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.