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is probably a virus. This type of virus can cause diabetes by attacking your pancreas directly and diminishing your ability to produce insulin, which quickly creates the diabetic condition in your body. The virus can also cause diabetes if it is made up of a substance that is also naturally present in your pancreas. If the virus and your pancreas possess the same substance, the antibodies that your body produces to fight off the virus will also attack the shared substance in your pancreas, leaving you in the same condition as if the virus itself attacked your pancreas.

      A small number (about 10 percent) of patients who develop type 1 diabetes don’t seem to need an environmental factor to trigger the diabetes. In them, the disease is entirely an autoimmune destruction of the beta cells. If you fall into this category of people with diabetes, you may have other autoimmune diseases, such as autoimmune thyroid disease.

      

Although genetics plays a role in developing type 1 diabetes, the connection is relatively minor. An identical twin has only a 20 percent chance of developing type 1 diabetes if his identical twin (who has the exact same genetic material) has it.

Preventing type 1 diabetes

      The most important study of prevention of diabetes complications ever done for type 1 diabetes is called the Diabetes Control and Complications Trial (DCCT), published in 1993. The DCCT showed that keeping very tight control over your blood glucose is possible but difficult. The difficult part of keeping your blood glucose close to normal is that you increase your risk of having low blood glucose, or hypoglycemia (see Chapter 4). The DCCT study showed that you can prevent many of the complications of diabetes – including eye, kidney, and nerve disease – by keeping your blood glucose as close to normal as possible. If you already suffer from such complications, improving your blood glucose control very significantly slows the progression of the complications. Since the DCCT, doctors generally treat type 1 diabetes by keeping the patient’s blood glucose as close to normal as is possible and practical.

      If you would like to read much more on the subject of type 1 diabetes, please see my book Type 1 Diabetes For Dummies (John Wiley & Sons, Inc.).

      Having Type 2 Diabetes

      

Edythe Fokel, a 46-year-old woman, has gained about 10 pounds in the last year, so that her 5-foot 5-inch body now weighs about 155 pounds. Edythe doesn’t do much exercise. She has felt somewhat fatigued recently, but she blames her age and approaching menopause. She also blames the fact that she now gets up several times a night to urinate, which she didn’t used to do. She is disturbed because her vision is blurry and her job requires working on a computer. Finally, Edythe goes to her gynecologist after developing a rash and discharge in her vagina. When Edythe describes her symptoms, her gynecologist decides to do a blood glucose test. He refers her back to her primary physician when Edythe’s blood glucose level registers at 220 mg/dl (12.2 mmol/L).

      Edythe’s primary doctor asks her whether other members of her family have had diabetes, and she replies that her mother and a sister are both being treated for it. The doctor also asks Edythe about any tingling in her feet, and she admits that she has noticed some tingling for the past few months but didn’t think it was important. The primary doctor repeats the random blood glucose test, which comes back at 260 mg/dl (14.4 mmol/L). He informs Edythe that she has type 2 diabetes (T2DM).

      The signs and symptoms that Edythe manifests in this scenario, along with the results of the two blood glucose tests, provide a textbook picture of type 2 diabetes. (Type 2 diabetes used to be known as adult-onset diabetes or non-insulin-dependent diabetes.) But be aware that people with type 2 diabetes may have few or none of these symptoms. Because of the varying symptoms, your doctor needs to check your blood glucose level on a regular basis. (I discuss how often you should do this test in Chapter 7.)

      Most people with type 2 diabetes are over the age of 40, but I am seeing more and more cases in children and young adults. Your chances of getting type 2 diabetes increase as you get older. Type 2 diabetes is a disease of gradual onset rather than the severe emergency that can herald type 1 diabetes. Because the symptoms are so mild at first, you may not notice them. You may ignore these symptoms for years before they become bothersome enough to consult your doctor. No autoimmunity is involved in type 2 diabetes, so no antibodies are found. Doctors believe that no virus is involved in the onset of type 2 diabetes.

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