Dominic Raj, MD, Discusses Diabetes and the Long-term Health Implications

woman with glasses on holding a blood sugar monitor

November is National Diabetes Awareness Month. Roughly 37 million Americans, including children and adults, experience either type 1 or type 2 diabetes, and the disease can affect almost every part of the body, including the eyes, kidneys, nerves, and heart, and diabetes can even cause some types of cancer. The good news is, according to the American Diabetes Association, by identifying and managing their diabetes, patients can prevent many of the health problems associated with the disease, and in the case of a type 2 diagnosis, even reverse the effects. Here, Dominic Raj, MD, Bert B. Brooks Chair in the Medical School, professor of medicine, of biochemistry and genetics, and of biostatistics and epidemiology at the GW School of Medicine and Health Sciences, and director of the Division of Renal Disease and Hypertension at GW’s Medical Faculty Associates, discusses the differences between type 1 and type 2 diabetes, the long-term health implications of the illnesses, and treatment options.

What is the difference between type 1and type 2 diabetes?

Raj: Insulin is a hormone that controls blood sugar is produced by beta cells in the pancreas. 

In type 1 diabetes, due to some unknown trigger, the body’s immune system attacks and the beta cells and are destroyed resulting in reduced production of insulin leading to elevated blood sugar. 

In diabetes type 2, the pancreas makes less of the insulin required to maintain blood glucose level within normal range. Often it is associated with the body’s resistance to the action of insulin. It is more common in adults, and having obesity predisposes an individual to develop type 2 diabetes. 

What is insulin resistance?

Raj: Insulin is the key that facilitate the delivery of glucose from the blood into cells where it is used as energy source. In insulin resistance, it takes more insulin to move the insulin into the cell. Insulin resistance is often associated with obesity. 

Can you be diabetic and not know it? What are some of the tell-tale signs that you might be diabetic?

Raj: The Centers for Disease Control and Prevention reports that about 8.5 million people (23% of adults in the United States) have undiagnosed diabetes. Often the symptoms of type 1 diabetes manifest suddenly and hence it is identified.

Symptoms of diabetes include urinating more often than usual, excess thirst, feeling tired, unintentional loss of weight, and poor wound healing. If left unnoticed the individual may develop a coma. 

Do you treat type 1and type 2 diabetes differently? 

Raj: For both lifestyle modification is crucial. 

People with type 1 diabetes need insulin either as daily injections or through an insulin pump. In general, type 2 diabetic patients are treated with oral hypoglycemic agents, but some may progress on to require insulin therapy as well. There are newer novel medications are available, such as SGL2 inhibitors (which work by reducing the absorption of glucose) and GLP-1 inhibitors (which work by increasing insulin production), which are used in type 2 diabetics. These medications also have been shown to offer cardiorenal protective effects.

Can you reverse type 2 diabetes?

Raj: In early stages of diabetes, it’s possible to control and even reverse type 2 diabetes with diet and exercise. This improves insulin resistance, and less calorie consumption requires less insulin to maintain blood sugar within normal range. 

What are some of the long-term health implications for someone diagnosed with either type 1or type 2 diabetes?

Raj: Patients with diabetes are at risk for microvascular and macrovascular complications including diabetic retinopathy, neuropathy, diabetic kidney disease, atherosclerotic vascular diseases (including coronary artery disease and peripheral vascular disease), diabetic foot ulcers, and sexual dysfunction.  

For more information about managing diabetes or to make an appointment with a specialist, please visit the GW MFA Division of Renal Disease and Hypertension or call 202-741-2283, or visit the GW MFA Division of Endocrinology and Metabolism or call 202-741-3422, or the

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