The Evidence: Diabetes and Income
Income inequality in the US has recently increased dramatically. Poverty is a great contributor to death and diseases, so are nonclinical factors such as education, employment, race, ethnicity, and geography that influence health outcomes. Although income inequality exacerbates health disparities, poor health also contributes to reduced income, creates a negative feedback loop also referred to as health-poverty trap. Basically, low-income Americans have high rates of physical limitations and heart diseases, diabetes, stroke, and other chronic conditions. This is for the fact that low-income Americans face greater barriers to accessing medical care compared to higher-income earners since they are less likely to have health insurance and to access specialty care.
What is IT?
Diabetes is a condition when blood glucose or blood sugar is too high. Blood glucose comes from the food we eat and is the main source of energy in the body. The pancreas produces hormone Insulin to synthesis glucose into energy. However, sometimes the body does not make enough or any Insulin, therefore, glucose remains in the blood and does not reach the cells. Glucose is an important source of energy for the brain and cells that make up the muscles and tissues. Too much sugar in the blood leads to health problems such as cardiovascular, neuropathy (nerve damage), kidney failure, eye damage, foot damage, Alzheimer’s disease, and depression.
Types of diabetes
- Type 1
Is referred to as insulin-dependent diabetes mellitus (IDDM) or juvenile-onset diabetes and is a chronic condition where the pancreas produces little or no Insulin.
- Type 2
Referred to as Non-Insulin Dependent Diabetes Mellitus (NIDDM) or adult-onset diabetes. In type 2, the body does not use insulin properly. Primarily, the pancreas secretes Insulin to make up for it, but it does not keep up over some time, so cannot keep the blood glucose at normal levels.
- Gestational diabetes
Gestational diabetes is a type of diabetes in pregnant women who had non before they became pregnant. It shows up in the middle of pregnancy more common between the 24th and 28 weeks of pregnancy.
What are the risk factors?
Genetics: You are at risk if your parent or sibling has diabetes type 1
Environmental factors: For example, exposure to a viral illness can play a part in leading to type 1diabetes
Autoimmune (autoantibodies): The presence of damaging the immune system cells.
Geography: Some countries have a high risk of developing cases of type 1diabetes such as Finland and Sweden.
Older age: You develop diabetes risk as you get older due to immobility and lack of exercise.
Obesity: Cells with many fatty tissues become resistant to insulin
Physical inactivity: Physical activity assists in controlling weight since it uses energy made from glucose making the cells more sensitive to insulin.
Family history of diabetes: If your parent or sibling has diabetes, the risk increase
Race/e ethnicity: Most commonly, American Indians, Asian- Americans, Hispanics, and black people are at high risk
Prior history of gestational diabetes: If you developed gestational diabetes during pregnancy, then you are at a high risk of contracting diabetes type 2.
Impaired glucose tolerance: When the blood glucose is raised beyond normal levels
Polycystic ovary syndrome: Experts believe there is a relationship between polycystic ovary syndrome (PCOS) and diabetes type 2
Race: Gestational diabetes (GDM) is most prevalent among Asian Indians, African Americans, Hispanic/Latino, American Indians, Asian Americans, and Pacific Islanders. This is due to differences in population prevalence.
Obesity: Being overweight increases the risk of diabetes since the body makes enough insulin but the cells become resistant to the salutary action of insulin for being overweight stresses the inside of the heart
Family history; Learning about your family diabetes history is an important step in finding out if you are likely to contract diabetes
Age: The risk of diabetes iiincrease with age making it more common in older adults
How common is IT?
The number of diabetic cases continues to increase globally especially in middle and low-income countries. According to the World Health Organization (WHO), an estimated 1.6 million people died in 2016 due to diabetes and estimate it as the seventh leading cause of death. Centers for Disease Control and Prevention (CDC) estimates that more than 100million US adults are currently living with diabetes or are pre-diabetes. About 9.4% of the US population, that is 30.3 million Americans have diabetes. While another 84.1 million people have pre-diabetes.
If pre-diabetes is left untreated it results in diabetes type 2 within a span of five years. The report released by CDC also confirms the number of new cases of diabetes rise steadily despite the condition being a growing health concern. Shockingly, the majority of people with diabetes or pre-diabetes do not know they have it. Therefore, we must put in efforts to reduce the burden of diabetes which is a serious disease.
Who is most at risk of developing type 2 diabetes?
Any person can develop type 2 diabetes regardless of age. However, type 2 is more common among middle-aged and older people. That is 45 years of age and older. In addition, physically inactive people, and people with health problems such as hypertension, have a higher risk of contracting diabetes type 2. Moreover, the risk of getting diabetes type 2 increases if you have pre-diabetes or gestational diabetes during pregnancy. Also, advance in age family history, and overweight.
What are the possible health complications of diabetes?
If you do not make an effort (such as watching your diet, doing exercises, and taking medication) to control your blood glucose levels, there are serious complications, short or long term to contend with. More so, getting control of your blood glucose from the time you were diagnosed with type 2 can help reduce the severity of complications. Type 2 develops gradually and it is likely you will have some complications from the first time you are diagnosed with the disease. Type 2 complications that are short term include;
Low blood sugar (Hypoglycemia)
In this case, the blood glucose level drops below normal especially if you are taking insulin or a sulfonylurea drug for glucose control. Sulfonylureas make the body produce insulin throughout the day, therefore, if you are more active or eat less the blood glucose is likely to fall below normal. In spite of that, there are certain medications that can cause hypoglycemia for example, when you take aspirin in a dose more than 81mg and too much alcohol; it limits the liver from releasing glucose. Signs and symptoms that indicate low blood sugar include rapid heartbeat, excessive sweating, skin paleness, anxiety, insomnia, and confusion, numbness in fingers, toes, and lips, headaches, and slurred speech. In mild cases of hypoglycemia, eating a glucose tablet or drinking orange juice restores the blood sugar levels. In addition, glucagon is used in case you are on insulin and the blood sugar drops drastically.
Hyperosmolar Hyperglycemic Non-ketotic Syndrome (HHNS)
It is a condition where blood glucose level shoots way high and can result in death if left untreated. It occurs in sick and elderly people with its sign being frequent urination as the body tries to get rid of the excess glucose. This condition is managed by frequent hydration and keeping watch of your blood glucose level when you fall sick.
Complications that are long-term
Long-term complications develop over many years and relate to how blood sugar levels affect blood vessels.
Microvascular Complications (damage to the tiny blood vessels)
Consistent high blood glucose cause damage to the small blood vessels, as a result, they do not supply blood as they should. For example, high levels of blood glucose over a period of time can damage the eyes due to cataracts or retinopathy which can both cause loss of vision. Uncontrolled diabetes can damage the kidneys leading to kidney failure thus; they will be unable to clean the blood properly. In addition, it can cause nerve damage also called diabetic neuropathy but getting blood glucose level under control can prevent further damage. Diabetic neuropathy causes loss of sensation in the feet as well as pain, weakness, and tingling. The worst part is when you get sore and it becomes infected, if the infection is left untreated, it may necessitate amputation of the foot. It is important to have regular feet examinations to prevent infections.
Diabetes type 2 can affect the large blood vessels causing a buildup of a plague that leads to heart attack, stroke, or blocked blood vessels in the legs. To prevent such complications ensure that the blood glucose level is under control while paying attention to blood cholesterol.
What happens if diabetes is left untreated?
We can effectively manage diabetes when caught early. However, if left untreated it can affect various cells and organs in the body and cause complications such as mentioned above. An untreated case of diabetes type1 can cause coma and can even kill you, however, there is the availability of treatment that can help treat such problems.
What are the most common symptoms of diabetes?
Increased urinary frequency
The kidneys will try to eliminate excess sugars by filtering it out of the blood thus increasing the need to urinate particularly at night.
Due to frequent urination, the body loses a lot of water, after some time it leads to dehydration and can cause a person to feel thirsty quite often and more than usual.
People with diabetes feel constantly hungry for the fact that the digestive system breaks down food into simple sugars which the body uses for energy. They also have less glucose moving from the bloodstream into the cells thus feel hungry regardless of how recently they have eaten.
A diabetic person tends to feel tired or fatigued as a result of insufficient sugar moving from the bloodstream to the cells.
Excess sugars damage the tiny blood vessels as a result damages the eyes causing blurry vision
The wounds or cuts heal slowly
Damaged blood vessels impair blood circulation; as a result, small cuts and wounds may take longer to heal which increases the risk of infections.
Pain, tingling, or numbness in the hands, feet, or lips
This is as a result of damaged nerves which affects the blood circulation.
Itching and skin infections
Sugars are food for yeast which can lead to yeast infections on moist and warm areas of the skin such as the armpits, genital areas, and the mouth.
How to prevent diabetes
- Control your weight
- Be physically active
- Watch your diet, avoid processed carbohydrates and refined grains, avoid sugary drinks, choose healthy fats, and limit red meat
- Quit smoking
- Avoid excessive alcohol intake
There is a need to address socioeconomic disadvantages for prevention which play a large role in diabetes outcomes. Outcomes are much influenced by income and poor adults with type 2 have a high risk of death than those with a higher income even with the same access to care. Therefore, addressing the underlying risk factors and providing support to disadvantaged populations can help prevent and improve diabetes-related outcomes.
Opinion: It’s not only about Paris: Will America confront all the environmental treaties it put in limbo?
Rejoining the Paris Agreement is just the first step toward U.S. green global leadership
February 19, 2021 — A U.S. president announced America’s distancing from the most significant climate treaty in history. Sixteen years later, President Donald Trump followed suit. In other words, whiplash is not new to U.S. environmental politics — and, for decades, it has been at the center of our treaty-making.
Trump took a page out of President George W. Bush’s playbook when he announced in 2017 he was ditching the Paris climate deal. Bush had taken similar action when he refused to move forward with the Kyoto Protocol, the 1990s precursor to the Paris Agreement. On Inauguration Day of this year, President Joe Biden initiated the rejoining of the Paris Agreement. Today it becomes official.
Rejoining the Paris deal, according to John Kerry, the new U.S. envoy on climate change, will allow the U.S. to become a global climate leader. He summarized the administration’s core belief about the global climate crisis: “It is existential.”
But climate change isn’t the only existential crisis the world is facing. Biodiversity loss and ocean exploitation, to name just two, are crises happening concurrently with climate change — and much of the rest of the world has turned to a number of lesser-known environmental treaties to address these. But, the U.S. government has never signed, has failed to ratify, or still dances around them. America may re-sign the Paris Agreement but it will not be a convincingly green leader on the global stage until it confronts the forgotten environmental treaties it has trapped in limbo, sometimes for decades — and the world will suffer more from all the existential crises it faces than if the U.S. led the way.
From Walden Pond to Paris
When I teach college students in my U.S. environmental policy courses, I start with Thoreau’s cabin on Walden Pond and end with the Paris Agreement. America popularized the genre of nature writing, came up with national parks, and drafted the first federal endangered species lists — nature-saving solutions now adopted by many nations around the world. Yet we’ve failed to fully embrace the global community’s choice of nature-saving solution: environmental treaties. By hyper-focusing and hyper-villainizing any one former administration’s climate legacy, America obscures its past failing as a whole to step into environmental leadership positions.
Few of the non-climate environmental agreements are household names — the Convention on Biological Diversity, the Bonn Convention, Law of the Sea — but America’s lack of official participation makes it a major holdout on global efforts to stop biodiversity loss, protect migratory animals, and steward our global ocean. While America still sends “observers” to meetings that further negotiate or expand these treaties, formally speaking, the country of Liechtenstein (estimated population 38,000) currently has a more legitimate voice in global environmental governance than America.
Take the Convention on Biological Diversity, the Paris Agreement-equivalent for the extinction crisis. In 1993, the Clinton Administration signed the treaty, it arrived at the U.S. Senate for ratification, and the Senate did nothing. The documents wait for action in a kind of treaty purgatory, with a sad internet presence, alongside thirty-six others. Consider the Bonn Convention, officially known as the Convention on the Conservation of Migratory Species of Wild Animals (CMS). It coordinates transboundary operations that conserve the migratory routes and habitat of mobile species. Canada and Mexico join the U.S. and a handful of other major nations that never signed on to this convention. It’s true that America has signed on to a few of CMS’s memorandums of understanding, but on a species-by-species basis. Meanwhile, billions of birds continue vanishing from North America’s migratory routes over just one generation, including climate-sensitive seabirds like albatross and petrels.
Lastly, the UN Law of the Sea Convention (UNCLOS), an agreement that governs human activities in seas and oceans: America was one of its earliest architects in the 1980s, but in the 1990s the treaty followed the similar signed-but-not-ratified fate as the biodiversity agreement. Today, scientists in the U.S. are again helping to design an international legal binding agreement that will address problems resulting from UNCLOS’s gaps, notably: how to deal with the overfishing of biodiversity on the high seas, technically called Marine Biodiversity of Areas Beyond National Jurisdiction (BBNJ). After the pandemic subsides, the BBNJ treaty will likely be on the diplomatic table, but scientists are cautious, based on America’s fickle history, that political leaders will formally join, despite the urgent message of ocean exploitation.
Such concrete action would make absolutely clear where America will and will not lead when it comes to environmental problems, from climate change to biodiversity loss to overfishing of the high seas.
There is no shortage of political explanations and diplomatic rationales for America’s historical self-distancing from these agreements. First, the U.S. Senate must advise to ratify treaties by a two-thirds vote. Some senators have long been treaty-averse, with arguments circling that claim treaties risk U.S. sovereignty and its global economic position. Second, the U.S. has in these cases preferred to make progress through soft diplomacy, making handshakes and good neighbors without signing the dotted line.
These political traditions are like our battleships — they don’t turn on a dime, no matter which party is in power. But from a scientific and historical perspective, a smart approach would be the one that is most comprehensive: confronting all the treaties that are in limbo now, in a transparent way. Such concrete action would make absolutely clear where America will and will not lead when it comes to environmental problems, from climate change to biodiversity loss to overfishing of the high seas.
Reconciling the Past to Move Forward
The lack of clear-eyed and transparent treaty-making has long-term consequences, as seen in another instance where the U.S. has failed in this area: the injustices wrought by not honoring and breaking treaties by the U.S. government against Native Americans. Many Native Americans still have high levels of mistrust for non-tribal government because of this historical trauma and, because of this and many other reasons, often low levels of voter turnout. When Native American communities do engage, they can swing political outcomes. The lack of Native American participation in democratic processes is a lasting bruise on our democracy. As with other injustices, our ability to successfully move forward on this front requires a full recognition of the past.
America’s leaders have a window and opportunity in 2021 to turn this legacy around and make it clear where the country will and where it will not lead on the environment.
Turning the page on America’s environmental story also involves an honest telling of the past. That story is rich in national vision but undeniably fickle when it comes to the hard work — arguably the hardest work — of saving the whole planet through global cooperation and agreements.
America’s leaders have a window and opportunity in 2021 to turn this legacy around and make it clear where the country will and where it will not lead on the environment. One of President Biden’s orders signed on January 27 seeks the U.S. Senate’s advice on ratifying the Kigali amendment — an important amendment to the lesser-known climate treaty, the Montreal Protocol — which could reduce the use of climate-warming hydrofluorocarbon (HFC) pollutants. This treaty expansion ratification is possible due to at least some bipartisan agreement, in part because of its potential economic benefits for the U.S.
And further bipartisan environmental agreement in the Senate does exist. The 2020 passage of The Great American Outdoors Act, the largest land conservation legislation in the 21st century, had bipartisan support. Similarly, there may be bipartisan support for the creation of a jobs corps bill that has the same appeal of supporting public lands and rural jobs, while also focusing on the new administration’s climate agenda. This kind of bipartisan momentum matters for seeking ratification of green treaties in the Senate.
If successful, the ratification of an expanded Montreal treaty still stays within the climate action realm the Biden Administration seems most comfortable in — at least for now. By ratifying or at least confronting the treaties that have been left in the lurch all these years, the country has the opportunity to show its environmental leadership in a way that is clear about what it does — and does not — consider “existential” enough to address meaningfully in concert with other nations.
President Biden says he will host global leaders on Earth Day 2021 for a dialogue about the climate crisis, echoing Kerry’s language, that climate change is an existential threat. “And just as with the pandemic,” Biden said, “it requires global cooperation.”
With the pandemic, another science-based crisis, America can build trust with other nations with laser focus and moving forward. But for America to become an environmental leader, the country must reckon with its past failings to lead, take stock, and understand that climate change is not the only environmental problem that needs leadership and global cooperation.
Editor’s note, 2/20/21: Early in the piece, “Biodiversity loss and ocean health” was updated to “Biodiversity loss and ocean exploitation.” Originally posted by Ensia at.
Are We Living in a Simulation?
A simulation is defined as an imitative representation of a system, or process, that utilizes the function of another. The simulation theory proposes that it is highly likely that our world, or the perception of it, is a simulation in a multi-verse system.
In his seminal work Republic, Plato presents the allegory of the cave; Imagine a group of people imprisoned from childhood in a darkened environment. The chained prisoners are only able to see the walls in front of them and identify their fellow prisoners through their shadows appearing on the walls. One day a prisoner exits the cave and finds a vast landscape basking in bright sunlight, finally able to see the world for what it is. When the prisoner returns to tell the others about the world outside, his tribe refuses to believe him and leave the cave. Through this allegory, Plato proposes that people only believe what they see and hear, failing to ascertain that true knowledge comes from philosophical reasoning. The same line of thought leads us to the idea that the world we presume as an absolute reality could very well be a simulation.
A simulation is defined as an imitative representation of a system, or process, that utilizes the function of another. The simulation theory proposes that it is highly likely that our world, or the perception of it, is a simulation in a multi-verse system. This hypothesis was popularized in recent years by British philosopher Nick Bostrom.
Many renowned scientists and famous technologists, including Elon Musk, lend credence to Bostrom’s hypothesis. Musk explains it in this way: Video games from forty years ago such as Pong had generic 2-D graphics, as simple as two rectangles and a dot. But today, advancements in the field have led to photo-realistic, multi-player games being played online by millions around the world at any given moment. The constant technological progression of AI and VR will make games of the future indistinguishable from the world outside. Wired into these games, players would create the worlds as they think, inter-connected with their neural synaptic systems. At that time human beings would have the capacity to simulate the hyper-realistic worlds, but it would no longer be so easy to differentiate the real world and the simulation. If we reverse engineer the same thought, the argument that the world we live in today is also a simulation being projected by a superior civilization becomes a probability.
The world as we know it works on physical and scientific laws based on mathematical equations. All these equations function with the presence of arbitrary constants that haven’t changed in many decades, to as far as the millionth decimal. As such, if a powerful enough system were programmed with these laws, the system would be capable of simulating our entire cosmic experience. This computer would need to be set up on a planet mimicking the conditions of our own planet and within reach to a powerful energy source like the Sun. Bostrom’s hypothesis then states that if a civilization can project a simulation, the argument that it itself is a simulation becomes highly probable.
Various methods have been presented to test this idea, one such being that a simulation being run by a computer will undoubtedly accumulate glitches over time. To fix these glitches, the simulators would have to make modifications in the system the same as any other software or computer we’ve built. The scientists suggest that these changes could actually be calculated, if changes in the constants of some of the physical laws of our world were to occur. These changes, however, might be so subtle that it could take centuries along with more advanced computational devices to measure.
Another theory is that the multi-layered simulation system has to be controlled by the top layer of simulators and no matter how strong their computing system, it will hit the bottom at one level and that level wouldn’t have the capacity to create another simulation. The world we experience might very well be the bottom-most layer of the simulation.
Elon Musk and many other scientists believe that the only thing that could refrain us from achieving the level of technology with which we can simulate our universe through an inter-connected synaptic system would be an apocalyptic war or natural calamity. Another reason might be that when we reach that stage, humanity could decide not to create a simulation as ethical reasons toward pain and suffering arise.
Whatever humanity achieves in the future isn’t clear to us now, but when we reach the point of creating simulations, the argument that we are one ourselves would become stronger. This would finally answer the age-old question of where life begin and the secrets of consciousness.
The Importance of Embracing Our Differences
We live in a country that promotes freedom and a country that celebrates independence; with that, every single city in the United States is unique in its own right. We have cities that celebrate diversity and others that celebrate their own heritage and cultures passed down from their first settlers.
Some traditions are born out of hatred and are non-inclusive of others based on opposing views, some traditions include all people and share the experience with the spirit of giving.
You cannot have a country that includes such a vast and expansive group of people from all over the world and not provide the same rights to everyone as equals. To assume someone else is not equal to you based on job title, the color of skin, gender, or anything that doesn’t acknowledge the humanity you both share is wrong.
We are lead to believe that if you share an opposing view you belong to the party that agrees with you. “You must be a liberal” or “you must be a conservative” these aren’t facts, these are excuses designed to change the subject and end the conversation. People are so afraid to question their own beliefs they hold onto ideas that no longer serve the better good of our cities and our own country.
We become so distracted by the idea that it is “them” vs “us” that we don’t stop to think about who gave us this idea. We can learn a lot from taking a second to reconsider our own views and how we want to live and co-exists with others. There is a lot of truth in what we all believe, but in order to be sure we must be open to the idea that we could be wrong, and that scares a lot of people. Something as simple as saying “I’m sorry I fucked up” is terrifying for many. But how else are we supposed to learn how to live next to one another and support people in need?
Most fear isn’t real, and we continue to create fake narratives about our personal rights and freedoms being taken away by the opposing parties. This isn’t true at all, it’s a way to create more fear and more division.
Instead of taking a moment to have real conversations, we look for easy responses, “oh you’re a Democrat”, “Oh, you’re a Republican” you must think or feel this way… that’s bullshit. The only way to know how an individual truly feels about something is to ask them. Just because someone says they aren’t racist, sexist, or a bigot doesn’t mean they aren’t. You ask questions without judgment and ask to understand, not to condemn them for being what they are, but to learn about who they are.
There are many people you don’t want in your corner but there are some people you don’t know who might fight alongside you. We’re all too afraid to step outside our comfort zone and learn about the person we think is so different from us. One thing I know for sure is that most of us are passionate about something, we let fear get in the way and we focus more on the things we hate instead of the things we’re passionate about and need to share. We all have talents and gifts that bring people together, that can help and support others, that can inspire people in very unique ways. The more you focus on what you hate or don’t like in others, the more you learn how to give out what you hate and that’s no way to live. Celebrate differences and give what you can, even if it’s only a smile.
Thank you, for coming to my Ted Talk
Holla at me.