There are two types of diabetes, type 1 and type 2. According to the National Institutes of Health, an estimated 850,000 to 1.7 million Americans have Type 1 diabetes. Type 1 diabetes, which is typically seen in children, involves an autoimmune component. There are antibodies that are inappropriately directed towards your islet cells. Therefore your insulin goes down and your blood sugar level goes up. Insulin is what allows our cells to utilize blood sugar as energy. The more common form of diabetes is type 2. It used to be called adult-onset diabetes, but as more and more children are becoming obese, the disease is becoming more prevalent in children. The reasons people get type 2 diabetes are multifactorial, but obesity is one main cause. As people get larger and larger, their bodies develop a resistance to the effects of insulin. As a result, their blood sugar levels rise over the course of months or years. In both types of diabetes, when blood sugar levels rise, it results in sugar “sticking” to the proteins right outside capillaries. Capillaries are the smallest of the blood vessels, and the place where oxygen is transferred to the tissues. As a result, long-standing diabetes prevents oxygen from going to all organs, but mostly affects nerves, kidneys, and eyes. Therefore, diabetes can lead to kidney damage, nerve damage, and blindness. Diabetes can also affect larger vessels and place patients at risk for early heart attack, stroke, and peripheral artery disease which is a blockage of the blood flow to the legs. Therefore, patients with diabetes can get sores that won’t heal on their legs, and combined with loss of feeling from nerve damage, can lead to amputation. Diabetes often goes undetected because many patients are not symptomatic until their blood sugar is very high. Some of the symptoms you can get include blurred vision, due to a tremendous amount of water that follows sugar into the lens of the eye. You can get thirst, and frequent urination. This is because sugar drags water with it into the bladder, and is lost in the urine. If you ignore those symptoms you can end up with the ravages of diabetes over the course of several years. For example, there are patients who end up with the micro vascular complications of diabetes, and that usually only happens after many years. Many people who have kidney failure have it because they have diabetes. They have nerve problems, such as men who have erectile dysfunction, or tingling in hands and feet. And they often have blindness. If your doctor said, “You have mildly elevated blood sugar, let’s keep an eye on it.” I would have to disagree. I wouldrecommend quickly seeing an endocrinologist, or someone who can take that more seriously. The mechanism and pace of the damage done by high blood sugar is a very similar concept to the mortgage you pay on your house. For example if you get a rate of 6% compared to 6.5% it doesn’t sound like a big difference; and it isn’t a big difference, for one month. But over the course of thirty years, it adds up to a big difference in the problems that diabeste can cause. Even mild fluctuations in blood sugar levels need to be taken seriously. Most people don’t know this, but you can actually reverse diabetes. We try not to use the word cure as it’s mostly successful if you catch it early and drop enough weight. Others, however, cannot get rid of diabetes, even if they lose the weight. But many people can manage their diabetes just by diet and in fact reverse it. What does an Endocrinologist learn at medical school, and what kind of experience do they garner in their practice, that is over and above what an internal medicine doctor learns? Many people are not aware of this but for a variety of specialties, you study a base first, then you move on to the specialty. For example, a plastic surgeon first studies general surgery, then does a plastic surgery fellowship. You learn the fundamental techniques and then you go above and beyond that for specializing. It’s the same with internal medicine. First you do three years of internal medicine, then you do your endocrinology fellowship. So it’s training in addition to an internship and residency. That training entails enhanced book learning, including journal articles, didactic learning, and also includes practical learning. Essentially apprenticing as a fellow, rather than just an internal medicine resident. You would have an area of focus, in this case diabetes, so you would see many more patients with a particular disease. Also, you see them in conjunction with other endocrinologists. Even a well-trained internist wouldn’t see the same volume of patients with diabetes, and wouldn’t necessarily be managing them alongside other experts in the field. Author Dr. Joseph J. Pinzone serves as the endocrinologist and primary concierge medicine physician for AMAI patients, board-certified in Internal Medicine as well as Endocrinology, Diabetes and Metabolism. Connect with AMAI on Google+.