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Diabetes In African American Women - A Primer

Diabetes in African American Women

Many African Americans have Diabetes. According to the American Diabetes Association, 3.2 million African Americans aged 20 years or older have diabetes.

African American are 1.8 times more likely to have diabetes as non Hispanic whites
Twenty-five percent of African Americans between the ages of 65 and 74 have diabetes.
One in four African American women over 55 years of age has diabetes.

Maybe it’s your mother, grandmother, father, aunt, brother, sister or even a close friend. Studies have shown that diabetes is 33 percent more common among African Americans than Whites, and that the highest rates are among African American women. It is extremely important to learn more about this very common illness. You can take steps now to either prevent the onset of diabetes or to better manage the illness if you have already have it.

What is Diabetes?

Diabetes, commonly referred to as "sugar diabetes," is a condition in which the body is unable to properly process the carbohydrates (sugars and starches) we eat. As you may know, diabetes is characterized by high levels of glucose (sugar) in the blood. Let’s take a moment to go over the basics of the problem before we go any further.

Normally, digestion converts the carbohydrates we eat into glucose in the bloodstream. The body responds to elevated glucose levels by releasing a hormone called insulin from the pancreas. Insulin is responsible for reducing the glucose level in the blood by transporting it to cells in the body where it is used for fuel. People with diabetes suffer from either a lack of insulin production or an inability to properly use the insulin that their body makes.

Diabetes can be associated with serious medical complications. Fortunately, there is a lot that people with diabetes can do to reduce the likelihood that major complications occur.

Types of Diabetes

There are 4 major types of diabetes.

Type 1 (also called juvenile-onset diabetes or insulin dependent diabetes)

Type I diabetes usually develops before age 20 and is caused by a lack of insulin production. A small number of African Americans (5-10% with diabetes) have Type I and this is treated with daily insulin injections.

Type 2 (also called adult onset diabetes or non-insulin dependent diabetes)

This type of diabetes usually develops in adults and is responsible for 90-95% of the diabetes in African Americans. In Type II diabetes, the body produces inadequate amounts of insulin. Additionally, the insulin that is produced is not effectively utilized in the body.

Pregnancy Associated Diabetes (Gestational Diabetes)
This refers to patients who develop elevated blood glucose levels during pregnancy. Glucose levels usually return to normal following delivery, but these women have an increased risk for developing diabetes later in life. Gestational diabetes is 80 percent more common in African Americans than Whites.

Medication Induced
People can sometimes develop elevated levels of glucose in the blood after taking certain medications like steroids such as Prednisone.

What are the Signs and Symptoms of Diabetes?

Increased glucose in the blood and in the urine leads to the classic symptoms of diabetes, which include:

Frequent Urination
Increased Thirst
Increased Appetite
Blurred Vision
Weight Loss
Extreme Hunger

Complications of Diabetes

African Americans experience higher rates of complications from diabetes than do White Americans. Perhaps you know a family member or friend who has experienced kidney failure, eye disease, or even an amputation as a consequence of diabetes. By increasing your knowledge about diabetes, you will be able to take steps now that will decrease the likelihood that you will suffer from the complications of this disease.

Blindness: African Americans are almost 50% as likely to develop diabetic retinopathy compared to other populations.
Kidney Disease: African Americans are 2.6 to 5.6 times as likely to suffer from kidney disease with more than 4,000 new cases of End Stage Renal Disease (ESRD) each year.
Amputations: African Americans are 2.7 times as likely to suffer from lower-limb amputations.
People with diabetes can develop a disease affecting the blood vessels of the eye called "Diabetic Retinopathy" which leads to impaired vision and ultimately blindness.
Nerve Dysfunction: Many diabetics develop numbness, tingling and/or generalized decrease in sensation. Often, these symptoms begin in the feet and may migrate to other parts of the body. Careful attention is required to prevent the development of ulcers (especially in the feet).
Atherosclerosis (Hardening of the Arteries): a disease of the arteries (blood vessels) that eventually leads to obstruction of blood flow. Atherosclerosis is more common in diabetics and this leads to increased rates of heart attacks, stroke, and poor circulation throughout the body.

How can you be tested for diabetes?

Diabetes can be easily diagnosed by measuring the amount of glucose (sugar) in a blood sample. There are a few different ways that this simple test is done (a lot depends on how recently you have eaten before the blood sample is drawn !) Your health care provider will be happy to give you further information.

Treatment Options

Type II Diabetes: In the early stages, patients can be treated by adhering to a diet low in sugar and by increasing exercise. Weight loss may increase the effectiveness of insulin, allowing for better glucose control. If diet and exercise cannot adequately control Type II diabetes, then oral medications can be prescribed. Finally, if the oral medications are not enough, insulin injections are required.

Type I Diabetes: As stated above, Type I diabetes has its onset in childhood and patients require insulin to maintain normal blood glucose levels.

Empowerment Points

1. You Can Make a Difference!

Healthy lifestyles are particularly important for people who are at increased risk for developing diabetes. The most common form of diabetes can often be prevented with weight control through healthy eating and participating in regular exercise such as walking, running, swimming or other aerobic activity.

2. Get Tested

If you are overweight, have a family history of diabetes, are over 40, have hypertension, increased cholesterol and/or have the classic symptoms of diabetes (increased thirst, increased urination, and blurred vision) you are at increased risk for diabetes and should be tested.

3. If You Have Already Been Diagnosed With Diabetes

It is imperative that you measure your blood glucose (sugar) on a daily basis. Studies show that aggressive management of diabetes greatly reduces your likelihood of suffering from the complications of this disease.

Also, remember to schedule regular examinations with your doctor. The examination should include:

A yearly eye exam,
Tests to evaluate your kidney function,
An exam of your feet to look for changes in sensation or the development of skin lesions, infections or ulcers,
Your blood pressure should be measured at every routine diabetes visit. If your systolic blood pressure is greater than 130 mmHg or your diastolic blood pressure is greater than 80 mmHg you should have blood pressure confirmed on a separate day, so schedule another appointment.

Also, you are encouraged to lose weight and eat more fruits and vegetables and less fattening foods. (Yes, you can do it!)

References

1. American Diabetes Association. Report of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. 1997
2. Harris MI, Flegal KM, et al. Diabetes Care Vol.21, p 518-24, 1998.
3. American Diabetes Association www.diabetes.org
4. National Diabetes Information Clearinghouse www.niddk.nih.gov
5. American College Of Foot And Ankle Surgeons www.acfas.org

David Pryor, MD
BlackWomensHealth.com