The Baltimore Sun

About 20.8 million people in the United States have diabetes, according to the American Diabetes Association. And as the general population ages and continues to gain weight and exercise less, more people are at risk for diabetes, says Dr. Thomas Donner, an endocrinologist and director of the University of Maryland's Joslin Diabetes Center.

What is diabetes?

Diabetes is a disease of elevated sugar levels in the blood. There are two main types of diabetes. Type 1, which is seen more in children, is an auto-immune disease in which the immune system destroys the beta cells that make insulin for the body. [Insulin is a hormone used by the body to convert sugar and starches into energy.] The more common Type 2 disease is a disorder of insulin resistance - the insulin doesn't work as well - and insulin deficiency - the body can't make as much insulin as needed. What causes the disease?

There are a number of factors. Being overweight, inactive and growing older increase your risk. And having a family member with diabetes and being a member of a minority population - non-Caucasian - places you at higher risk, as well. This tells us there is a strong genetic component to getting diabetes. Also, if you have had gestational diabetes [which occurs during pregnancy], there is a high future risk of developing diabetes. Finally, diabetes is more common if you have cardiovascular disease - high blood pressure, high cholesterol or a prior heart attack. Recently a study indicated that soda - both diet and regular - has been linked to a cluster of conditions that increase risk for heart disease as well as diabetes and stroke. What do you think of the results?

It is hard to say: The study showed an association [between soda and increased risk], but cause and effect hasn't been determined. There has been some criticism of the article because other unhealthy lifestyle choices made by the people in the study [such as what they eat and drink overall and how much they exercise] may not have all been factored in. The fact that diet sodas, which are calorie-free, also were associated with increased risk makes this study's findings even more unclear. We are not at this point restricting diet drinks in our patients with diabetes, as they lead to better weight and diabetes control. If a patient asked you what to drink, what would you say?

Water and low-calorie flavored water are the best to drink, but that diet sodas have not been conclusively shown to increase risk of cardiovascular disease at this point. What are the symptoms of diabetes?

Early on, when the blood sugar is mildly elevated, a person may feel completely normal. Later, a person might feel fatigued, or have an increased thirst, increased urination or blurred vision. What do you tell patients about diabetes?

The most important message is that complications [such as those that affect the heart, kidney, eyes or feet] are to a large degree preventable by good blood sugar control and management of cardiovascular risk factors. Type 1 and Type 2 diabetes can be effectively controlled, but it is important for patients to become educated about how to control their disease, especially how to lead a healthy lifestyle. Is there any new development in diabetes research that excites you?

There is exciting research going on that is helping us to understand the genetics and other causes of diabetes. New medications are also being developed to treat and even potentially cure the disease. A new device that helps patients track their blood sugar levels [is available]. These continuous glucose monitoring systems have catheters or fibers that go under the skin and give patients glucose readings every five minutes. The readings appear on portable receivers that can clip on their belt or go in their pocket and alert patients to impending low blood sugar levels.

Holly Selby

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