CALIFORNIA DIABETES FOUNDATION

Are You at Risk for Type 2 Diabetes?

18.2 million Americans have diabetes - one in three does not know it! Take this test to see if you are at risk for having diabetes. Diabetes is more common in African Americans, Hispanic and Latino Americans, American Indian and Alaska Natives, Asian Americans and Pacific Islanders. Please pay attention to this test.

Taking Steps to Lower the Risk of Getting Diabetes

• What is type 2 diabetes?
• How can type 2 diabetes be prevented?
• What are the signs and symptoms of type 2 diabetes?
• Types of Diabetes
• Should I be tested for diabetes?
• What does it mean to have pre-diabetes?
• Besides age and overweight, what other factors increase my risk for type 2 diabetes?
• What can I do about my risk?
• Doing My Part: Getting Started
• Hope Through Research

What is Type 2 Diabetes?

Diabetes is a disease in which blood glucose levels are above normal. People with diabetes have problems converting food to energy. After a meal, food is broken down into a sugar called glucose, which is carried by the blood to cells throughout the body. Cells use the hormone insulin, made in the pancreas, to help them process blood glucose into energy.

People develop type 2 diabetes because the cells in the muscles, liver, and fat do not use insulin properly. Eventually, the pancreas cannot make enough insulin for the body's needs. As a result, the amount of glucose in the blood increases while the cells are starved of energy. Over the years, high blood glucose damages nerves and blood vessels, leading to complications such as heart disease, stroke, blindness, kidney disease, nerve problems, gum infections, and amputation.

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How can Type 2 Diabetes be prevented?

Although people with diabetes can prevent or delay complications by keeping blood glucose levels close to normal, preventing or delaying the development of type 2 diabetes in the first place is even better. The results of a major federally funded study, the Diabetes Prevention Program (DPP), show how to do so.

This study of 3,234 people at high risk for diabetes showed that moderate diet and exercise resulting in a 5- to 7-percent weight loss can delay and possibly prevent type 2 diabetes.

Study participants were overweight and had higher than normal levels of blood glucose, a condition called pre-diabetes (impaired glucose tolerance). Both pre-diabetes and obesity are strong risk factors for type 2 diabetes. Because of the high risk among some minority groups, about half of the DPP participants were African American, American Indian, Asian American, Pacific Islander, or Hispanic American/Latino.

The DPP tested two approaches to preventing diabetes: a healthy eating and exercise program (lifestyle changes), and the diabetes drug metformin. People in the lifestyle modification group exercised about 30 minutes a day 5 days a week (usually by walking) and lowered their intake of fat and calories. Those who took the diabetes drug metformin received standard information on exercise and diet. A third group received only standard information on exercise and diet.

The results showed that people in the lifestyle modification group reduced their risk of getting type 2 diabetes by 58 percent. Average weight loss in the first year of the study was 15 pounds. Lifestyle modification was even more effective in those 60 and older. They reduced their risk by 71 percent. People receiving metformin reduced their risk by 31 percent.

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What are the signs and symptoms of type 2 diabetes?

Many people have no signs or symptoms. Symptoms can also be so mild that you might not even notice them. More than five million people in the United States have type 2 diabetes and do not know it.

Here is what to look for:

• increased thirst
• increased hunger
• fatigue
• increased urination, especially at night
• weight loss
• blurred vision
• sores that do not heal

Sometimes people have symptoms but do not suspect diabetes. They delay scheduling a checkup because they do not feel sick. Many people do not find out they have the disease until they have diabetes complications, such as blurry vision or heart trouble. It is important to find out early if you have diabetes because treatment can prevent damage to the body from diabetes.

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Types of Diabetes

The three main kinds of diabetes are type 1, type 2, and gestational diabetes.

Type 1 Diabetes

Type 1 diabetes, formerly called juvenile diabetes or insulin-dependent diabetes, is usually first diagnosed in children, teenagers, or young adults. In this form of diabetes, the beta cells of the pancreas no longer make insulin because the body's immune system has attacked and destroyed them. Treatment for type 1 diabetes includes taking insulin shots or using an insulin pump, making wise food choices, exercising regularly, taking aspirin daily (for some), and controlling blood pressure and cholesterol.

Type 2 Diabetes

Type 2 diabetes, formerly called adult-onset or noninsulin-dependent diabetes, is the most common form of diabetes. People can develop type 2 diabetes at any age, even during childhood. This form of diabetes usually begins with insulin resistance, a condition in which fat, muscle, and liver cells do not use insulin properly. At first, the pancreas keeps up with the added demand by producing more insulin. In time, however, it loses the ability to secrete enough insulin in response to meals. Being overweight and inactive increases the chances of developing type 2 diabetes. Treatment includes taking diabetes medicines, making wise food choices, exercising regularly, taking aspirin daily, and controlling blood pressure and cholesterol.

Gestational Diabetes

Some women develop gestational diabetes during the late stages of pregnancy. Although this form of diabetes usually goes away after the baby is born, a woman who has had it is more likely to develop type 2 diabetes later in life. Gestational diabetes is caused by the hormones of pregnancy or a shortage of insulin.

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Should I be tested for diabetes?

Anyone 45 years old or older should consider getting tested for diabetes. If you are 45 or older and overweight (see BMI chart), it is strongly recommended that you get tested. If you are younger than 45, overweight, and have one or more of the risk factors, you should consider testing. Ask your doctor for a fasting blood glucose test or an oral glucose tolerance test. Your doctor will tell you if you have normal blood glucose, pre-diabetes, or diabetes.

What does it mean to have pre-diabetes?

It means you are at risk for getting type 2 diabetes and heart disease. The good news is if you have pre-diabetes you can reduce the risk of getting diabetes and even return to normal blood glucose levels. With modest weight loss and moderate physical activity, you can delay or prevent type 2 diabetes. If your blood glucose is higher than normal but lower than the diabetes range (what we now call pre-diabetes), have your blood glucose checked in 1 to 2 years.

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Besides age and overweight, what other factors increase my risk for type 2 diabetes?

To find out your risk for type 2 diabetes, check each item that applies to you.

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What can I do about my risk?

You can do a lot to lower your chances of getting diabetes. Exercising regularly, reducing fat and calorie intake, and losing weight can all help you reduce your risk of developing type 2 diabetes. Lowering blood pressure and cholesterol levels also help you stay healthy.

If you are overweight

Then take these steps:

• Reach and maintain a reasonable body weight.
• Make wise food choices most of the time.
• Be physically active every day.

If you checked

    I am fairly inactive.

Then take this step:

• Be physically active every day.

If you checked

    My blood pressure is 140/90 or higher.

Then take these steps:

• Reach and maintain a reasonable body weight.
• Make wise food choices most of the time.
• Reduce your intake of salt and alcohol.
• Be physically active every day.
• Talk to your doctor about whether you need medicine to control your blood pressure.

If you checked

    My cholesterol levels are not normal.

Then take these steps:

• Make wise food choices most of the time.
• Be physically active every day.
• Talk to your doctor about whether you need medicine to control your cholesterol levels. 

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Doing My Part: Getting Started

Making big changes in your life is hard, especially if you are faced with more than one change. You can make it easier by taking these steps:

• Make a plan to change behavior.
• Decide exactly what you will do and when you will do it.
• Plan what you need to get ready.
• Think about what might prevent you from reaching your goals.
• Find family and friends who will support and encourage you.
• Decide how you will reward yourself when you do what you have planned.

Your doctor, a dietitian, or a counselor can help you make a plan. Here are some of the areas you may wish to change to reduce your risk of diabetes.

Reach and Maintain a Reasonable Body Weight

Your weight affects your health in many ways. Being overweight can keep your body from making and using insulin properly. It can also cause high blood pressure. The DPP showed that losing even a few pounds can help reduce your risk of developing type 2 diabetes because it helps your body use insulin more effectively. In the DPP, people who lost between 5 and 7 percent of their body weight significantly reduced their risk of type 2 diabetes. For example, if you weigh 200 pounds, losing only 10 pounds could make a difference.

Body mass index (BMI) is a measure of body weight relative to height. You can use BMI to see whether you are underweight, normal weight, overweight, or obese. Use the body mass index table to find your BMI.

• Find your height in the left-hand column.

• Move across in the same row to the number closest to your weight.

• The number at the top of that column is your BMI. Check the word above your BMI to see whether you are normal weight, overweight, or obese.

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Body Mass Index Table