Risk Factors and Diagnosis of Diabetes

Risk Factors For Type 1 Diabetes

Medical experts believe that two defects are necessary to get Type 1 Diabetes: an imbalance in the immune system plus exposure to a toxin, such as a virus or an environmental toxin, that causes insulin or the beta cells to become a target for an immune system that is out of balance. One part of the puzzle appears to be heat shock proteins that, despite their unusual name, are involved in the proper folding of the insulin molecule into its natural, active form. When heat shock proteins get damaged or sidetracked during a viral or toxic event, insulin may be released into the blood with abnormal shapes that then attract the immune system. Gradual destruction of the beta cells begins. After many months to a few years, when only 10% of the beta cells are left to make insulin, the blood sugar abruptly rises. Symptoms then begin to develop.

Genes play a role in placing a person at risk for developing Type 1 Diabetes. The strongest genetic links are associated with the HLA-DR and HLA-DQ regions of DNA. These regions are 10 times more strongly linked to Type 1 diabetes than any other genetic region, but they account for only one-third of the total risk. Most people who have these genes will never develop diabetes, and many others who do not have them will develop it. When both parents have Type 1 diabetes, there is only a 20% chance that a child will get it. About 70% of those who develop Type 1 diabetes have a weak inheritance pattern or seemingly none at all. Most often, only one person in a family will have Type 1 diabetes.

Risk Factors For Type 2 Diabetes

The National Institutes of Health (NIH) recommends that people aged 45 and older consider getting tested for diabetes, and the American Diabetes Association (ADA) suggests a routine test every three years for those over 45. If you are over 45 and also overweight or obese, a major risk factor for Type 2 Diabetes, more frequent testing may be necessary.

You should also consider talking to your doctor about testing at any age if you are overweight and have one or more of these risk factors:

  • A parent or sibling with type 2 diabetes.
  • Being of African American, American Indian, Asian American, Pacific Islander, or Hispanic American/Latino descent.
  • A history of gestational diabetes or having at least one baby weighing more than 9 pounds at birth.
  • Blood pressure of 140/90 mm Hg or higher.
  • HDL cholesterol (“good” cholesterol) levels of 35 or lower and/or triglyceride levels of 250 or higher.
  • Living a sedentary (inactive) lifestyle (i.e., exercising less than three times a week).

Diagnosis of Diabetes

One method of diagnosing diabetes is using the Fasting Plasma Glucose(FPG) test. This test measures blood glucose levels after fasting. Normally, fasting causes plasma glucose levels to rise. In people without diabetes, the body will produce and process insulin to counteract the rise in glucose levels. In people with diabetes, this does not happen, and levels will remain high. The ADA recommends having this test administered in the morning because you must fast 12 to 14 hours before the test is given. Also, test during the afternoon tends to give lower readings. This test consists of having blood drawn and tested for glucose levels by your doctor. A fasting blood glucose level between 100 and 125 mg/dl signals pre-diabetes. A person with a fasting blood glucose level of 126 mg/dl or higher has diabetes.

Another method is the Oral Glucose Tolerance Test (OGTT). In the OGTT test, a person’s blood glucose level is measured after a fast and two hours after drinking a glucose-rich beverage. If the two-hour blood glucose level is between 140 and 199 mg/dl, the person tested has pre-diabetes. If the two-hour blood glucose level is at 200 mg/dl or higher, the person tested has diabetes.