The medical term “diabetes” typically refers to sugar diabetes (diabetes mellitus) which, as its name implies, is associated with sweet urine. This is due to the presence of abnormally high levels of sugar in the urine that results from a disordered metabolism, which arises from a combination of hereditary and environmental causes. The hormone insulin made in the pancreas controls blood sugar levels by transporting glucose, a simple sugar, from the bloodstream to the muscle and fat cells of the body where it is burned for energy. Insulin bonds to receptors on the outside of cells where it acts like a key to allow glucose to enter inside the cells. When the cellular receptors no longer respond to the insulin key or if there is a deficiency of insulin, glucose levels build up in the bloodstream rather than entering the cells.

Type 1 diabetes (formerly known as “juvenile” diabetes but renamed because it can also occur in adults) is due to a marked deficiency or absence of insulin production. It represents about 10 percent of all diabetes. Type 2 diabetes, which accounts for 90 percent of diabetes, is due to both an inability of insulin to act as the key for glucose to enter the cells (so-called insulin resistance) and a mild deficiency in insulin production by the pancreas. Both types of diabetes lead to high levels of sugar in the blood which cause the three classic symptoms of diabetes: frequent urination, increased thirst and increased appetite. Additional signs are blurred vision, sudden weight loss and daily fatigue.

If a diabetic condition is not adequately managed, serious long-term complications will eventually appear, such as heart disease. In fact, the risk of heart attack is doubled while the risk of stroke is almost tripled. Consequently, at least 65 percent of diabetics die from heart disease or stroke.

But diabetes just does not affect the heart and circulatory system. It adversely affects all organ systems, especially the eyes, nerves and kidneys. In fact, diabetes adversely affects the whole body and rapidly accelerates the human- aging process. According to findings from hospital and death records of roughly 9.5 million Canadians, people with Type 2 diabetes develop heart disease about 15 years earlier than non-diabetics and also lose about 18 years from their expected life span.

Diabetes complications include kidney disease/failure, blindness from retinal damage, several types of nerve damage (foot/leg pain, erectile dysfunction), and poor healing of wounds from damage to the vascular system. This last category of poor healing of wounds can lead to gangrene of the lower extremities, especially the feet, and possible amputation. In America, diabetes is the leading cause of non-traumatic foot and leg amputations.

All types of diabetes are treatable, but there is no widely available cure for any form of diabetes. The main goal of diabetes treatment is to control the high blood sugar levels. The better the control of the sugars, the less likely that a person will develop any of the complications of diabetes.

Many Americans find themselves being diagnosed with Adult Onset Type 2 Diabetes, which may have gone unnoticed for years because visible symptoms are typically mild, non-existent or sporadic. Once diagnosed, Type 2 diabetes may be treated by lowering intake of carbohydrates (dietary changes) in combination with increasing physical activity (exercise) to achieve weight loss. In some cases diet, exercise and weight loss are sufficient to restore the body’s normal sensitivity to insulin, thereby achieving satisfactory blood sugar control. If this is not successful, the next step in treatment is to introduce oral medication, usually in various combinations, to improve insulin production and lessen insulin resistance. Oral medication may eventually fail due to the continued inability of the pancreas to produce insulin. If so, insulin therapy is necessary to maintain normal or near normal blood sugar levels.

Complicating the situation in Type 2 diabetes is the fact that insulin promotes the formation of fat (adipose) tissue. The more insulin that is secreted by the pancreas, the more likely that person will gain weight. This is because fat cells do not develop insulin resistance to the degree that other types of cells do. The result is that, in insulin resistance, one’s muscles and organs become starved for glucose while the fat cells are being overfed.

Education should be a big part of a Soldier’s visit with a health-care provider where weight-control, proper diet and exercise programs are addressed.

The question arises as to whether a Type 2 diabetic can continue in military service or whether this chronic disease without a cure has effectively interrupted the Soldier’s service career? The long-term medical consequences of diabetes, such the development of a cardiovascular disease, are clearly incompatible with continued military service by placing the Soldier in a high-risk category for injury and death. However, if a diabetic Soldier can effectively manage his blood sugar levels to achieve near-normal levels, the Soldier can be found to have met retention standards.