By Monica Northington MD, MPH
Jackson Advocate Guest Writer

If you’re a Black person in the United States, especially if you live in the South, then you know one or more people with “sugar.” You may even have it yourself. Most people have heard of this disease, but they don’t understand it or how it affects the person who has it.

When people say they have “sugar,” they mean they have diabetes mellitus. Diabetes affects over 34 million people in the United States or about 10% of the population. Non-Hispanic Black people account for 11.7% of all diabetes cases, behind American Indians/Alaska Natives (14.7%) and Hispanics (12.5%). Diabetes is an expensive disease, accounting for $327 billion in health care expenditures by 2017 estimates.

Diabetes is prevalent in what has become known as the “diabetes belt,” which includes the state of Mississippi and 14 other states, mostly in the South. It is not surprising that these states have high incidents of diabetes, given our love of Southern cuisine and buffet restaurants. The foods we love the most tend to be high in refined sugars and fats. And because we watch more sports than we participate in, we tend to carry excess weight more than our fellow Americans in other parts of the country.

Diabetes is not a single disease; rather, it is a group of disorders that affect the way a person’s body processes glucose (“sugar”) from food in order to provide fuel for the body. In order to metabolize glucose, the body requires insulin, which is a hormone produced by the pancreas. When cells don’t properly process glucose, the excess remains in the bloodstream.

There are four types of diabetes. Type 1 diabetes involves inadequate production of insulin by the pancreas. This type of diabetes is most commonly diagnosed among children and young adults. However, given the high incidence of childhood obesity in the past two to three decades, individuals in younger age groups are now diagnosed with Type 2 diabetes with increasing frequency.

Type 2 diabetes, the most commonly diagnosed type of diabetes, involves the inability of the body’s cells to utilize the insulin made by the pancreas. This failure to effectively use insulin to metabolize glucose is known as “insulin resistance.” This is the reason people with Type 2 diabetes require insulin injections and/or oral medications to bring their blood glucose levels into a normal range.

Gestational diabetes sometimes occurs in pregnant women. This type of diabetes is usually transient, resolving once the baby is born. However, if a woman develops gestational diabetes, it puts her at higher risk to develop Type 2 diabetes later in life.

The fourth type of diabetes is not technically diabetes at all. It is known as “prediabetes,” and in this state, blood glucose levels are elevated, but not elevated enough to be classified as Type 2 diabetes.

People are often unaware of their diabetes until they seek medical attention for symptoms of abnormal glucose metabolism, such as polydipsia (excessive thirst), polyuria (frequent trips to the bathroom), confusion, disorientation, dizziness, unexplained weight loss, fatigue, or blurry vision. Occasionally, borderline to moderate elevations of glucose will be discovered on routine blood tests, or the presence of glucose will be detected on routine analysis of the urine.

Once your medical provider diagnoses you with diabetes, a treatment strategy will become necessary. Close management and regulation of blood glucose levels is of prime importance. Your provider may prescribe insulin, oral hypoglycemic agents, or a combination of the two. You will also need careful and continuing education about dietary intake, weight management, and exercise in order to keep blood glucose levels as close to normal as possible.

Poor management of diabetes with prolonged elevated glucose levels can lead to detrimental effects. High glucose levels in the bloodstream damage the body’s organs and tissues, such as the heart, the kidneys, the eyes, and the nerves. This damage occurs at the level of small blood vessels, and it affects blood flow to the lower extremities as well. At its worse, this results in ulcers, infection, tissue death, and amputation of limbs. Death from diabetes usually occurs indirectly, through organ damage resulting in heart attack, heart failure, stroke, kidney disease, or complications from amputations. Acute episodes of extremely high blood glucose levels can result in a condition called diabetic ketoacidosis or in another condition known as hyperglycemic/hyperosmolar syndrome. These are life-threatening conditions that require timely, aggressive treatment in an ER or ICU, and they may result in prolonged hospitalizations or even death.

Despite the risk of these undesirable outcomes, people with diabetes can lead perfectly normal lives, with minimal interruptions of daily activities due to the need for checking glucose levels, injecting insulin, or taking oral medications to regulate their blood glucose. With recent advances in medical technology, such as insulin pumps and subcutaneous glucose monitoring, there are even fewer interruptions in one’s daily routine. Through adherence to dietary modification and regular exercise, prediabetes is completely reversible, and patients with Type 2 diabetes may successfully lose weight and reduce or eliminate their insulin and oral hypoglycemic medication requirements.

As with most diseases, early detection and prevention are the most valuable weapons in the fight against diabetes. Establishing a relationship with a primary care provider is the first step. Your provider will get to know your personal medical history and your family history. Then, they will recommend appropriate screening tests to determine if you have diabetes. If you have diabetes, they will design a treatment plan for you and also schedule routine follow-up visits to make sure you remain on track with your glucose monitoring and therapeutic goals for managing your diabetes.