Do you know anyone who has had a heart attack? Or who has gone on dialysis? Or who has had a toe, foot, or finger amputated? I hope the answer to all those questions is a resounding “No.” But chances are that you said “Yes” to at least one of them.
Heart disease is a major cause of death in America. Data from the Centers for Disease Control and Prevention (CDC) show that in recent years, more than 610,000 people per year died from heart disease. Kidney failure—which requires dialysis for treatment—afflicts another 661,000 Americans. Risk factors for these well-known diseases include some that are very visible, like smoking and obesity. Other risk factors can sneak up on you, like high blood pressure, high cholesterol, and diabetes—the “silent killers.”
Diabetes is known as a silent killer because people often don’t have any symptoms or may miss the symptoms altogether, especially early in the disease. In fact, the CDC estimates that in 2018, there were 1.4 million Americans ages 18-44 with undiagnosed diabetes. That’s on top of the 3.6 million Americans in this age group who were aware of their diabetes diagnosis.
Some early symptoms of diabetes (known clinically as Diabetes Mellitus or DM) are easy to overlook, such as fatigue, excessive thirst, and frequent urination. Everyone has days when they feel tired, but if you’re getting enough sleep and you’re still tired, don’t dismiss your fatigue. And of course, feeling thirsty or needing to urinate can be related to your hydration level. Maybe you’re feeling thirsty because you actually haven’t been drinking enough water (not uncommon in a busy, physically demanding job) or you have to urinate because you really have been drinking a lot of water. If this describes you on one or two days, then it probably is just related to your hydration level. But if you’re feeling as if you’re thirstier than other lobstermen or you notice that you’re going to the bathroom more frequently these days, then maybe it’s time to talk with a healthcare professional. Other symptoms of diabetes include weight loss, blurry vision, poor wound healing, and tingling or loss of feeling in your fingers and toes.
Do you have a family history of diabetes? Both types of diabetes (Type 1—typically beginning in childhood, and Type II—adult onset) tend to run in families, although we still don’t understand exactly how they are inherited. Part of the challenge of understanding diabetes is that both genetic and environmental factors play a role in who develops the disease. If you have a family member with diabetes, you are at increased risk, but that risk may be because you’ve been exposed to the same environment and lifestyle as your parents or siblings. Even if you are healthier than most of your family, it’s reasonable to consider getting screened with a simple blood test periodically to be sure that diabetes isn’t sneaking up on you, too.
You may be wondering, “What does it mean to have diabetes or high blood sugar? I thought my body needed sugar to function.” Our bodies are incredible and use many different molecules for energy, including protein and fat, but all of our tissues can readily use glucose, a form of sugar. When our bodies are functioning well, they regulate how much glucose is in our blood at any given time. This regulation is accomplished by the pancreas, which makes insulin.
When blood sugar levels are high, insulin is released by the pancreas. This insulin then acts as a signal to cells that excess sugar is circulating in the blood and needs to be absorbed. The cells respond to the insulin signal and absorb the glucose from the bloodstream, thus bringing the glucose levels back down.
In adults, diabetes usually develops along a spectrum going from “pre-diabetes,” also known as insulin resistance, to full-blown diabetes. In pre-diabetes, your body’s cells stop reacting normally to insulin. At this stage, your cells are like unruly teenagers. Even though the pancreas is making insulin and telling your cells what to do, your cells aren’t listening, and they don’t absorb the excess glucose. This is known as insulin resistance. In this scenario, your blood glucose levels will stay elevated. If you don’t address the pre-diabetes at this point, then full-blown diabetes can develop. After working really hard to make a lot of insulin—which is akin to the pancreas yelling at your cells all of the time—the pancreas can begin to wear out and stop producing enough insulin—kind of like a parent who gets tired and gives up trying to discipline their teenager. Eventually, the pancreas can become completely overwhelmed and may stop making insulin altogether.
Why does diabetes start and how do I prevent it? As mentioned earlier, it can be complicated. Many factors can contribute to the development of diabetes. In 2018, 89% of adults diagnosed with diabetes were overweight and 38% were physically inactive. Please note that being overweight and physical inactivity are related but different risk factors!
Diet is the main driver of weight gain, as well as the main tool in weight loss. When someone is overweight or obese, their body has more volume and more cells, which means that the pancreas has to work harder to make enough insulin to circulate throughout the body. We’re not entirely sure why, but the cells also become more resistant to insulin. Weight loss can reverse the volume problem and exercise (even independent of weight loss) has been shown to help reverse insulin resistance. If you are diagnosed with diabetes, don’t give up. Work with your healthcare professionals to get healthy again. With diligence and determination, you can control and even reverse diabetes.
So how do you catch this silent killer before it’s too late? There are several things you can do. First is to be aware of the disease and know what the symptoms are so that you don’t dismiss them. This includes watching out for your fellow crewmembers and helping them notice these symptoms in themselves, too. Second, discuss your risk of diabetes with your healthcare professional and ask about screening. In the past, getting checked for diabetes involved having blood drawn after fasting, but now, your doctor is most likely to use a test called a hemoglobin A1c, usually just called an “A1c.” This test does not require you to fast. It’s more helpful than a fasting blood glucose test because it gives your healthcare professional a better idea of what your average blood sugar has been over the past 3 months. And third, focus on fending off diabetes altogether with healthy lifestyle choices, such as eating a balanced diet, exercising regularly, only drinking alcohol in moderation, and not smoking.
Preventing diabetes is far easier than treating it. As a community, we can support each other in making healthy choices and fending off this modern disease.