He’s in his 70s and is mistaken for being in his 50s because he’s in excellent shape, so I was stunned to find out that he has diabetes. He has to give himself two shots every day of insulin. Everything else with his health is totally perfect. He doesn’t have high cholesterol, heart problems or anything else. He is still approved to pilot his own planes (his hobby) so he’s in good shape. I’m just scared about the diabetes. His dad lived to 94 and that’s what I need for him to do. Will diabetes shorten his life if he carefully manages his diet and continues to look after himself?
Atomic Bologna – You’re going to die sooner or later too. So will your parents, grandparents and everyone else you’ve ever loved. That’s life. Try showing decency while you’ve still got yours.

I recently found out that my grandfather has adult-onset diabetes, and I know it’s not that uncommon for older adults to develop this, but I thought it mainly occurred in people who are overweight. He is in his 70s and seriously looks like he’s in his 50s, and has never been overweight. He was an athlete growing up and continued to be on competitive crew teams through his 30s, and he still runs marathons and pilots his own planes. He’s never been fat. He does eat meat, but mainly just fish and poultry. I’ve been trying to get him to go vegetarian for a while but he won’t.

So why is this happening to him? He doesn’t eat that much sugar at all. Nothing else is wrong with him. He had to get this total physical two months ago to get approved to get his pilot license’s renewed and they said he was in perfect health, and then he got diabetes. I thought this mainly just happened to overweight people and poor eaters.
It’s not a genetic issue. Nobody in our family has diabetes, and his parents lived till their 80s and 90s. All his siblings are still alive and well, and none of them have it. His kids and grandkids don’t have it either.

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…in other words is it always associated with weight, or can a person who is skinny but still eats a bad diet get type II?
Also, what if the person is skinny not because of metabolism, but because they don’t eat very much? Is insulin level affected by this?

It used to be clear that Juvenile, or Type-I diabetes, occurred only with children, and Type-II (“Adult Onset”) diabetes occurred solely among adults. While Type-I diabetes remains a problem of the young, and has a different etiology than Type-II diabetes, both are climbing in incidence. Each has a different cause, and can be treated in different ways.

The classic definition of Type-I diabetes was a reduction in the ability of the pancreas to produce insulin. The insulin-producing parts of the pancreas, the Islets of Langerhans (a good trivia question on your college biology exam), would somehow lose their ability to produce insulin. As a result, children of otherwise normal weight and constitution would need to move relatively quickly to treat their affliction, or die in a diabetic coma.

Recently, we’ve learned that much of Type-I diabetes occurs because children develop a form of auto-immune reaction to their own pancreatic cells. This hyperreaction to the body’s own cells results in a destruction of the Islets of Langerhans, and results in a lifelong need to replace insulin production with injections.

Type-I diabetes is a serious pathology, which can lead to much-increased levels of blindness, heart disease and neuropathies. If not treated properly, Type-I diabetics can contract diabetic ulcers of their feet and legs, leading to amputation.

We’ve seen a revolution in diabetes treatment with long-term insulin, better diagnosis, and, more recently, insulin pumps. The longer-lasting insulin gives the body a chance to respond in a more normal way to spikes in glucose levels. Diagnosis has been improved through the institution of glycosylated hemoglobin tests, which are more reliable in predicting longer-term glucose levels. Finally, insulin pumps have allowed Type-I diabetics to better match their insulin production with their food intake, thus reducing the deleterious effects of too high glucose in the bloodstream.

Type-II diabetes has been called “adult onset,” as it is closely linked to obesity caused by consumption of high-sugar, high-fat diets and a lack of exercise. Once exclusively a preserve of adults, Type-II diabetes has become an increasingly-common fixture amongst teens. It’s estimated that 13% of teens today have Type-II diabetes in the US.

This syndrome of early stage obesity and resulting Type-II diabetes was almost unknown 20 years ago. The proliferation of junk foods and a sedentary lifestyle have caused the obesity epidemic, which in turn has resulted in an epidemic of Type-II diabetes throughout the population.

Type-II diabetes affects the body in much the same way as Type-I diabetes over the long term. While some people with Type-II diabetes can become insulin dependent, some drugs (such as glucophages) can diminish the deleterious effects of excess insulin and glucose circulation. People with Type-II diabetes nevertheless encounter higher incidences of heart disease, estimates are three to seven times as high as non-diabetics’ and related diseases, such as strokes, neuropathy and kidney disease.

It is clear that more exercise and weight loss can reverse the diabetic effects of insulin resistance. Since few obese patients are willing or able to increase exercise or reduce caloric intake, many are condemned to suffer the lifelong consequences of diabetes.

Type-I diabetes will be treated in the future by drugs and devices which reduce the body’s tendency in some people to attack its own cells. Anti-inflammatory drugs, immune suppressants and, in the future, more targeted drugs will improve the outlook for such people. Better and earlier diagnosis, coupled with this better therapy, will reduce the overall rate of Type-I diabetes.

Type-II diabetes, on the other hand, will continue to climb dramatically, along with the rate of obesity in this country. Without a clear strategy to reduce obesity, we must resign ourselves to the fact that more and more people will suffer from Type-II diabetes, and the resulting co-morbidities.