Nearly a quarter of Americans with diabetes are undiagnosed. Are you one of them?
Daniel Cox had been studying diabetes for 40 years when he woke up one night with its classic symptoms.
“Not only did I find myself getting up in the night more often to use the bathroom, but all of a sudden I was drinking a lot of water,” says Cox, 71 (at the time, he was 60), who holds a Ph.D. in clinical psychology and is a professor in the department of medicine and the department of psychiatry at the University of Virginia.
Lately, he’d also noticed his blurry vision and mysterious weight loss (15 pounds in two months).
That's when it hit him. "I rolled over to my wife and said, 'I've got diabetes,'" he recalls.
An A1C test confirmed it. Cox’s blood sugar was “through the ceiling,” he says, “and I didn’t know.”
While Cox, whose diagnosis led him to shift his research focus from type 1 to type 2 diabetes, probably has more insight into diabetes than most, he’s hardly alone in this experience.
According to the Centers for Disease Control and Prevention, 37.3 million people in the United States have diabetes, but nearly a quarter of them (8.5 million) are undiagnosed.
What’s more, over a third of U.S. adults (96 million) have prediabetes, including 26.4 million people over the age of 65. Prediabetes is a condition that can lead to diabetes.
Untreated diabetes is associated with serious complications like heart disease, nerve damage, and eye problems (including blindness).
That’s why it’s so important to know the risk factors and warning signs of type 2 diabetes—and to get screened.
When to Get Screened for Diabetes
A blood test can spot diabetes or prediabetes long before symptoms occur, says Cox. So you shouldn’t wait for symptoms to develop before getting tested.
Christine Lee, M.D., M.S., of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), agrees.
“Don’t wait for warning signs—be warned by your risk factors,” Dr. Lee says.
Talk to your health-care provider about scheduling a diabetes screening if you have any of the following risk factors:
- First-degree relative with diabetes
- Body mass index higher than 25 (23 if you’re of Asian heritage)
- High blood pressure
- Low HDL (good) cholesterol (<35 mg/dL) and/or high triglycerides (>250 mg/dL)
- Women with polycystic ovary syndrome
- Sedentary lifestyle
- Some racial/ethnic groups: African Americans, Hispanic/Latino Americans, American Indians, Pacific Islanders, and some Asian Americans
Depending on the findings, your doctor can advise you on how often to get screened going forward, Dr. Lee says. If you have prediabetes, you should be screened every year, she adds.
An Easy Way to Check Your Diabetes Risk
Take the American Diabetes Association’s type 2 diabetes risk test at diabetes.org/risktest.
You’ll answer a few quick questions and be given an assessment of your risk.
It’s worth mentioning that, even if you have no risk factors at all, the American Diabetes Association recommends you still get screened for prediabetes and diabetes every three years over age 45.
Cox recommends a blood sugar test should be part of your annual physical after age 65.
Don’t wait for your doctor to ask, either.
"You have to be proactive," Cox says. "Some doctors might think, 'I'm not going to charge the extra twenty dollars for that blood glucose reading.' But as you get older, it's important."
Medicare covers an annual diabetes screening for those who qualify, including folks over 65 who have certain risk factors mentioned above, like being overweight or having a family history of diabetes.
How to Prevent Diabetes if You’re at High Risk
If you discover you have prediabetes, you can take steps to prevent or delay diabetes from happening.
In fact, the Centers for Disease Control and Prevention developed the National Diabetes Prevention Program to help people do just that. The program connects you with a lifestyle coach and prescribes lifestyle changes proven to lower the risk of diabetes. If you're eligible, Medicare will cover the program's full cost.
Also check out the strategies in “Your Doc Says You Have Prediabetes. Now What?” here.
The National Diabetes Prevention Program is based in clinical research, which Dr. Lee oversees, funded by the NIDDK.
Those studies show that people at high risk of developing diabetes who adopted this kind of program had a 58 percent lower risk of developing type 2 diabetes over three years. Those placed on diabetes medication had a 31 percent lower risk.
The effect of lifestyle changes was even more pronounced in adults over age 60, reducing diabetes risk by 71 percent.
“The message for those over 60 is if you have prediabetes, you really want to target making those healthy lifestyle changes,” says Dr. Lee.
The study subjects were instructed to do 150 minutes of moderate to intense physical activity per week, Dr. Lee says.
Moderate intensity exercise can mean brisk walking (at a pace of about three miles per hour), cycling, water aerobics, tennis, or ballroom dancing, Dr. Lee says.
As a side benefit, participants also saw improvements in other health conditions, lowering cholesterol, blood pressure, and levels of fats in the blood, Dr. Lee says.
Those in the lifestyle-change program were also 37 percent less likely to become frail later in life.
Be sure to talk to your doctor before starting a new exercise program. This is especially if you have a health condition like angina, Dr. Lee cautions.
11 Symptoms of Type 2 Diabetes You Should Know
Blood sugars travel throughout the body, affecting many tissues.
When blood sugar levels get high enough—typically well into the range that indicates you have diabetes—a myriad of symptoms can occur, Dr. Lee says.
Call your doctor right away if you have any of these symptoms:
Frequent urination: The body’s way of trying to get rid of extra blood sugars is to pee them out, Dr. Lee says. You may find yourself heading to the bathroom more than you used to, particularly at night.
Increased thirst: If you’re peeing more, you may become dehydrated and more thirsty than usual, Dr. Lee says. Of course, everybody’s different, so pay attention to what’s normal for you, Cox says.
“If you usually drink four or five glasses of water a day and now you’re drinking eight, things are changing.”
See the “5 Sneaky Signs of Dehydration” for more information.
Weight loss: When you have diabetes, your body has a hard time converting sugar into fuel, Cox says. So your body turns to its other fuel source—fat—causing you to lose weight, he explains.
“It’s kind of like going on a ketogenic diet,” Cox explains, referring to the popular low-carb keto diet.
"Except on a ketogenic diet, you're not eating carbohydrates, forcing the body to burn fat as fuel," he adds. "With undiagnosed diabetes, it's not that your body doesn't have carbohydrates, it's that it can't utilize them."
Fatigue: A metabolic switch from burning carbs to burning fat is associated with fatigue, Cox says. Once the body has adapted, however, the fatigue usually goes away.
Dr. Lee notes that both the fatigue and weight loss may also be related to the dehydration we mentioned above.
Blurry vision: High blood sugars can cause the lens of the eye to swell, distorting vision, Dr. Lee says.
A more advanced complication of diabetes is diabetic retinopathy—when blood vessels in the back of the eye become damaged, possibly leading to vision problems or even blindness.
Dry skin, dry mouth: Another product of dehydration can be dryness, Dr. Lee says.
"If you're peeing out the sugar and losing water along with that, you get dehydrated," she says. "You feel thirsty, you have dry mouth, you have dry skin."
Hunger: Diabetes means sugar gets stuck in the blood and your cells can’t access it for energy, Dr. Lee says.
Because your tissues, muscles, and organs aren’t getting that energy, your brain may think you need more food.
Neuropathy: If you have uncontrolled diabetes for long enough—five or six years, Cox says—nerve damage can occur. You may experience tingling, numbness, burning, or pain in the feet or (less commonly) the hands.
Slow healing sores: People with type 2 diabetes seem to have impaired wound healing, though we’re not sure why, Dr. Lee says.
It could be a combination of factors, including poor blood flow to the wound and impaired immune response.
Frequent infections: That impaired immune response may be to blame for infections too, Dr. Lee says.
In particular, diabetes may leave you more prone to urinary tract infections and yeast infections (which thrive on sugar), Dr. Lee says. People with type 2 diabetes who get COVID-19 may be more likely to develop severe symptoms, according to the Mayo Clinic.
Impotence: The nerve damage mentioned above can cause erectile dysfunction, Dr. Lee says.
Damage to the small blood vessels due to uncontrolled high blood sugar may also have something to do with it, Dr. Lee adds, though more research is needed to confirm that.
How Diabetes Is Diagnosed
Standard tests for diagnosing diabetes include:
Fasting blood sugar test: A blood sample is taken after you’ve fasted overnight.
A fasting blood sugar level from 100 to 125 mg/dL is considered prediabetes. Anything over 126 mg/dL is considered diabetes.
Glycated hemoglobin (A1C) test: A measure of how much glucose is stuck to your hemoglobin (red blood) cells, this reveals your average blood sugar level for the past two to three months.
An A1C level of 6.5 percent or higher indicates diabetes. Between 5.7 and 6.4 percent indicates prediabetes.
How Diabetes Is Treated
While there is no cure for diabetes, lifestyle changes and medication can help you manage the condition and possibly put it into remission.
Clinical research from the U.K. found high rates of diabetes remission among patients who lost at least 22 pounds and kept it off. (In fact, Cox says he has managed his type 2 diabetes with lifestyle changes alone for 11 years, maintaining an A1C under 6 percent.)
In other research from the NIDDK (the Look AHEAD study), lifestyle changes helped people with type 2 diabetes lower the risk of heart problems, improve mobility, and reduce frailty risk.
Bottom line: There’s a lot you can do to prevent or manage diabetes, but it starts with getting yourself screened so you can make informed choices.
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