes of moderate to vigorous physical activity 5 days or more per week can help improve insulin sensitivity and decrease insulin resistance.

  • Eating a healthy diet: Diets rich in whole grains, fruits, vegetables, legumes and nuts, moderate in alcohol, and low in refined (white) grains, red meat and sugar-sweetened beverages have been found to help promote healthy blood sugar and cholesterol levels. A Mediterranean diet is linked with a lower incidence of disease and mortality and has been shown to reduce complications such as cardiovascular disease risk.

  • Aim for a healthy weight: Large weight fluctuations, including weight gain, can increase the risk of developing diabetes. Losing ~11 pounds can reduce diabetes risk by over 50%.

  • Control your blood pressure: Practicing healthy habits such as being active, eating healthy (like the Mediterranean diet), and managing stress can help promote healthy blood pressure levels. and reduce the risk of cardiovascular disease.

Conclusion

Diabetes has three presentations: type 1, type 2, and gestational diabetes. Type 1 is the least common of the three and has very different risk factors than type 2 and gestational diabetes.

Prediabetes, or “borderline diabetes,” occurs when blood sugar levels are slightly elevated, but not enough to be considered diabetes. People with prediabetes are more likely to develop diabetes over time if healthy lifestyle changes aren’t made.

People can reduce their risk of type 2 and gestational diabetes by being regularly physically active, eating a healthy diet, and abstaining from smoking.

Anyone over the age of 45 should be screened for blood sugar problems; those at increased risk (e.g., family history, sedentary lifestyle, etc.) should be screened even earlier.

Being screened for blood sugar issues is one way to prevent the progression of borderline diabetes to diabetes. Due to its nature, there aren’t set screening guidelines for type 1 diabetes.

Sources

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  5. Kampmann U, Madsen LR, Skajaa GO, Iversen DS, Moeller N, Ovesen P. Gestational diabetes: A clinical update. World J Diabetes. 2015;6(8):1065–1072. doi:10.4239/wjd.v6.i8.1065
  6. Balaji V, Balaji MS, Datta M, et al. A cohort study of gestational diabetes mellitus and complimentary qualitative research: background, aims and design. BMC Pregnancy Childbirth. 2014;14:378. Published 2014 Nov 25. doi:10.1186/s12884-014-0378-y
  7. https://www.diabetes.org.uk/preventing-type-2-diabetes/can-diabetes-be-prevented
  8. https://www.niddk.nih.gov/health-information/diabetes/overview/preventing-type-2-diabetes
  9. https://care.diabetesjournals.org/content/40/Supplement_1/S44

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