One day a patient left a message that caught my attention. He wanted a blood sugar test for diabetes because there were ants in his toilet. When we spoke, he denied having any of the more typical signs of diabetes. His only reason for concern: the ants feasting on the sugar.
According to the Centers for Disease Control, 29 million people in the United State have diabetes, and approximately 27 percent are 65 and older. An additional 86 million people have pre-diabetes (50 percent ages 65 or older), and most of them don’t know it. Without a change in lifestyle, within five years 15 to 30 percent of pre-diabetics will develop type 2 diabetes.
There are three main types of diabetes:
Type 1: Your body does not produce enough insulin.
Type 2 (the most common, affecting up to 90 to 95 percent of diabetics): Your body does not use insulin properly.
Gestational diabetes: occurs in four percent of pregnancies. These women are at increased risk of developing type 2 diabetes after pregnancy.
Typical symptoms of diabetes include feeling thirsty, frequent urination, fatigue, blurry vision, cuts or bruises that heal slowly, and tingling or numbness in the hands and feet. Many people with diabetes have no symptoms, or have mild ones that go unnoticed.
Uncontrolled diabetes raises the risk of stroke and heart attack, and leads to organ damage — particularly the eyes, nerves and kidneys. I once treated a young man because his dentist noticed a severe gum problem that was going to require extraction of most of his teeth. A blood test revealed that diabetes was the root cause of his dental woes.
Diabetes is also associated with an increased risk of certain cancers, specifically the liver, pancreas, endometrium, colon, breast and bladder. The explanation for this is unclear, although theories include shared risk factors such as obesity, diet and inactivity.
Diabetes and pre-diabetes also raises the propensity for Alzheimer’s and other types of dementia.
The mainstay treatments for most type 2 diabetics are diet and exercise, but because it is so hard to change one’s habits, pharmaceutical companies are reaping enormous profits from a multitude of diabetic drugs. There are medicines that work on the pancreas, liver, gut hormones and kidneys to lower sugar. There’s even inhaled insulin.
It’s more of an effort for people to make personal changes, but it can be done. One Asian diabetic patient of mine was determined to rid herself of diabetes. Her blood sugar was so high when she was diagnosed that she needed to take insulin twice a day to keep her diabetes under control. She decided to give up her routine of eating rice at every meal, the main staple of her diet. She went from minimal exercise to working out three hours a day. When I saw her two months later, she was successfully able to discontinue her insulin entirely.
She serves as an inspiration and example of what a healthy lifestyle can achieve. With early diagnosis, proper medication and lifestyle changes, diabetes can be prevented or controlled. (However, never make changes to your medications without first consulting your physician.)
The American Diabetes Association recommends that adults get screened for diabetes every three years. People should be tested more often if higher risk factors apply — such as being overweight, family history of diabetes, a sedentary lifestyle, history of gestational diabetes, or polycystic ovary syndrome. Certain racial backgrounds also are at higher risk, including African American, Hispanic, NativeAmerican, AsianAmerican, or Pacific Islander ancestry.
As for those ants in the toilet, my patient didn’t have any particular risk factor for diabetes, but I tested him anyway and guess what? He did have diabetes. Once we got his diabetes under control, the ants left his toilet to host their picnic elsewhere.
To learn more about diabetes, visit the American Diabetes Association at www.diabetes.org.
Jerry Saliman, M.D., is a volunteer internist at Samaritan House Medical Clinic in San Mateo and a contributing medical blogger for the Peninsula JCC in Foster City. He retired from Kaiser South San Francisco after a 30-year career.