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Health & Exercise Forum

National Diabetes Month: Part 1 of 2

Nov 21, 2016
Nicole Marianelli,  MD2, TCMC

Nicole Marianelli, MD2, TCMC

Co Author: Nicole Marianelli, 2nd year medical student The Commonwealth Medical College

 This column is a monthly feature of “Health & Exercise Forum” in association with the students and faculty of The Commonwealth Medical College.

 Nicole Marianelli is a second-year medical student at The Commonwealth Medical College. A native of Old Forge, Nicole plans to pursue either family medicine or pediatrics when she graduates in 2019.



Part 1 of 2

Diabetes is a fact of life for 29.1 million adults and children in the U.S., according to the American Diabetes Association (ADA).  Of that number, ADA says 8.1 million are undiagnosed and therefore not taking the necessary steps to safeguard their health. This statistic is truly frightening, given that diabetes remains the seventh leading cause of death in the U.S.

Diabetes is a disease in which the hormone insulin is not adequately produced or used by the body. Insulin is needed for cells to take up glucose after it is broken down from sugars, starches and other food that we eat. When working properly, this provides the fuel necessary for activities of daily living. While the exact cause is not completely understood, environmental factors, such as obesity and inactivity, have been found to play an important role, particularly in Type 2 diabetes. Type 1 diabetes is linked to genetics and is believed to have a connection with  autoimmune disorders. No amount of diet and exercise can reverse Type 1 diabetes, but it will have significant positive impact on Type 2.

“I am not only the doctor to be, but also a patient!” I have been living with Type 1 diabetes, also called juvenile diabetes, since I was 11 years old. My experience can help give others insight into what it’s like to have diabetes of any type and why it’s so important for everyone to establish a healthy diet, maintain a normal weight and try to get 30 minutes of exercise each day, if possible.

Parents should be aware of any changes in their child’s habits. For example, the summer when I was 11, my mother noticed that I seemed to urinate more frequently than was normal for me. When I told her that I was also suddenly thirsty all the time, she drew the right conclusions and took me to the doctor. That was on a Tuesday. My doctor said if I had waited until Saturday, I would have needed an ambulance. Mine were the classic signs of both Type 1 and Type 2 diabetes. However, people with type 2 diabetes can experience symptoms that are vaguer and more gradual in onset than with type 1 diabetes. Type 2 symptoms include feeling tired or ill, increased thirst and urination, weight loss, poor vision, frequent infections and slow wound healing.People with these symptoms should not delay in seeking medical attention.

Once diagnosed, heightened awareness of your diet becomes a way of life. As a person with Type 1 diabetes, I maintain dietary vigilance because I use an insulin pump that I must re-calibrate depending on what I eat, what my blood sugar reading is when I test it and how active I am. All of these factors go into a complex formula I process mentally every time I sit down to a meal. In my case, Type 1 diabetes will oblige me to always perform the ritual of counting carbs, deciding if they’re complex or simple and weighing them against my activity levels for the day. Most people with Type 2 diabetes have a ray of hope, however. In many instances, being strict with your diet will improve your condition and can even get some patients off of insulin shots.

Type 2 diabetes is far more prevalent than Type 1. In fact, ADA says it is the most common form. of the disease.

Type 2 Diabetes

 Type 2 diabetes, also known as adult-onset, is the most common type as most Americans are diagnosed with type 2 diabetes. Obesity has been found to contribute to more than half of all type 2 diabetics. The increased rate of childhood obesity in between 1960 and 2000 is believed to have caused the increase in type 2 diabetes in present day adults and children. It occurs when the body fails to use insulin properly and eventually it fails to produce an adequate amount of insulin. When sugar, the primary source of energy in the body is not able to be broken down and transported in the cells for energy, it builds up in the blood. There it can immediately starve cells of energy and cause weakness. Also, over time it can damage eyes, kidneys, nerves or heart from abnormalities in cholesterol, blood pressure and an increase in clotting of blood vessels. Like type 1, even though the problems with type 2 are scary, most people with type 2 diabetes live long, healthy, and happy lives. While people of all ages and races can get diabetes, some groups are at higher risk for type 2. For example, African Americans, Latinos, Native Americans and Asian Americans/Pacific Islanders and the aged are at greater risk. Complications are the same as those for type 1 diabetes.


People with type 2 diabetes experience symptoms that are vaguer and more gradual in onset than with type 1 diabetes. Type 2 symptoms include feeling tired or ill, increased thirst and urination, weight loss, poor vision, frequent infections and slow wound healing.

 Gestational Diabetes

 Gestational diabetes occurs in about 4% of all pregnant women in the United States each year according to the ADA. If you develop diabetes during pregnancy, there is a 50% chance you will develop type 2 diabetes later in life.


 According to the ADA, pre-diabetes, or impaired glucose tolerance, occurs when blood glucose levels are higher than normal (110 to 125mg/dl) but below type 2 diabetes levels (126mg/dl). 86 million Americans have pre-diabetes in addition to the 29.1 million with diabetes.

* Your physician will determine which treatment is most appropriate for your problem. However, maintaining your ideal body weight is always important!

Visit your doctor regularly and listen to your body.

NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum” in the Scranton Times-Tribune. Part II: Diabetes: Top 10 Tips to Lower Your Blood Sugar Naturally.

This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email:

Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at The Commowealth Medical College.