Diabetes affects about 21 million people in the US, and much more around the world. It raises our risk for other diseases as well. Here you will learn what it is, and how to avoid it altogether.

Danger level: Medium

Health forums category: Diabetes

What is it?

Diabetes, or by its long medical name diabetes mellitus, is a condition in which there is an abnormally high level of sugar in the blood.

Sugar. You blood is rich in it when you have diabetes. Photo by Uwe Hermann.

Who gets it?

That depends. There are 2 types of diabetes:

Type 2 diabetes:
Even though it’s number 2, this is actually the most common type. 90% of people with diabetes have type 2. This is an adult disease, as opposed to type 1 diabetes, although it is seen more and more in children. There are some risk factors which can put you at risk for diabetes type 2 -

1. Obesity – If you have a high BMI you’re at risk
2. Inactivity – The less exercise you do and the more sedentary you are, the greater your chances are of getting it
3. Family history – If someone in your close family has it, you are more likely to get diabetes
4. Race – People at higher risk include African Americans, Hispanics, American Indians and Asian Americans.
5. Age – As you get older your risk rises.

As Western society gets more sedentary and more fat, so is the disease spreading more rapidly. That is why more and more children get diabetes type 2.

Type 1 diabetes:

This is a disease which usually starts in childhood. No one knows the reasons behind why it develops, but it possibly runs in families (meaning it’s genetic), which means that if someone in your close family has it, your chances are probably higher than the rest of the population.

What causes it?

It all starts with insulin. This is a hormone produced by our pancreas, which is an organ that sits in our abdomen. When we eat, sugars from the food we ate are broken down into a molecule called glucose. Glucose fuels our body. Glucose gets into our bloodstream and then enters the cells in our body, fueling them. It can’t enter the cells, though, unless insulin is present in the blood.

In diabetes, little or no insulin is produced by the pancreas. This causes glucose to stay in the blood and not enter the cells, causing a high level of glucose in the blood (a situation which in medicine is called hyperglycemia).

This video shows it graphically:

Why it happens differs between the two types of diabetes:

Type 2 diabetes:

There are two things happening here:

The first is called insulin resistance, and it happens early in the disease. In this stage, the pancreas produces insulin, but the body is resistant to its effects, for an unknown reason. The pancreas, in turn, produces more and more insulin, until, with time, it produces less and less of it. This is the later stage of the disease.

Type 1 diabetes

In this type, the body attacks its own pancreas. Antibodies, the molecules the body usually uses to fight infections, are used against the body itself. Diseases in which antibodies attack the body are called autoimmune diseases. We covered several of those in the past, including lupus, celiac, Crohn’s disease, vitiligo and others.

The antibodies lead to the destruction of the pancreas, which can no longer produce insulin.

How does it feel?

There’s a groups of symptoms characteristic of diabetes:

1. Frequent urination and Increased thirst – In diabetes glucose builds up in the blood, and the kidneys want to get rid of it. To do this, they produce more urine. This is why people with diabetes urinate more, and as a result feel more thirsty.
2. Extreme hunger – Since sugar doesn’t enter the cells (since there is no insulin to help it do that), the body screams that it needs fuel, causing hunger.
3. Unexplained weight loss – Again, since sugars don’t get into the cells and are lost in urine, there is no weight gain.
4. Fatigue

How is it discovered?

Diabetes is discovered by simply taking a blood sample and watching the level of glucose in it. It can be done after fasting or without fasting. In both these circumstances, the level of sugar in the blood will be excessively high.

How is it treated?

That depends on the type and extent of the diabetes:

In type 2 diabetes, drugs are given which work in several ways to increase the amount of insulin produced by the pancreas, or  increase the body’s responsiveness to insulin. With time, though, the pancreas may stop producing insulin altogether, which may require the use of artificial insulin, which is injected by the patient.

In type 1 diabetes usually insulin, and not drugs, is given, since early in the disease the pancreas gets destroyed and not enough insulin exists in the body.

What happens after treatment?

Diabetes is a life-long disease. If it is discovered early and treated carefully, people can live with it a normal life.

If, on the other hand, treatment isn’t adequate, complications can develop, including:

1. Diabetic ketoacidosis – This is a condition that’s more common in type 1 diabetes. It’s a life-threatening condition in which the body breaks down fat since it is starved for energy. It then turns the fat into toxic acids known at ketones, which are dangerous for the body.
2. Blood vessel problems – Diabetes increases the risk for atherosclerosis, heart attacks and strokes.
3. Nerve damage – Excess sugar in the blood can damage the small arteries which supply oxygen to our nerves, especially the ones in the legs, causing them to get damaged. This can lead to anything from numbness and tingling, to a complete loss of feeling in the legs, which in turn can lead to dangerous infections. These sometimes necessitate amputation of the legs.
   Other nerves which can get damaged include those in our digestive system, which can lead to nausea, vomiting, diarrhea or constipation. In men, the nerves responsible for erection can get damaged as well.
4. Kidney damage – This can lead to failure of our kidneys, which may necessitate dialysis or a kidney transplant.
5. Eye damage – The blood vessels in our retina (a part of our eye) can get damaged, leading to blindness.

The bottom line – How do I avoid it?

If you have type 2 diabetes you can help to prevent it (this unfortunately doesn’t apply to type 1 diabetes, which no one knows yet how to prevent).

You can do this by taking the following steps:

1. Lose weight – If you’re overweight, losing the excess pounds can lower your risk of developing diabetes. You can start by reading our article about using the Internet to lose weight.
2. Get more physical activity – The American Diabetes Association recommends 30 minutes a day of moderate physical activity. They say that if you combine this with a 5-10% reduction in your body fat, you lower your chances of having diabetes by 60 percent. You can read their recommendations for exercise here.
3. Eat healthier – This means foods that are lower in fat and calories. You should instead opt for more fruits, vegetables and whole grains. Again, you can read the American Diabetes Association’s recommendations about diet here.

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Last week, 18-year-old South African athlete Caster Semenya won a gold medal in the 800 meters race at the 2009 World Championships in Athletics. Now she may be forced to return the medal if she fails a gender-verification test imposed by the International Association of Athletics Federations (IAAF). the IAAF are testing to see whether Semenya has a rare genetic disorder that means she has female genitalia but male chromosomes. This disorder is called hermaphroditism.

Caster Semenya.

Danger level: Low

What is it?

Our gender is determined, among other things, by our internal and external sex organs (Such as a penis or vagina on the outside, and a uterus on the inside). In some people, this distinction doesn’t fully exist – they may have both female and male sex organs.

Who gets it?

The numbers change from one study to another, but it is believed that between 0.1% and 0.2% of the population may be born with this condition.

What causes it?

We have 23 pairs of chromosomes in our DNA. These are molecules which hold our genetic material and tell our body how to develop and who we are going to become.

One of these pairs are the sex chromosomes. They are different between males and females. In males this pair is composed of an X chromosome and a Y chromosome. Females, on the other hand, have two X chromosomes.

When we develop in the uterus, our internal organs have the potential to become both male and female. Only at weeks 9-13 of pregnancy do we start developing into either males or females.

We usually develop into females by default unless we have the Y chromosome. This happens since there are certain genes on the Y chromosome which tell our body to develop testicles. Once testicles develop, they secrete a substance called testosterone (among other things), which helps us further develop into males, including a penis.

If we lack the Y chromosome, that gene is absent. In this case, instead of testicles, ovaries develop. Since there are no testicles to secrete testosterone, a female develops, including a uterus, fallopian tubes and vagina.

Some children are born differently, forming a group of disorders in which the above doesn’t necessarily happen:

• Female pseudohermaphroditism – In this case the sex chromosomes are XX and the female has ovaries, but also external male sex organs (penis).
• Male pseudohermaphroditism – They have XY as sex chromosomes, but their external organs are not fully developed or they are completely female on the outside.
• True hermaphroditism – While the above were “pseudohermaphroditism”, meaning they are mostly male or mostly female, in this case there are both testicles and ovaries. These people can appear anywhere from females with a large clitoris to those with male external organs.

We won’t go into details as to why this can happen, since it’s beyond the scope of this article. The reasons generally include problems with the development of testicles, problems with the creation of testosterone and other problems.

How is it discovered?

As you may understand, the condition is visible to the eye in most cases. The diagnosis contains checking the baby’s DNA to understand whether they are females or males by genetics and so understand what they were “supposed” to be.

Other measures include an ultrasound and other imaging techniques which will show which organs exist on the inside.

How is it treated?

Treating the condition involves surgical restoration and psychological support of the whole family. The direction the surgery will take (male or female) isn’t always an easy choice and can affect the child later on in life, as can be seen in this video from the show “without prejudice” (please note that we do not endorse the idea of a $25,000 prize given for people’s misfortunes, and the video is only given here as an example):

There is currently no known way to prevent the condition.

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Danger level: Medium

What is it?

Osteoporosis (the word is in Greek: “Osteo” means bone, and “porosis” means holes) is a condition in which bones become thin and weakened, which makes them susceptible to fractures.

Who gets it?

About 10 million people in the US, and 200 million people worldwide have osteoporosis. One in 3 women and one in 5 men over the age of 50 will experience fractures as a result of osteoporosis.

White people (especially of northern European origin) as well as Asians are at an increased risk. The condition is also more common in women – 4 times more common.

In terms of age, osteoporosis occurs in women after menopause, meaning it’s most common in women in the ages 50-70. Another form of osteoporosis, called senile osteoporosis, isn’t related to menopause and can happen to both men and women, usually after the age of 70.

On top of all of those, there are a few risk factors, which can put you at risk of developing osteoporosis:

1. A family history – Osteoporosis runs in families. If you have a parent or sibling with osteoporosis you are at greater risk of developing it yourself.
2. Your build – Men and women who are very thin or have small body frames are at a greater risk (since they have less bone to begin with).
3. Smoking – Osteoporosis is just one of the many perks you get when you smoke.
4. Excessive drinking – Excessive drinking of alcohol interferes with the body’s ability to build bone.
5. A sedentary lifestyle – Exercise accelerates the process of bone building. Not doing it raises your risk for osteoporosis.

What causes it?

Our bones aren’t stagnant. A process called bone remodeling is always at work, in which new bone (made of minerals like calcium) is formed and old bone is broken down. Early in life (up until our mid 30s or so) this process is even – the amount of bone that is breaking down equals the amount of new bone being formed. At that time, though, the breakdown starts to outpace the building process. This causes the bones to become thinner.

During that time, though, this process isn’t significant.

In women, around age 50-60, menopause occurs. This is the time when the body stops producing the hormone estrogen. As its levels drop, bone loss increases dramatically. This doesn’t mean it doesn’t happen to men, but the process in them is slower, so the disease happens at an older age.

Our bones get thinner and are at a risk of breaking when we reach a certain age. Photo by BillRhodesPhoto.

How does it feel?

In the early stages of the disease usually there are no symptoms, but when fractures start to occur, the symptoms begin. Most of the fractures in osteoporosis occur in the spine, hip or wrist. Symptoms which appear when the fractures occur include:

1. Back pain – Due to fractures in the vertebra.
2. Loss of height, and an accompanying stooped posture
3. The fractures themselves – Which are disabling.

It’s important to note that since the bones are so brittle in this condition, you don’t need a lot to happen in order to have a fracture. Even mild stresses like bending over, lifting a vacuum cleaner or coughing can cause a fracture.

This video explains it:

How is it discovered?

A special x-ray picture called dual energy X-ray absorptiometry (DEXA) is used to detect if you have osteoporosis. It measures the density of bones in the spine, hip and wrist (the areas most involved in the disease). You should consult you doctor about taking this test if you’re a woman and you’re older than 65, post menopausal or have any of the other risk factors mentioned above.

How is it treated?

There are a few ways to treat osteoporosis:

1. Medications – A group of drugs called bisphosphonates are the most common drugs used to treat osteoporosis. They inhibit the process in which bones are broken down, thereby slowing the disease process.
2. Calcium – Since calcium is a mineral used in building bone, supplementing with it is one of the treatments for osteoporosis. In order for calcium to absorb better in the body, you should also take vitamin D.
3. Exercise – Doing aerobics, weight bearing exercises and resistance exercises help in the building of new bone and the slowing down of the disease.

What happens after treatment?

It’s important to not reach a stage when the fractures occur. Hip fractures, for example, can lead to complications (such as deep vein thrombosis and others), and can lead to major disability and even death.

If you do adhere to the treatment, though, you will most probably die with the disease instead of from it.

The bottom line – How do I avoid it?

1. Exercise – It’s recommended that you get at least 30 minutes of exercise each day to strengthen your bones and prevent osteoporosis. Exercise stimulates your bones to create new bone. Examples of exercises you can do include aerobics, climbing stairs, dancing, jogging, running and walking.
2. Get enough calcium and vitamin D in your diet – Not getting enough calcium will cause your body to break down bones (which contain it) when it needs it. Eating low-fat or fat-free dairy products and other calcium-rich foods, or even taking calcium supplements, can help prevent osteoporosis. Since vitamin D helps the body absorb calcium, taking it is also important.
3. Quit smoking
4. Don’t drink too much alcohol
5. Don’t drink too many soft drinks – Especially cola drinks, since the extra phosphorus in them binds with calcium and prevents it from being absorbed in the body.

Know any tips of your own to prevent osteoporosis? Share them in the comments.

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Danger level: Medium

What is it?

Paget disease is a condition that affects the growth of bones, causing them to be enlarged and deformed.

Who gets it?

In the US, Paget disease affects 3-4% of people older than 40 (it’s uncommon before age 45). It’s more common in African Americans (and rare in Asians).

Paget disease is almost twice as common in men than in women.

What causes it?

Even though we all know bones as hard, rigid and unliving things, they are actually a living tissue like any other tissue in our body. They constantly grow and break down. Cells in the bones named osteoblasts are responsible for growing the bone, while cells called osteoclasts are responsible for breaking it down, so that in the end the result is an even bone.

In Paget disease, this breakdown of bones is faster than normal, and to keep up with it, the body builds bone much faster. The problem is that the new bone which was built in such a hurry is weaker and more brittle, which causes it to break more often. The bones which are most involved in the disease are those in the pelvis, the spine, the skull, the arms and the legs.

The cause for this phenomenon is unknown. It might be related to a genetic cause or to viruses.

Paget disease affects the bones. Photo by D’arcy Norman

How does it feel?

Most people don’t feel anything. When they do, the symptoms have something to do with the defective process in the bones:

1. Pain – It can develop from a bone that’s affected by the disease or from complications such as inflammation of the joints (arthritis).
2. Fractures – Since the new bone that develops in the disease process is weaker, fractures are more common.
3. Deformities in the bones – When the bone breaks down and builds up properly, the new bone that forms is even. In Paget disease, the new bone doesn’t grow naturally, and so it’s distorted or deformed. For example, the legs may get a bow shape or the skull may be bigger.
4. Related problems – The growth of bone in the skull can cause things related to its location – such as problems with hearing, since the new bone presses on a nerve. When it’s near the spine, it can cause weakness. And so on, depending on the area where the disease is.

How is it discovered?

Usually, since most people have no symptoms of the disease, it’s discovered by chance when you go to a doctor for a different reason. There are two ways to discover it:

1. By an X-ray image – The thickening or deformity of the bones will be seen. You can see an example of such a deformity here.
2. By a blood test – The cells responsible for bone creation (osteoblasts) produce an enzyme (a molecule that’s responsible for reactions in the body) called ALP. Since these cells work overtime, the level of this enzyme will be high.

How is it treated?

The main treatment is with drugs called bisphosphonates – they inhibit the osteoclast cells, which in turn inhibits the breakdown of the bone. Another treatment are pain killers.

If a joint was affected by a nearby disease, a surgery might also be needed to replace the joint.

What happens after treatment?

If treatment is started before any bone deformities occur, the outlook is usually good.

In less than 1% of people with Paget disease, tumors of the bone might develop with time (both cancerous and noncancerous).

The bottom line: How do I avoid it?

There is no known way to avoid it. You can, however, avoid the complications by taking the treatment.

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2. Graves Disease – Why Some People Are Hyperactive For A Reason
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Danger level: Medium

What is it?

Hashimoto’s Thyroiditis (or in short Hashimoto) is a disease that affects the thyroid gland, causing it to function less than it should.

Who gets it?

As many as 3.5 out of 1000 women, and 0.8 out of 1000 men have Hashimoto’s in the United States (all over the world it’s around 0.3-1.5 per 1000 people).

As you can see, it’s about 10-15 times as common in women than in men. The most common age of getting Hashimoto is 30-50.

What causes it?

Hashimoto is an autoimmune disease – This means the body’s immune system, which was meant to attack infections, attacks the body for some reason. (We discussed other autoimmune diseases here previously, like Graves, Lupus, Celiac, Myasthenia Gravis, Vitiligo).

In Hashimoto, antibodies (the molecules of the immune system) attack our thyroid gland.

Our thyroid gland produces hormones called T3 and T4, which are responsible for a few things in our body:

1. Increasing our metabolic rate, or energy
2. Help with the growth of bones
3. They increase our sensitivity to adrenaline

These are just some of their roles.

Since in Hashimoto the thyroid is attacked, less hormones are produced.

The thyroid gland in the neck. The body attacks it in Hashimoto.

How does it feel?

The condition that is caused by a lack of thyroid hormones is called hypothyroidism (there’s a name for it since this disease isn’t the only one that causes it. We’ll discuss others that do the same thing in the future).

Here are the features of hypothyroidism -

1. Loss of energy
2. Difficulty losing weight
3. Cold extremities
4. Sensitivity to cold
5. Difficulty concentrating
6. Depressed mood
7. Hair loss
8. Dry skin
9. Constipation
10. Fluid retention
11. Muscle pain and cramps

These are just the main symptoms. There are even more. This video sums it all up nicely -

How is it discovered?

To discover the disease, blood tests are performed. In them, the doctor will look for levels of the thyroid hormones, T3 or T4, and for the levels of a substance called TSH, which rises in hypothyroidism (to understand why, you can read about Graves disease, where the “feedback mechanism” is explained). Another thing that can be tested is the levels of the antibodies that attack the thyroid.They can also be found in the blood.

The problem is that not every doctor will think about this disease on time, since the symptoms above might hint at other diseases, such as depression.

How is it treated?

The treatment is very simple – your doctor will give you a drug called L-thyroxine, which is simply a synthetic version of the thyroid’s T4 hormone.

What happens after treatment?

With the appropriate treatment, people with Hashimoto can lead a normal life.

It’s important to remember that treatment is necessary – Without treatment, a state called a myxedema coma can develop, which has a 60% chance of mortality.

The bottom line – How Do I avoid it?

There are cases when Hashimoto might be more common, and in these cases it’s recommended to test the TSH levels in the blood once a year. These cases include:

1. Elderly people: Hypothyroidism is more common in the elderly. The symptoms in the elderly might me more subtle, so they might not even suspect having it.
2. People with other autoimmune diseases, such as Addison disease, type 1 diabetes, vitiligo, pernicious anemia, lupus.
3. People who have the disease running in their family.
4. People with Down syndrome, or with Turner syndrome.

Detecting the disease early on will not prevent it, but might lead to an earlier treatment.

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