A Guide to Diabetes: Symptoms, Causes, Treatment & Disability Rule

Introduction

In this free educational guide on diabetes, we provide you with a general discussion about this severe medical condition, and review what evidence or tests are needed to help prove that you are eligible for Social Security Disability Insurance (SSDI) and/or Supplemental Security Income (SSI).

For your general knowledge about this medical condition, we have included in this guide helpful information about what the disease is, symptoms, diagnosis, common treatment, and where you can find more help and information for this medical condition. This guide may also provide information about current legal issues that may be of value to you. This guide is not intended as legal advice or as a legal opinion.

After reading this guide, if you still have questions or would like to discuss your case with us, please call Chad Brown Law at (336) 962-5373. We are here to help you get the benefits you deserve.

1. What is diabetes?

Diabetes, also called diabetes mellitus, is a serious, lifelong condition. There are an estimated 23.6 million people in the US with this disease, approximately 7.8 % of the population.

Diabetes is an endocrine disorder where the pancreas does not respond to the sugar your body consumes during meals. Sugars and carbohydrates are converted into glucose, which is a vital part of metabolism and growth within your body. It provides energy to your muscles and tissues and is the main source of energy for your brain.

In people with normal pancreatic function, the pancreas produces the proper amount of insulin to pair with the glucose in the bloodstream (blood sugar). The insulin then moves the glucose from the bloodstream to the cells to provide energy. However, in people with diabetes, the pancreas does not produce enough insulin to move the glucose out of the bloodstream, or the body does not use the insulin appropriately. This causes the body to lose fuel and energy even though the person is eating regularly.

There are several types of diabetes; however most of the incidences of diabetes involve two main types:

Type 1 diabetes – Formerly known as “juvenile diabetes”, type 1 diabetes is commonly diagnosed during childhood, although some adults are diagnosed with the condition. This autoimmune disease causes the body’s immune system to attack and destroy the beta cells in the pancreas that produce insulin. This impairs the pancreas’s ability to produce insulin. Type 1 diabetics must take a daily insulin replacement.

Current research has yet to reveal the cause of type 1 diabetes and the autoimmune response to the insulin-producing cells. Type 1 diabetes, also known as insulin-dependent diabetes, accounts for approximately five to ten percent of all diabetes cases in the U.S.

Type 2 diabetes – Type 2 diabetes is the most common form of diabetes and is estimated to make up 90 to 95 percent of all diabetes diagnoses in the U.S. Type 2 diabetes can be diagnosed in adults as well as children. Some risk factors for the disease are obesity, poor dietary habits, lack of exercise, and previous history of gestational diabetes. This type of diabetes is also more prevalent in certain ethnic groups such as African Americans, Mexican Americans, and Pacific Islanders. Approximately 80 percent of people with type 2 diabetes are overweight or obese.

Although previously considered an adult-only condition, type 2 diabetes is now becoming increasingly common in children and adolescents.

In contrast to type 1 diabetes where the body does not produce enough insulin, people with type 2 diabetes usually produce enough insulin, but the body cannot use that insulin effectively. This is known as insulin resistance and over several years of living with the disease, it can cause insulin production to decrease. Glucose can build up in the bloodstream and the body struggles to use this energy source.

People may first be diagnosed with “prediabetes,” which is identified as abnormally high blood sugar levels but not high enough to be considered diabetic. Prediabetes is also known as impaired glucose tolerance (IGT) or impaired fasting glucose (IFG) due to the unusually high glucose levels seen during fasting glucose tests. If caught early, it is possible to halt the progress of the condition by following medical advice and adopting certain lifestyle adjustments.

1a. Risk Factors

Some people are at greater risk of developing diabetes than others. Risk factors differ depending on the type of diabetes.

Type 1 – Doctors have yet to identify the exact cause of type 1 diabetes, although it is likely that genetics plan an important role. People with parents or siblings with type 1 diabetes have an increased risk of developing the disease themselves. Doctors also believe that some environmental factors such as exposure to a viral illness may play a role in developing type 1 diabetes.

Two other factors that may increase your risk for type 1 diabetes include your geographic location and your race. People from Sweden and Finland have higher rates of type 1 diabetes. Type 1 diabetes is also more common among Caucasians.

Type 2 – There are many theories of why people develop type 2 diabetes, although researchers still aren’t sure why some develop the disease. However, researchers have found evidence that the following factors put people at a higher risk of prediabetes, which can lead to type 2 diabetes if left untreated.

Age – The risk of developing type 2 diabetes increases as you age. This can be due to lifestyle changes such as exercising less and gaining weight, but may also be due to natural parts of aging such as loss of muscle mass. However, type 2 diabetes is also becoming more common in younger patients, including children.
Family history – People with a family history of diabetes, especially a close relative such as a parent or sibling, are at a higher risk of developing type 2 diabetes themselves.
Gestational diabetes – This type of diabetes develops during pregnancy and typically goes away after giving birth. Mothers who experienced gestational diabetes during their pregnancy are at a higher risk of prediabetes and type 2 diabetes. This is especially true for mothers who gave birth to a baby weighing more than 9 pounds (4 kilograms).
High blood pressure (hypertension) – People with an average blood pressure reading of 140/90mm Hg or higher are at a higher risk of developing type 2 diabetes.
Inactivity – A sedentary lifestyle puts you at a greater risk of diabetes. Physical activity such as an active job or regular exercise helps you control your weight and uses excess glucose, giving it less time to sit in your bloodstream. Regular physical activity at least three times a week can help reduce your type 2 diabetes risk and make your cells more sensitive to insulin.
Race – People of African, Hispanic, American Indian, and Asian descent are more prone to type 2 diabetes, although the reason is not known.
Weight – The more body fat you carry, the higher your risk of type 2 diabetes. In fact, studies show losing just seven percent of your body fat could reduce your risk by 58 percent.
Low levels of HDL cholesterol – Low levels of high-density lipoprotein (HDL), known as “the good cholesterol”, can mean an increased risk of type 2 diabetes. Most doctors consider HDL levels of 35 mg/dL and below as low.
High triglyceride levels – Triglycerides are a lipid (fat) found in your bloodstream that can increase your risk of type 2 diabetes. Triglyceride levels above 250 mg/dL place you at a higher risk of diabetes.

2. Common Medical Terms Associated with Diabetes

For North Carolina residents with diabetes, this list of common medical terms associated with diabetes may prove helpful to review.

A1C Test – The A1C test is a common blood test used to diagnose type 1 and type 2 diabetes and then to gauge how well you’re managing your diabetes.

Body Mass Index (BMI) – BMI is a fairly reliable indicator of body fatness for most people.

Fasting glucose test – The fasting plasma glucose test measures blood sugar levels and is used to diagnose diabetes.

Glucose – Glucose is a sugar that provides the body with its primary source of energy.

Insulin – Insulin lowers the amount of glucose in the blood and is used to treat type 1 diabetes.

Oral glucose tolerance test – The glucose tolerance test is a lab test that checks how your body breaks down sugar in the blood.

Pancreas – The pancreas produces chemicals that are vital for regulating blood sugar and proper digestion.

Prediabetes – A person with prediabetes has a blood sugar level higher than normal, but not high enough for a diagnosis of diabetes.

Type 1 Diabetes – Type 1 diabetes, once known as juvenile diabetes or insulin-dependent diabetes, is a chronic condition in which the pancreas produces little or no insulin.

Type 2 Diabetes – Type 2 diabetes, also known as insulin-resistant diabetes, is where the body produces enough insulin, but cannot use that insulin properly to move glucose from the bloodstream to the cells.

3. Symptoms of Diabetes

According to the American Diabetes Association, early detection and treatment of diabetes can decrease the risk of developing the complications of diabetes. The following is a list of symptoms of diabetes; however, absence of these symptoms does not mean you do not have diabetes. Some symptoms are so mild they go undetected.

Common Symptoms of Type 1 and Type 2 Diabetes

Blurry or fuzzy vision that comes and goes.
Constant hunger even though you are eating enough.
Constant thirst even though you are drinking enough.
Extreme fatigue.
Frequent urination.
More frequent infections.
High blood pressure (hypertension).
Tingling (“pins and needles”), pain, or numbness in the hands and feet (type 2 diabetes).
Slow-healing wounds or sores.
Unexplained weight loss even though you are eating a healthy diet (type 1 diabetes).

Complications of Diabetes

There are two types of complications of diabetes: short-term and long-term. The short-term complications can include lethargy, slow healing, higher infection rates, and in serious cases, diabetic coma or seizures due to low blood sugar or improper insulin doses.

The long-term complications of diabetes include the damage done over a lifetime if blood sugar is not properly controlled. Over time, diabetes can cause complications that affect nearly every part of the body, from heart disease to kidney failure. Diabetes damages the heart and blood vessel systems, which can lead to blindness, loss of limb (amputation), stroke, and permanent nerve damage. Without good control of your blood sugar, diabetic women who become pregnant could see complications in their pregnancy and risk birth defects in their unborn child.

Therefore, once diagnosed, getting treatment and maintaining a healthy life style is important to slowing down the progression of this disease. The longer you have had diabetes and the less control of your blood sugar, the greater the risk of getting these life-threatening and disabling complications.

4. How is diabetes diagnosed?

Type 1 diabetes symptoms often occur suddenly and symptoms for other types of diabetes often come on gradually or may not be evident. The American Diabetes Association recommends the following screening guidelines. The following scenarios are examples of when you should talk to your doctor about screening for diabetes.

You have a body mass index (BMI) higher than 25 at any age and you have any of the additional risk factors (high blood pressure, lack of exercise, high cholesterol levels, history of heart disease, family with diabetes, etc.). You can learn how to calculate your BMI at the following website: https://www.nhlbi.nih.gov/guidelines/obesity/BMI/bmicalc.htm
Older adults should have an initial blood sugar screening at age 45 if they do not already have regular screenings. If the results are normal, older adults should have a regular screening every three years.

There are three common diagnostic tests used to determine if you are diabetic or at risk of becoming diabetic. Your doctor will determine which of these tests are the best for you, and may require more than one test to get the most accurate information about your health. If your doctor orders one test and the results are positive, he or she will typically order a different test to confirm the diagnosis.

A fasting glucose test is a test of your blood sugar levels taken in the morning before you have eaten. A level of 126 mg/dL or higher may mean that you have diabetes.
An oral glucose tolerance test (OGTT) involves drinking a beverage containing glucose and then having your blood glucose levels checked every thirty to sixty minutes for up to three hours. If the glucose level is 200 mg/dL or higher at two hours, then you might have diabetes.
The A1C test is a simple blood test that reflects what your average blood sugar levels have been over the past 2-3 months. An A1C level of 6.5% or higher may indicate diabetes.

5. What is the common treatment for diabetes?

Treatment for both forms of diabetes requires keeping close watch over your blood sugar levels (and keeping them at a goal set by your doctor) with a combination of medications, exercise, and diet. By paying close attention to what and when you eat, you can minimize or avoid the “seesaw effect” of rapidly changing blood sugar levels, which can require quick changes in medication dosages, especially insulin.

The basic therapies for type 1 diabetes include eating a balanced diet full of healthy foods, getting plenty of physical activity, and taking your insulin as prescribed. Your doctor will teach you about how to balance your daily food intake with your insulin and may have you work with a dietitian to improve your eating habits. Most insulin is delivered via injections with a syringe, pre-filled insulin dispensing syringe pen, or through an implanted device called an insulin pump.

Along with the basic therapies, type 1 diabetics need to check their blood sugar regularly to ensure they are getting enough insulin and have a stable blood glucose level. Your doctor will also order regular A1C tests which reflect your average blood glucose over a two- to three-month period. This will help you determine if you are managing your type 1 diabetes well.

The treatment for type 2 diabetes is similar to type 1 diabetes, with good diet, exercise, and blood glucose testing being of utmost importance. There are many special medications that can help type 2 diabetics control their blood glucose levels, including injectable medicines like insulin and oral medications that can help your body control glucose levels.

Your medical professional will design a diabetes management program that will be easy for you to follow, and that is designed for you.

6. Diabetes – What has to be proven for you to be considered disabled by Social Security?

Social Security maintains a list of medical conditions that are so severe they automatically mean that you are disabled. This list of conditions are ones that are expected to be permanent, or expected to result in death, or have a certain length of time that it must last. Each medical condition on this list has a complete description of what symptoms or conditions have to be present with your medical condition for you to “meet the listing”.

The medical listing for diabetes and other endocrine system disorders, Social Security’s medical listing 9.00, is found on this Social Security Administration website and is shown below for discussion purposes:

https://www.socialsecurity.gov/disability/professionals/bluebook/9.00-Endocrine-Adult.htm

If you do not “meet” this listing, you may still be considered disabled if you are not able to do your past relevant work, or you are not able to do any other work that you may have the education or experience to do.)

6a. Social Security’s Rules for Diabetes

“9.00 Endocrine Disorders -An endocrine disorder is a medical condition that causes a hormonal imbalance. When an endocrine gland functions abnormally, producing either too much of a specific hormone (hyperfunction) or too little (hypofunction), the hormonal imbalance can cause various complications in the body. The major glands of the endocrine system are the pituitary, thyroid, parathyroid, adrenal, and pancreas.

Diabetes mellitus and other pancreatic gland disorders disrupt the production of several hormones, including insulin, that regulate metabolism and digestion. Insulin is essential to the absorption of glucose from the bloodstream into body cells for conversion into cellular energy. The most common pancreatic gland disorder is diabetes mellitus (DM). There are two
major types of DM: type 1 and type 2. Both type 1 and type 2 DM are chronic disorders that can have serious disabling complications that meet the duration requirement. Type 1 DM– previously known as “juvenile diabetes” or “insulin-dependent diabetes mellitus” (IDDM)–is an absolute deficiency of insulin production that commonly begins in childhood and continues throughout adulthood. Treatment of type 1 DM always requires lifelong daily insulin. With type
2 DM–previously known as “adult-onset diabetes mellitus” or “non-insulin-dependent diabetes mellitus” (NIDDM)–the body’s cells resist the effects of insulin, impairing glucose absorption and metabolism. Treatment of type 2 DM generally requires lifestyle changes, such as increased exercise and dietary modification, and sometimes insulin in addition to other medications. While both type 1 and type 2 DM are usually controlled, some persons do not achieve good control for
a variety of reasons including, but not limited to, hypoglycemia unawareness, other disorders that can affect blood glucose levels, inability to manage DM due to a mental disorder, or inadequate treatment.

a. Hyperglycemia. Both types of DM cause hyperglycemia, which is an abnormally high level of blood glucose that may produce acute and long-term complications. Acute complications of hyperglycemia include diabetic ketoacidosis. Long-term complications of chronic hyperglycemia include many conditions affecting various body systems.

(i) Diabetic ketoacidosis (DKA). DKA is an acute, potentially life-threatening complication of DM in which the chemical balance of the body becomes dangerously hyperglycemic and acidic. It results from a severe insulin deficiency, which can occur due to missed or inadequate daily insulin therapy or in association with an acute illness. It usually requires hospital treatment to correct the acute complications of dehydration, electrolyte imbalance, and insulin deficiency. You may have serious complications resulting from your treatment, which we evaluate under the affected body system. For example, we evaluate cardiac arrhythmias under 4.00, intestinal necrosis under 5.00, and cerebral edema and seizures under 11.00. Recurrent episodes of DKA may result from mood or eating disorders, which we evaluate under 12.00.

(ii) Chronic hyperglycemia. Chronic hyperglycemia, which is longstanding abnormally high levels of blood glucose, leads to long-term diabetic complications by disrupting nerve and blood vessel functioning. This disruption can have many different effects in other body systems. For example, we evaluate diabetic peripheral neurovascular disease that leads to gangrene and subsequent amputation of an extremity under 1.00; diabetic retinopathy under 2.00; coronary artery disease and peripheral vascular disease under 4.00; diabetic gastroparesis that results in abnormal gastrointestinal motility under 5.00; diabetic nephropathy under 6.00; poorly healing bacterial and fungal skin infections under 8.00; diabetic peripheral and sensory neuropathies under 11.00; and cognitive impairments, depression, and anxiety under 12.00.

b. Hypoglycemia. Persons with DM may experience episodes of hypoglycemia, which is an abnormally low level of blood glucose. Most adults recognize the symptoms of hypoglycemia and reverse them by consuming substances containing glucose; however, some do not take this step because of hypoglycemia unawareness. Severe hypoglycemia can lead to complications, including seizures or loss of consciousness, which we evaluate under 11.00, or altered mental status and cognitive deficits, which we evaluate under 12.00.

6b. Chad Brown’s Explanation of Social Security’s Rules

For you to “meet the listing” and thereby qualify for Social Security disability benefits, your diabetes has to be uncontrolled and have affected vital bodily functions. There are so many disabling medical complications that can happen with diabetes that it is not possible to review all the disabling components of this disease. Whatever body system or organ that your diabetes affects, review the medical listing for that disorder. For example, if you develop heart problems from diabetes, go to our discussion about heart diseases on our website.

7. Internet Resources for Diabetes

For other general information about Social Security and Supplemental Security Income disability programs and how the law firm of Chad Brown Law can help you, visit:

https://chadbrownlaw.com/

For a complete listing of conditions that Social Security considers disabling, go to Social Security’s website at:

https://www.socialsecurity.gov/disability/professionals/bluebook/AdultListings.htm

For medical information on diabetes, go to the American Diabetes Association website:

https://www.diabetes.org/

Or, the Mayo Clinic’s website:

https://www.mayoclinic.org/diseases-conditions/diabetes/basics/definition/con-20033091