URJHS Volume 10

Type 1 and Type 2 Diabetes:
Causes, Treatments, and Manifestations in Several Different Ethnicities

Tyler Ben-Jacob
Binghamton University

Abstract

Diabetes is a rapidly growing disease across the world. It manifests itself by unusually large amounts of sugar in the blood and urine and afflicts various populations. There are numerous causes for this disorder, and genetics often plays a role. This paper discusses types of diabetes, their causes, and the treatments. Diet, medical care, and self-management techniques play roles in dealing with diabetes.

Introduction

Diabetes is a disease caused by flawed carbohydrate metabolism and manifests itself by unusually large amounts of sugar in the blood and urine (Jacobs & Fishberg, 2002, p. 1). There are numerous causes for this disorder, some strengthened by genetic predisposition. This paper will focus on the disorder as it manifests itself in the Jewish, Latino, and African-American populations with regard to diet, access to medical care, and compliance with self-management techniques.

Discussion

 A rapidly growing disease across America and the world is diabetes, lesser known as diabetes mellitus (Marso & Stern, 2004, p. 179). There are 20.8 million children and adults in the United States, or 7 percent of the population, who have diabetes. Diabetes is a syndrome in which the afflicted person has a distorted metabolism. There are three traditional types of diabetes: type 1, type 2, and gestational diabetes. Type 1 diabetes is expressed as loss of beta cells that produce insulin, leading to an insulin deficiency. Type 2 is characterized as diabetes due to insulin sensitivity, combined with reduced insulin secretion. Gestational diabetes bears a resemblance to type 2 diabetes in that there is also inadequate insulin responsiveness and secretion. The newest addition to the traditional types is a new variation on type 2 diabetes. It is called Mature-Onset Diabetes of the Young or MODY. Most forms of type 2 diabetes occur in older, overweight individuals, but MODY tends to develop in younger people who are not necessarily overweight or sedentary. Both MODY and type 2 are similar in the sense that they occur when the pancreas does not make enough insulin (Ruhl, 2008, p.1). Metformin treatment in adolescents who are obese can modestly reduce risk factors for type 2 diabetes, including elevated body mass index (BMI), fasting insulin levels, and fasting glucose levels (Rodriguez, Shearer, & Slawson, 2007, pp. 1357-8).

Some of the symptoms that most people with diabetes have are high blood pressure and cholesterol. More than 65 percent of the population with diabetes dies from a stroke or heart disease (All about diabetes-ADA, n. d., p. 2). Other symptoms are what professionals call characteristics of “pre-diabetes” (House, Seale, & Newman, 2008, p. 38). The symptoms in the case of pre-diabetes include a higher than normal level of blood glucose but not high enough to diagnose it as diabetes (All about diabetes-ADA, n.d., p. 2).

There are differences between type 1 and type 2 diabetes. The following chart compares and contrasts the two types from several points of view.

“Type 1 Diabetes (IDDM) Insulin-Dependent Diabetes used to be-Juvenile-Onset Diabetes	Type 2 Diabetes (NIDDM) Non-Insulin Dependent Diabetes used to be-Mature Onset Diabetes
10-15% of cases Beta cells within the Pancreas produce little or no insulin, due to an autoimmune system malfunction. Can be due to a virus or other environ-mental agent. Exact cause is still a mystery. Treated with insulin. Various delivery options are available plus: Regular meals with even carbohydrate distribution to match insulin dosage. Regular exercise and weight control are recommended.	85-90% of cases Insulin is produced but body cells resist its action and glucose cannot enter cells. This is strongly associated with lifestyle factors such as obesity, inactivity and family history. With early detection can often times be treated with diet and exercise. Sometimes requires medication (pills, insulin and/or combination therapy). Alternative therapies in combination with medical therapy/diet & exercise, is being tried and proving very helpful under certain conditions and with many individuals
Some Warning Signals	Some Warning Signals
Frequent urination Continual thirst Rapid weight loss Unusual hunger Extreme weakness/fatigue Nausea, vomiting, irritability	Any type 1 symptom Blurred vision Excessive itching Skin infections with slow healing Tingling/numbness in feet  (All about diabetes- JDA, n.d., p. 1)

Statistics show that diabetes occurs among Jews from two to six times as often as it does among non-Jews of European races; thus, although this statistic does not specifically mention it, it is referring to Ashkenazic Jews (Jacobs & Fishberg, 2002, p. 2). Today, 7.2 percent of all Israelis (Jews) have diabetes (Mendosa, 2002, p. 1). Given the different backgrounds of the Jewish group in question, there appears to be various reasons for diabetes running through the Jewish population.

Diabetes is really a disease of the developed world, and this is supported by the Ethiopian Jews now living in Israel. Before they immigrated to the Holy Land, i.e. when they lived in Africa, diabetes, high blood pressure, and heart attacks were virtually non-existent for this group of people. Now, 17 percent of the 75,000 or so Ethiopian Israelis have diabetes. The cause of the onset of the disease to this group of people is attributed to the dramatic change in lifestyle. In Africa most of them lived a primitive farming lifestyle, and when moving to Israel their diets became much more fatty. Also, there is an excessive amount of stress in their lives now. Many are unemployed. They need to learn Hebrew, a totally new language, and they need to adapt to a totally new culture. It has been noted that diabetes seems to crop up in immigrant populations all over the world. This links the disease to stress as a significant cause (Lewis, n.d., p. 1).

Another group of Jews living in Israel who have a link to diabetes is the Israeli Yemenite community. They have shown a remarkably rapid increase in the frequency of type 1 diabetes (Weintrob et al., 2001, p. 1). This community has the highest rate of all Israeli ethnic groups. Studies have concluded that there appears be two main causes for the rapid increase in the occurrence of diabetes in this group. The first one is that there has been a dramatic change in the body size of the average Yemenite over the last twenty years. It has increased from an average weight and height in adult males of 36 kg and 160 cm to 63 kg and 171 cm. The increase in size is linked to obesity and insulin resistance (Weintrob et.al, 2001, pp. 1-5).

Studies have also shown that the Yemenite Jews carry a highly susceptible HLA class II gene for the development of type 1 diabetes. Yemenites tend to marry other Yemenites, and if the low rate of mixed marriages and few preventive manipulations do not change it is predicated that the percentage of Yemenite Jews with type 1 diabetes will increase dramatically. The results of molecular HLA class II typing of the Yemenites differ considerably from the other Jewish communities in Israel, so mixed marriages over the course of years should help ameliorate this difficulty (Weintrob et al., 2001, p. 5).

Ashkenazic Jews who have diabetes carry a gene called the HNF4; this gene causes type 2 diabetes and MODY. When this gene is not in good shape, so to speak, it affects post-meal insulin secretion, not fasting blood sugar (Touchette, 2004, p. 1). This in turns means that if a person is suffering from diabetes because of this gene, it is harder to detect because most doctors do a fasting test. When testing for diabetes, if a person suspects that he is diabetic and he is Jewish, it is recommended that he makes sure his doctor tests his post-meal blood sugars, not just the fasting blood sugar (All about diabetes –JDA, n.d., p. 2). Because this is a genetic deficiency, Ashkenzic Jews marrying others of the same group will not ameliorate the situation.

Though there is no antibiotic cure for diabetes, there are some methods of keeping this disease in check. The first (the most common and has seemed most effective over the years) is the consumption of insulin by way of a hypodermic needle or an insulin pump, which resembles a beeper (All about diabetes-ADA, n.d., p. 4). The other way is a lifestyle change in which persons reduce their dependency on insulin. These two methods can be combined. This means that by changing the way a person eats (Carson, Burke, & Hark, 2004, p. 197) and exercises, he/she can live and have a lifestyle as healthy as a regular person who does not have diabetes. This method is fully outlined in the 30 Day Diabetes Miracle, a book written by Dr. Franklin House, Dr. Stuart A. Seale, and Ian Blake Newman. The book is about changing your lifestyle, living healthier, and setting limitations on your diabetes. The goal is that you run your life and control the diabetes as opposed to the diabetes controlling you and running your life.

Diet is very important with regard to controlling diabetes. Meals and snacks play a strong role in determining an individual’s glucose (blood sugar) levels. The meal choices patients make are crucial to keeping blood glucose from spiking too high or falling too low. A good diet plan can also help patients keep an optimal weight, which can increase the body’s ability to use insulin more effectively. Even a modest weight loss of 8 or 10 pounds can pay big dividends when attempting to manage glucose (All about diabetes –JDA, n.d., p. 2). The American College of Preventative Medicine states that efforts to prevent diabetes can be significantly enhanced by planning a diet adequate in complex carbohydrates (including fiber-rich whole grains, fruits, and vegetables), moderate in protein and total fat, and restricted in saturated fat and trans fat (All about diabetes- ADA, n.d., p. 2).

 There is even a website for Jews with diabetes. This website, www.jewishdiabetes.org,contains recipes, holiday meal planners, and generic information on diabetes. It is an offshoot of the Jewish Diabetes Association and was started by Nechama Cohen. The information provided includes facts on what the laws and traditions of Judaism are with regard to diabetics and fasting on some holidays, e.g. Yom Kippur and eating very late at night on others, Passover. With regard to fast days, Jewish law says someone with diabetes is not supposed to fast as it is medically known that people with diabetes shouldn't fast. The religion asserts that a person’s health is of the utmost importance. Yet, on Yom Kippur the focus is on the fasting and observant Jews should do whatever they can to fast. This website offers support for those who are conflicted or have any questions (Mendosa, 2002, p. 1).

Jews are not the only ethnic group that is suffering from the diabetes epidemic. On the average, approximately 2.5 million, or 9.5 percent of Hispanic Americans over the age of 20 have been diagnosed with diabetes. Mexican Americans are 1.7 times as likely to have diabetes as non-Hispanic whites of comparable age. Residents of Puerto Rico are 1.8 times as likely to have diagnosed diabetes as United States non-Hispanic whites (DEHJA, 2005, p. 1).

It is not only the disease itself but its related complications that have a strong affect on the Hispanic and Latino community. In 2002 approximately 44,400 people with diabetes began treatment for end-state kidney disease in the United States and Puerto Rico. In the same year approximately 154,000 people with end state kidney disease due to diabetes needed regular dialysis or a kidney transplant in the United States and Puerto Rico (DEHJA, 2005, pp. 1-2).

As an ethnic group African-Americans suffer disproportionately from diabetes and diabetes-related complications. The statistics include the following: about 2.7 million or 11.4 percent of all African-Americans aged 20 or over have diabetes. Approximately one third of those afflicted are not even aware they have the disease. African-Americans are 1.6 times more likely to have diabetes than non-Latino whites. Twenty-five percent of all African-Americans between the ages of 65 and 74 have diabetes. One in four African American women over 55 years old has diabetes. African-Americans experience higher rates of cardiovascular diseases, blindness, amputation, and end-state kidney failure. This ethnic group is twice as likely to suffer form diabetes-related blindness as other people. They are 2.6 to 5.6 times more likely to suffer from kidney disease (DSAA, n.d., pp. 1-2; DAA, 2000, p. 1).

A potential difficulty among many people, independent of ethnicity, is ignorance. One might be experiencing symptoms of diabetes and not know how to interpret them and be too busy or ashamed to go to the doctor. One possible amelioration is to have pediatricians, whose patients include children of these ethnic groups, take a larger role. Children do have regular doctor visits, and knowledgeable pediatricians can casually share information with the parents when they bring their children in for check-ups or sick visits. There are websites for people with diabetes that can help, but the truth is that some people do not have access to the Internet for reasons ranging from lack of knowledge of usage to religious prohibition.

Another setback in a positive course of action for people is denial. Having a disease such as diabetes is considered a stigma and people do not want to admit to being afflicted.
Genetics plays a strong role in a person’s susceptibility to a disease when the genes are on both sides of the biological parents. This can be determined using a Punnett Square (Campbell and Reece, 2005, p. 255). One has to be careful about passing on bad genes to children when a disease runs in the families of both parents (T. Ben-Jacob, personal communication, April 15, 2008).

If persons have been watching television recently, they cannot help but see Robert Jarvik, the person credited with inventing the Jarvik-7 artificial heart. As part of the commercial for Lipitor, he contends that he originally wanted to be an architect, but his father’s heart attack compelled him to study medicine instead. My goal is to become a doctor, and analogously to Jarvik perhaps my family history will propel me into working hard at eliminating or at least ameliorating diabetes.

Summary

Diabetes is a disease that occurs in the aforementioned populations to a greater degree than it should. Some claim that this now hereditary trait is passed on through generations because Jews tend to marry other Jews, African-Americans other African-Americans, and Latinos other Latinos. The origins of the disease for Ashkenazic Jews are attributed to the sedentary lifestyles of the Jews in Europe coupled with their overeating. Whatever the causes or reasons for the infiltration of the disease into the specific ethnic populaces, it is also a disease that can be controlled and ameliorated with proper diet, exercise, and some medication when necessary. Education is the key to making this situation better (Dunning, 1994, pp. 230-38).

References

All about diabetes. Jewish Diabetes Association.(n.d.) Retrieved March 15, 2011 from http://www.jewishdiabetes.org

Ben-Jacob, Talia. Personal interview. April 15, 2011.

Campbell, N., & Reece, J. Biology. 7th ed. (2005). New York: Pearson Education Publishing Company.

Carson, J., Burke, F., & Hark, L. (Eds). (2004) Cardiovascular nutrition: disease management and prevention. Washington, D.C.: American Dietetic Association.

Diabetes epidemic among Hispanic and Latino Americans.(DEHJA) (2005). NIH. Retrieved April 7, 2011 from ndep.nih.gov/diabetes/pubs/FS_HispLatino_Eng.pdf

Diabetes in African Americans. (DAA) (2000). Black Health Care.com. Retrieved April 7, 2011 from http://www.blackhealthcare.com/BHC/Diabetes/Description.asp

Diabetes statistics for African Americans.American (DSAAA)(n.d.). Diabetes Association. Retrieved April 6, 2011 from http://www.diabetes.org/diabetes-statistics/african-americans.jsp

Dunning, T. (1994). Care of people with diabetes. England: Blackwell Publishing.

House, F., Seale, S., & Newman, I. B. (2008).The 30-day diabetes miracle. New York: Penguin Group (USA).

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Lewis, B. (n.d.)Defeat diabetes: visiting Ethiopian Jews learn to deal with diabetes patients. Defeat Diabetes Association. Retrieved February 13, 2011 from http://www.defeatdiabetes.org/Articles/international021216.htm

Marso, S., & Stern, D., Eds. (2004).Diabetes and cardiovascular disease. Philadelphia: Lippincott Williams & Wilkins.

Mendosa, D. (2002). Jewish diabetes.  Diabetes Monitor.com. Retrieved March 15, 2008 from http://www.mendosa.com/jewish.htm

Rodríguez, J., Shearer, B., & Slawson, D. (2007). Metformin therapy and diabetes prevention in adolescents who are obese. American Family Physician. Leawood: Vol. 76, Issue 9, 1357-8.

Ruhl, J. (2008).Diabetes update: a diabetes gene found in type 2 Jews. Online posting. Diabetes Update. Retrieved March 14, 2011 from http://diabetesupdate.blogspot.com/2006/07/diabetes-gene-found-in-type-2-jews.html

Touchette, N. (2004).Diabetes susceptibility gene discovered. . J Craig Ventor Institute. Retrieved March 19, 2011 from http://www.genomenewsnetwork.org./articles/2004/04/02/diabetes.php

Weintrob, N., Sprecher, E., Israel, S., Pinhas-Hameil, O., Kwon, O. J., Block, K., et al. (2001).Type 1 diabetes environmental factors and correspondence analysis of HLA class II genes in the Yemenite Jewish community in Israel. American Diabetes Association. Retrieved February 2, 2008 from  http://care.diabetesjournals.org/cgi/content/full/24/4/650