Dan Rehmann thought a change in the weather made his mouth dry in the middle of the night.
"I thought it would go away," Rehmann said. "The dry mouth continued for a couple of weeks. Then, I began getting up in the middle of the night having to urinate, and I also had excessive thirst and blurred vision. I would drink almost a half-gallon of water in about 10 minutes."
Rehmann, 33, scheduled a physical and described his symptoms to a doctor, who conducted tests for diabetes. Four hours later, a clinic staff member called and urged him to go to the nearest emergency room.
His blood sugar level had climbed to 563. A normal fasting blood sugar level is 80 to 110. The numbers indicate the milligrams of glucose per deciliter of blood.
"Most of the staff were pretty surprised, as was I," Rehmann, who has no family history of diabetes, said.
Rehmann became one of more than 14 million people in the U.S. who have been diagnosed with diabetes, a condition characterized by the hallmark of consistently high blood sugar levels.
Blood sugar refers to the amount of glucose, which supplies the body with energy, in the blood. The pancreas makes the hormone insulin, which helps the sugar get into the cells to provide that energy. When insulin is low, absent or the body resists it, the sugar remains in the blood, causing increased thirst and urination. It may also damage blood vessels, leading to many complications.
A blood sugar level that is too low is called hypoglycemia, also a dangerous condition. Symptoms include fatigue, confusion, irritability and loss of consciousness. When the blood sugar level gets too high, it is called hyperglycemia. This condition can lead to long-term health problems involving eyes, kidneys and nerves.
Doctors conducted tests and determined that Rehmann had not suffered any heart problems or other complications. He was diagnosed with type 2 diabetes, which is not considered as dangerous as type 1 diabetes.
In many cases of type 1 diabetes, the pancreas may not produce any insulin. Although some of these cases used to be called juvenile onset diabetes, type 1 diabetes can affect adults and children. Type 1 diabetes often involves more severe symptoms than type 2 diabetes, though experts stress that both conditions require attentive treatment.
Type 2 diabetes is the more common form, accounting for 90 percent of all cases. It also has been called non-insulin dependant diabetes and adult-onset diabetes, but it is becoming more prevalent among children as obesity rates increase.
"Regrettably, both can happen at all ages," said Dr. Larry Deeb, president of medicine and science with the American Diabetes Association. "Obesity is everywhere, including younger kids. A lack of activity is everywhere, including younger kids. Fat is insulin-resistant."
Type 2 diabetes may develop when cells become insulin-resistant, meaning they do not respond to normal levels of the substance. Glucose builds up in the blood and does not get to the cells to provide energy, and the pancreas often loses the ability to produce insulin.
Symptoms of type 2 diabetes often develop so gradually that some people might not notice them until after a doctor points out the symptoms. The American Diabetes Association reports that 6.2 million people with diabetes are undiagnosed.
"It's already ticking the clock and causing damage to your kidney and eyes," Deeb said. "We need to diagnose it and get it treated to prevent that damage. The only way to know is to see a doctor and get tested. Not knowing doesn't do your health any good. You don't feel bad until it's too late."
TreatmentsType 1 diabetes is treated with insulin, which can be delivered by a syringe, an insulin pen, jet injectors and pumps.
There are different methods to treat type 2 diabetes and reduce the risk of long-term problems. Treatments -- including diet and exercise plans, insulin, and oral medications that make the body less resistant to insulin -- can help a diabetic patient manage the disease.
"We used to talk about starting diabetes treatment in type 2 with diet and exercise," Deeb said. "If that didn't work, they'd go on drugs. Now, the idea is to just start drugs right away. It's an admission that we're just not motivating enough people to exercise as they need to, and to eat correctly.”
"Diet and exercise, when applied vigorously, can help control diabetes. We know we can prevent diabetes with diet and exercise. But for a lot of people, that's hard to do."
Rehmann's initial stage of treatment included a medication used to reduce blood sugar.
"Through exercise and diet, I no longer need to take it," Rehmann said. "I really cut back on pasta, refined carbs -- sugar and flour -- and no longer drink any soda."
About one year after his diagnosis, Rehmann's A1c test was 6.1 percent. Deeb said that a diabetic actively participating in the treatment plan should not be satisfied with a result above 7 percent.
The test provides the average blood sugar level over a three-month period.
"One of the major failures in American medicine is that too few people have diabetes well-controlled," Deeb said. "You should insist that it is treated until that A1c gets down. You should not be complacent with an A1c that is not below 7. At 10.2, everything's not fine. You have to push, but it is manageable."
A treatment plan should be discussed with a doctor. Serious complications can result if diabetes is not treated. Those complications include heart disease and stroke, high blood pressure, blindness, kidney disease, nervous system disease, amputations, dental disease, and complications linked to pregnancy.
"Many times, if diabetics manage the disease properly, they will end up leading better, healthier lives than people who eat whatever they want," Rehmann added. "It's a very manageable disease, but also a very serous one if ignored."
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