/ Categories: Better Health (BH)

The Cost of Diabetes

Author Karl Knopf, EdD


The incidence of diabetes is rapidly increasing around the world. According to the American Diabetes Assoc nearly 10 percent of the population of the United States is diabetic (2018).   The term "diabetes mellitus" refers to a group of diseases that affect how your body uses blood glucose, commonly called blood sugar. Diabetes is a costly disease – financially and physically.  After adjusting for population age and sex differences, average medical expenditures for people with diagnosed diabetes were 2.3 times higher than would be in the absence of diabetes. The cost to your physical health is even greater!


Diabetes is not just a simple blood sugar concern, it can be a contributing factor in loss of vision, heart disease, kidney damage, loss of limbs and quality of life. Complications develop gradually. The longer blood sugar remains unchecked, the higher the risk of disabling or even life-threatening complications.   

Cardiovascular disease. Diabetes dramatically increases the risk of various cardiovascular problems, including coronary artery disease, heart attack, stroke and  atherosclerosis. People with diabetes are twice as likely to have heart disease or stroke.

Nerve damage (neuropathy). Excess sugar can injure the walls of the tiny blood vessels (capillaries) that nourish your nerves, especially in the legs. This can cause tingling, numbness, burning or pain in the affected limbs. Left untreated, it can lead to the loss of sensations in the affected limbs.

Kidney damage (nephropathy). The kidneys contain millions of tiny blood vessel clusters that filter waste from your blood. Diabetes can damage this delicate filtering system. Severe damage can lead to kidney failure or irreversible end-stage kidney disease, requiring dialysis or a kidney transplant.

Eye damage. Diabetes can damage the blood vessels of the retina (diabetic retinopathy), potentially leading to blindness.

Foot damage. Nerve damage in the feet or poor blood flow to the feet increases the risk of various foot complications. Left untreated, cuts and blisters can become serious infections. Severe damage might require toe, foot or even leg amputation.

Skin and mouth conditions. Diabetes can increase susceptibility to skin problems, including bacterial infections, fungal infections and itching. Gum infections also may be a concern, especially if there is a history of poor dental hygiene.


Diabetes symptoms vary somewhat, depending on the type and severity of the diabetes.  People with pre-diabetes or gestational diabetes may not experience any symptoms.  The most common symptoms of diabetes include:

Increased thirst

Frequent urination

Extreme hunger

Unexplained weight loss


Blurred vision

Slow-healing sores

Frequent infections

Types of Diabetes

Type 1 diabetes can develop at any age, although it typically appears during childhood or adolescence. Type 1 is characterized by a lack of insulin producing beta cells in the pancreas, which contributes to high levels of sugar levels.  Individuals with type 1 diabetes require insulin.  Type 1 is less common effecting approximately 5% of the population. The exact cause of type 1 diabetes is unknown, family history may play a role. The risk of developing increases if a parent or sibling has type 1 diabetes.

Type 2 diabetes, the most common type accounting for 90% of the cases, can develop at any age and is often preventable.  Type 2 diabetes is associated with high levels of sugar in the blood stream.  The individual’s body is able to produce insulin, but their cells do not utilize it efficiently; this is referred to as insulin resistance.  Cells become resistant to the action of insulin, and the pancreas is unable to make enough insulin to overcome this resistance.  Instead of moving into the cells, sugar builds up in the bloodstream. 

Pre-diabetes, is a potentially reversible condition where blood sugar levels are higher than normal, but not high enough to be classified as diabetes.  Gestational diabetes occurs during pregnancy.  

Researchers don't fully understand why some people develop pre-diabetes and type 2 diabetes and others don't. It's clear that certain factors increase the risk, including:

Excess body fat. The more fatty tissue in the body, the more resistant the cells become to insulin.

Inactivity. The less active the individual, the greater the risk. Physical activity helps to control weight, uses up glucose as energy ,and makes cells more sensitive to insulin.

Race. Although it's unclear why, people of certain races are at higher risk.  According to the American Diabetes Association (ADA), African Americans, American Indians, Hispanics, and some Pacific Islanders and Asian Americans are all at higher risk for type 2 diabetes than Caucasians.

Age.   The risk of diabetes increases as we age, especially after the age of 45.  However, type 2 diabetes is increasing dramatically among children, adolescents and younger adults.

Gestational diabetes. If a woman develops gestational diabetes, the risk increases for developing pre-diabetes and type 2 diabetes later.  If a woman gives birth to a baby weighing more than 9 pounds (4 kilograms), there is a greater risk of developing  type 2 diabetes.

Polycystic ovary syndrome. PCOS has been linked to developing type 2 diabetes.

Family or personal history.  The risk of developing diabetes increases if a person has pre- diabetes or if a parent or sibling has type 2 diabetes.  

An important part of managing all types of diabetes includes maintaining a healthy weight through a healthy diet and exercise plan and following the proper doses of medications when required.  Some recent findings suggest that strength training has a profound impact on managing diabetes, maybe even better than an aerobic training. But bottom line, increase physical activity – any and all types of physical activity – and sit less!


American Diabetes Association, www.diabetes.org

IDEA Fitness Journal 2015

International Sports Sciences Association. ISSA Fitness Therapy Manual.

KSBW Health Watch 9/10/15

Tufts University Healthy & Nutrition Letter.  Special Report Spring 2019. www.nutritionletter.tufts.edu



Dr. Karl Knopf has been involved in health and fitness for over 45 years, working in almost every aspect of the industry – from personal trainer and therapist to consultant. While at Foothill College, he was the Director of the Fitness Therapy Program, a teacher of adaptive PE, and recognized with several awards for teaching excellence. For 15 years, Dr. Knopf served as the President and Founder of Fitness Educators Of Older Adults. He has authored many articles, has written over 20 books, and has been a frequent guest on the Sit and Be Fit television show.

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