Diabetes: should you be screened?

Philip J. Goscienski, M.D.

February 2008

Someone you know has type 2 diabetes. Can't think of anyone? It's because they don't know it yet!

One American out of 12 has type 2 diabetes. Among persons over the age of 60 it's one out of 5. And for every 2 persons who have already been diagnosed there is another who has not, the "symptom-free" diabetic. The quotation marks emphasize that symptom-free is an illusion. Lack of energy, increased thirst and frequent urination creep up on us so slowly that it's easy to ignore them or to blame these annoyances on aging.

Unlike type 1 diabetes, which can cause obvious symptoms within days or weeks of its onset, type 2 diabetes is a smoldering disease that may take years to notify its victim that the body's chemistry is falling apart. The most practical screening test is a blood glucose (sugar) measurement after an overnight fast. If it's abnormal your physician might want to do a more extensive glucose tolerance test, which is usually the clincher.

Who should get screened, and when? Everyone over the age of 45 years should get a fasting blood glucose measurement at least every 2 years but some of us need to start earlier and make it annual. Twenty years old is a good starting point for several groups: Hispanics, African-Americans, Native Americans, Pacific Islanders and anyone with a family history of type 2 diabetes. Persons who are overweight (10 pounds over ideal weight) or obese at any age should be tested every year and so should women who have had gestational diabetes. High blood pressure or an abnormal cholesterol pattern are so often associated with type 2 diabetes that anyone with these conditions should be screened every year.

When diabetes or prediabetes appear in any family member it's a signal that all close relatives need to be screened for the disease, especially those that are older or overweight.

Screening matters. It may reveal prediabetes, the early stage in which the body has become somewhat resistant to the action of insulin but during which a change in dietary habits and physical activity will prevent progression to frank diabetes. More than half the persons who are willing to avoid refined carbohydrates, lose a few pounds and start exercising several hours a week will postpone or prevent the full-blown disease. Some type 2 diabetes experts refer to it as an exercise deficiency disease and they tell us that persons who exercise several times a week and keep their weight down almost never become its victims.

Early diagnosis makes it more likely that the victim will avoid the worst complications of the disease, such as blindness, kidney failure and limb amputation. These lifestyle-shattering disabilities are costly to the individual and to society and they threaten the financial stability of the healthcare system. That is no exaggeration. The Centers for Disease Control and Prevention estimate that more than a third of today's second-graders will have type 2 diabetes when they reach middle age. If, as is likely, half of them develop complications, the cost of their care will be enormous.

Philip J. Goscienski, M.D. is the author of Health Secrets of the Stone Age, Better Life Publishers 2005. Contact him at drphil@stoneagedoc.com.