Diabetic Live

Diabetes: Statistically Speaking – Part 3: In part one and two of this report we presented statistics that provided the harsh realities of diabetes, but we also discussed some of the ways to manage your health in the midst of a pre-diabetic scenario.

We finish this report with more information derived from the National Institute of Diabetes and Digestive and Kidney Diseases. This final article is designed to empower readers who are diabetic with very specific ways to reduce the complications they may face. In doing so they will add more health to their years and gain a sense of enjoyment in a disease controlled environment. If you’re willing to fight back – read on.

Glucose Control

• Studies in the United States and abroad have found that improved glycemic control benefits people with either type 1 or type 2 diabetes. In general, every percentage point drop in A1C blood test results—for example, from 8.0 to 7.0 percent—can reduce the risk of microvascular complications—eye, kidney, and nerve diseases—by 40 percent.
  In patients with type 1 diabetes, intensive insulin therapy has long-term beneficial effects on the risk of cardiovascular disease.

Blood Pressure Control

• Blood pressure control reduces the risk of cardiovascular disease—heart disease or stroke—among persons with diabetes by 33 to 50 percent, and the risk of microvascular complications—eye, kidney, and nerve diseases—by approximately 33 percent.
• In general, for every 10 mm Hg reduction in systolic blood pressure, the risk for any complication related to diabetes is reduced by 12 percent.

Control of Blood Lipids

• Improved control of LDL cholesterol can reduce cardiovascular complications by 20 to 50 percent.

Preventive Care Practices for Eyes, Feet, and Kidneys

• Detecting and treating diabetic eye disease with laser therapy can reduce the development of severe vision loss by an estimated 50 to 60 percent.
• Comprehensive foot care programs can reduce amputation rates by 45 to 85 percent.
• Detecting and treating early diabetic kidney disease by lowering blood pressure can reduce the decline in kidney function by 30 to 70 percent.
• Treatment with angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) are more effective in reducing the decline in kidney function than other blood pressure lowering drugs.
• In addition to lowering blood pressure, ARBs reduce proteinuria, a risk factor for developing kidney disease, by 35 percent—similar to the reduction achieved by ACE inhibitors.

For newly diagnosed diabetics the sheer volume of information can be so overwhelming as to create a period of inaction. This can happen for a variety of reasons. The individual may be suffering depression or they may fear that any move could result in greater problems so they simply stay in the same pattern that caused the problem in the first place.

Diabetes is a war fought on numerous fronts. Things that may have been taken for granted in the past are suddenly subject to review and are either cherished more or discarded as counterproductive.

Those diabetics who take a personal role in the fight are the ones who tend to feel the most hope for the future and often experience fewer physical problems. This is true because they seek out information that allows them to make microchoices that lead to improved health in small doses. Those small deposits in the health bank account can result in greater joy and physical longevity.

So, while we’ve dealt with some intense issues we wanted to leave you with the hope we know can help you succeed in your diabetes management goals.

This really is a fight worth engaging.

Diabetes: The Asian Influence: Many American’s who live with diabetes have been helped by information and therapies discovered through clinical trials throughout the years. Since 1997, however, there has been a growing trend toward conducting clinical trials outside the United States.

Over the past ten years overseas clinical trials have risen from 14% to an impressive 43%. The primary reason for the shift stems from the fact that clinical trials in other countries generally cost less than they do in the United States. Many pharmaceutical companies who often pay for the trials are motivated by the bottom line.

The Tufts Center for the Study of Drug Development in Boston indicates there were nearly 1,800 clinical trials staged outside the US in 2007.

The Asian Diabetes Association indicates the Federal Drug Administration (FDA) has plans to increase the total number of drugs they approve in the near future. This would, of course, be a direct result of successful clinical trials. It should be noted that there are medical personnel in the United States that have expressed concern over the success or failure of the clinical trials in other countries simply because they often do not represent circumstances normally experienced by Americans.

While this may be true the United Nations has indicated that of the more than 240 million cases of diabetes about half of those affected by the disease are from Asian countries. Further, it is estimated that diabetes is a disease that is ranked forth in mortality rates on a global basis.

Reports from Asian countries seem to indicate the disease is most common in urban areas while rural areas see diabetes rates as low as 2% among those 20 and over.

It could be argued that the primary reason for the lower diabetes rates among those who live in rural areas has to do with the lack of access to stores and restaurants that supply abundant processed foods. It could also be argued that there are other environmental concerns that may contribute to the onset of diabetes in Asia.

On a purely organic level Asian researcher Dr. Victor Marcial-Vega, M.D., studied the effects of the natural product ‘goji juice’ for many years. Marcial-Vega discovered that “blood sugar levels decrease in 64 percent of the patients with diabetes, and more than half of them decreased or eliminated their medications.”

Goji Juice can be purchased in health food stores as well as in an online environment. If you are interested in pursuing this as a potential addition to your traditional regimen it is possible you may see some results. This natural product is just one of several products that have gained some attention because of the way they seem to assist in the health management goals of diabetics. An online sample of prices finds a 32 oz bottle for as little as $11 or as much as $50. If you do use an online source make sure it is one that you trust.

It is interesting to note that the crisis of diabetes is a global issue. It is also interesting to note that just as there is an American Diabetes Association there is also one developed for Asian countries. Researchers in both spots on the globe are working relentlessly to find a cure or at the very least a better management plan for their citizens who must live with diabetes.

The Glycemic Index – What is it: Medicinenet.com describes the Glycemic Index as, “An indicator of the ability of different types of foods that contain carbohydrate to raise the blood glucose levels within 2 hours. Foods containing carbohydrates that break down most quickly during digestion have the highest glycemic index.”

When food breakdown quickly they can introduce spikes in blood sugar within the body of diabetics. If a diabetic can learn to find foods with a low GI they will likely see a more manageable glucose level in the long-term.

Knowing this information can actually help in cases where significant exercise may require an energy boost. For instance the use of a high GI food item can provide a boost of energy that the individual may need. However, in most cases the lower the Glycemic Index the better.

A Few of the Best Choices
Wikipedia suggests a few of the following foods for low GI levels – “Most fruit and vegetables (except potatoes, watermelon), grainy breads, pasta, legumes/pulses, milk, products extremely low in carbohydrates (fish, eggs, meat, nuts, oils).”

More Specific Help
GlycemicIndex.com provides a searchable database to help you find the GI for most common foods you may choose to eat as part of your diet.

It may come as a surprise, but it appears pasta may not be a bad food item after all. GlycemicIndex.com reports, “Pasta has a low GI because of the physical entrapment of ungelatinised starch granules in a sponge-like network of protein (gluten) molecules in the pasta dough. Pasta is unique in this regard. As a result, pastas of any shape and size have a fairly low GI (30 to 60).”

GI – Not Just for Diabetics
Many athletes are learning to choose their food carefully to allow a slow release of blood sugar to provide greater endurance and energy. The use of GI information for this purpose should help show diabetics that there are compelling reasons for attention to the foods they eat.

There are also many diets such as South Beach and NutriSystem that use the Glycemic Index to help them develop a weight loss plan for their clients.

Always a Critic
There are some that suggest the GI is flawed to a greater or lesser degree because it doesn’t always take into account the way the food is prepared, the insulin resistance of the individual or a meal that has multiple foods. Certain combinations of food can either raise or lower the GI to levels that may not be suggested by strict adherence to the GI tables.

Like many things in life the Glycemic Index was designed to simply provide some direction in the foods an individual may choose to eat. It remains very important to consult with your doctor and/or nutritionist to maintain the best course of managed care for your diabetes.

The Other Side
Proponents will argue that the GI provides two levels of effectiveness. The first is to help diabetics understand what foods may cause a sharp and sudden burst in blood sugar levels. The second is that attention to the Glycemic Index can help users lose weight. By losing weight they will typically see a more stable blood sugar level and may require fewer meds. They may find they have the energy to exercise more as well. In combination these things are a help to the diabetic.

That being said it is still in your best interest to discuss managed care options with your physician.

Diabetes And Your Skin: It is estimated that at least one third of diabetics will suffer from a skin disorder following a diabetic diagnosis. Some suggest skin problems may be the first indicator to a primary physician that there may be an issue greater than a dermatological disorder.

Bacterial and fungal issues are a fairly common issue for diabetics, but the skin disorders do not stop there. Itching of the lower legs is another common issue diabetics face. This is typically the result of problems with circulation and can often be remedied with skin cream.

A Blood Vessel Top Three
There are three primary skin disorders that affect diabetics and each stem from issues related to alterations in the smallest blood vessels of the legs.

• Necrobiosis Lipoidica Diabeticorum. It is often diabetic women who will develop this condition. Raised blood vessels create sore red bumps on the legs that may develop into a scab-like area. As long as the skin does not break open no medical care may be required.
• Diabetic Dermopathy. Similar to age spots in appearance these flaky patches do not itch and require no treatment.
• Atherosclerosis. Legs that are shiny and have no hair are hallmarks of this skin disorder. It is caused by thickening arteries in the legs of diabetics. Since circulation is a problem for diabetics there are fewer infection fighting white cells to ward off potential problems. Feet tend to become cold and patients often discover changes to their toenails.

Other Skin Disorders
Most of the following skin issues are directly related to diabetes that is out of control. When patients get their blood sugar under control many of these issues tend to go away.

• Acanthosis Nigricans. These darkened skin patches are generally found in diabetics who are overweight and can cause knuckles, elbows and knees to be affected. Weight loss is the best remedy.
• Eruptive Xanthomatosis & Bullosis Diabeticorum. These are blisters that are not generally painful and will heal by themselves.
• Disseminated Granuloma Annulare. May appear a bit like ring worm in either skin tone or various shades of red. Medication is required to manage this skin disorder.
• Digital Sclerosis. A thickening and tightening of skin in Type 1 diabetics. In advanced cases can spread to other areas of the body causing stiff finger, knee or elbow joints.

Skin Care Tips
The American Diabetes Association provides some information on taking care of your skin when you also live with diabetes.

• Keep skin clean and dry. Use talcum powder in areas where skin touches skin, such as armpits and groin.
• Avoid very hot baths and showers. If your skin is dry, don’t use bubble baths. Moisturizing soaps may help. Afterward, use a standard skin lotion, but don’t put lotions between toes. The extra moisture there can encourage fungus to grow.
• Prevent dry skin. Scratching dry or itchy skin can open it up and allow infection to set in. Moisturize your skin to prevent chapping, especially in cold or windy weather.
• Treat cuts right away. Wash minor cuts with soap and water. Do not use Mercurochrome antiseptic, alcohol, or iodine to clean skin because they are too harsh. Only use an antibiotic cream or ointment if your doctor says it’s okay. Cover minor cuts with sterile gauze. See a doctor right away if you get a major cut, burn, or infection.
• During cold, dry months, keep your home more humid. Bathe less during this weather, if possible.
• Use mild shampoos. Do not use feminine hygiene sprays.
• See a dermatologist (skin doctor) about skin problems if you are not able to solve them yourself.
• Take good care of your feet. Check them every day for sores and cuts. Wear broad, flat shoes that fit well. Check your shoes for foreign objects before putting them on.

Diabetes In The News: With diabetes viewed as something close to an epidemic there are significant studies being conducted that are designed to provide better treatment options as well as new methods for ongoing care. This article is dedicated to some of the more recent studies and their findings. We will look at what some are doing to manage health cares costs associated with diabetes and other stories related to diabetes and its management.

Diabetics and Saliva
Researchers in both Oregon and India have been researching the possibility of using a saliva sample to help diagnose diabetes in patients. This research is also exploring the possibility of using a similar test to monitor blood glucose.

One of the stated purposes of the research was to find a non-invasive way to monitor the progress of a diabetic. Some feel that the use of standard blood glucose ‘pin prick’ tests make it undesirable for many diabetics to accurately monitor their blood sugar levels.

It should be noted that many in the medical community do not view this as a significant enough prospect to abandon traditional blood glucose tests.

Lowering Costs Associated With Diabetic Care
An insurance company (UnitedHealthcare) is offering savings of up to $500 for those who are diabetic and participate in “blood sugar checks, routine exams and wellness coaching”.

The company indicates it will provide the savings through free prescriptions and testing supplies. The presumed concept is that encouraging managed care will result in fewer costs associated with long-term diabetic care.

An Indicator of Heart Health in Diabetic Men
Erectile Dysfunction (ED) is being claimed as an important indicator of potential heart issues among men who also have diabetes. There seems to be evidence that blood vessels damaged by diabetes within the heart can contribute to ED. Cholesterol reducing drugs can help reduce the risk of heart issues. Interestingly Viagra also seems to provide some benefit to heart health as the drug was initially tested as a heart health aid.

Food Consumption
Researchers at Brigham Young University (BYU) suggest that if cutting calories is a discipline you can live with then you have the potential of better long-term health. Once past middle age your daily caloric needs decrease. Whether it’s simply a matter of habit or felt need most individuals will eat roughly the same amount of food throughout their lives. Lance Davidson who has followed this case carefully was quoted as saying, “Because the body’s energy requirements progressively decline with age, energy intake must mirror that decrease or weight gain occurs.” The weight gain described is a primary contributor to onset diabetes.

The Air We Breathe
The Ohio State University Medical Center conducted research that seems to point to a connection between high air pollution levels and an increase in the development of onset diabetes. It is argued that with as little as six months of exposure to high levels of air pollution the ingestion of air particulates, “exaggerates insulin resistance and fat inflammation.”

The fat inflammation mentioned in the study appears to be blamed for increasing obesity, which often leads to diabetes. One more shocking note from this report states, “221 million people [are] expected to suffer from [Type 2 diabetes] in 2010, a 46 percent increase compared to 1995.”

While there are significant advancements that are coming at a rapid pace there is still a long way to go. Education and discipline are often keys to success in diabetes care management.

Diabetics in Profile – Male Performers: In this column we would like to take a look at the lives of several well-known individuals who just happened to live with diabetes. The intent of this article is to provide encouragement for those who think life may have passed them by following a diagnosis of diabetes.

Elvis Presley – not only the King of Rock and Roll, but also a diabetic. He kept this part of his life relatively quiet. Those who knew about the role of diabetes in Presley’s life rarely commented on it. The prevailing belief was that this legend pursued life with such vitality that it didn’t seem important to bring it up. Presley’s death in 1977 does not indicate diabetes was a contributing factor.

Bret Michaels – the front man for the rock group Poison, Michaels has had diabetes since he was six years old. He has taken thousands of insulin shots and has even passed out on stage due to issues with his blood sugar, but Michaels is passionate about not allowing diabetes to incapacitate him. He simply does when he needs to do to get it under control.

Johnny Cash – the “Man in Black” lived with diabetes and suffered from complications during the 1990’s and early in the new millennium. He died from complications of the disease in 2003. He will be known for fusing multiple musical styles into a rockabilly/country sound that no one has dared duplicate.

David Crosby – a legend of folk rock Crosby has been entertaining audiences since 1963. He has also lived with diabetes and in 1993 endured a liver transplant. While often controversial Crosby has continued his musical pursuits.

Jerry Garcia – front man for the Grateful Dead, Garcia had seen millions of dollars in ticket sales and engaged in solo and collaborative work. It is believed Garcia was in a diabetic coma when he suffered a fatal heart attack in 1995.

Mark Collie – a rising star in the 1990’s Collie has used his elevated national platform to bring attention to diabetes. His own status as a diabetic has helped fuel passion for his involvement in the “Mark Collie Celebrity Motorsports Festival For Diabetes Cure”. He is also a regular volunteer for the American Diabetes Association. Collie’s career has included acting in several television shows.

Nick Jonas – a meteoric rise in popularity for the band Jonas Brothers has meant lots of touring and multiple recording sessions. Jonas discovered in 2005 that he had Type 1 diabetes. By 2007 Jonas was sharing his story with others and continues to try and raise awareness of the disease. He wears an insulin pump to regulate insulin delivery.

James Brown – having every right to give up Brown refused. He’s been called the hardest working man in show business. He was stillborn, but one of his aunts refused to let him go. She kept blowing into his lungs until he started breathing on his own. Brown grew up in a very poor family. He dropped out of school and was caught trying to steal a car. Time in prison allowed him to reorganize his priorities and music was rotated to the top of the list. His career took off, but he struggled with tax issues and the death of a son. He would spend another two years in prison, but would return once again to his music prior to his death.

This is a short list of popular male performers who live/lived with diabetes. Hopefully their successes encourage you to engage life in the midst of coping with your disease.

The Vietnam War and Diabetes: the U.S. Department of Veteran Affairs (VA) confirmed a link between military service in Vietnam and a higher instance of Type 2 diabetes also known onset diabetes or diabetes mellitus.

What this means in practical terms is that the nearly 3 million service personnel that served in Vietnam during 1962 and 1975 may be eligible for a variety of services and benefits from the U.S. Government if they have developed diabetes since their deployment to Vietnam.

Why was this alteration made? The use of Agent Orange has everything to do with the probable link between military service and onset diabetes. Agent Orange was used to kill ground cover making it much more difficult for the enemy to find hiding places. This herbicide unleashed a litany of long-term health complications including diabetes mellitus, cancer and a variety of less severe illnesses for service personnel. The VA confirms the use of some 20 million gallons of Agent Orange and other herbicides in Vietnam. It also indicates health issues were common among service personnel returning from the Asian country following the war.

A statement from the VA reads, “Military veterans who served in Vietnam who now have Type 2 Diabetes are eligible for presumptive service-connected disability compensation and health care connected with this condition through the VA. Service in the waters offshore or in the air does not qualify a veteran unless there is proof that he or she set foot on land in Vietnam. For most veterans who served in Vietnam, their service is clearly shown on their military discharge papers (DD-214). Veterans with qualifying service should obtain a detailed statement from their treating doctor that they are being treated for diabetes, as a successful VA claim could entitle them to compensation for diabetes.”

Once a military health case file has been created and accepted Vietnam War veterans will have justification for additional claims related to the care of their diabetes and a compliment of compensation benefits.

Health care benefits include medical care and prescription drugs related to the care of diabetes at no cost to qualified veterans.

The following is a list of health issues the VA presumes may be related to direct service in Vietnam during the war.

• Chloracne (must occur within 1 year of exposure to Agent Orange)
• Non-Hodgkin’s lymphoma
• Soft tissue sarcoma (other than osteosarcoma, chondrosarcoma, Kaposi’s sarcoma, or mesothelioma)
• Hodgkin’s disease
• Porphyria cutanea tarda (must occur within 1 year of exposure)
• Multiple myeloma
• Respiratory cancers, including cancers of the lung, larynx, trachea, and bronchus
• Prostate cancer
• Acute and subacute transient peripheral neuropathy (must appear within 1 year of exposure and resolve within 2 years of date of onset)
• Type 2 diabetes
• Chronic lymphocytic leukemia

What does the term ‘presumed’ mean in this context?

In relation to military service the term ‘presumed’ means that the VA will automatically assume the above conditions were the result of your involvement in the military if all conditions are met in the qualifying process. They presume this even if the actual reasons for the disease were not related to direct military involvement.

This revision in policy regarding the above illnesses was dated November 13th, 2008.

You can visit your regional VA or call them for more specific information about this presumptive coverage and related benefits. Additional information can be found at the following link: http://www.vba.va.gov/bln/21/benefits/Herbicide/

ADA Legislative Recommendations for the 111th Congress: The 111th Congress is taking place as of this writing. With a new President and many new congressmen and senators in office there will be a concerted push by the American Diabetes Association (ADA) to convince lawmakers to place a high priority on diabetes.

Let’s take a look at some of the issues the ADA believes to be important during this congressional cycle.

Research and Prevention
The ADA is lobbying for more than $23 million in additional funding for research and prevention projects as directed by the National Institute of Heath (NIH) and the Center for Disease Control (CDC). ADA acknowledges the difficulties associated with the current economic environment, but suggest that this increase is in direct proportion to the growth in new cases of the disease. Many of the proposed programs work at prevention on a local level. The ideas is that by spending funds on prevention there may be less need to spend money on future treatments.

Specific Research Using Stem Cells
Believing that stem cell research holds great promise for the potential cure of Type 1 and the improvement of Type 2 diabetes the ADA is urging congress to work toward greater funding of research related to the bioethical study of stem cells. The ADA has said, “Stem cell research allows scientists to better explore how to control and direct stem cells so they can grow into other cells, such as insulin-producing beta cells found in the pancreas.” Further, “The Association strongly supports legislation that would expand federal funding for embryonic stem cell research.”

Health Care Coverage
The ADA remains a strong proponent of meaningful health care coverage for those who live with diabetes. The American Diabetes Association indicates it will, “Oppose legislation that would it make it more difficult for individuals with diabetes to have the tools needed to manage the disease.” The opposite is also true as the ADA remains in strong support of any way the congress can exercise its role to enhance coverage for diabetics.

Maintain the Course on Medicaid
In tough economic times many in congress are asking for cuts in Medicaid. While the ADA may understand the need for fiscal diligence they also seem anxious to see congress to take a long-term approach to managed care. By denying existing diabetics the supplies they need for managed care it is the belief of the ADA that there will more significant costs in the long run related to vision loss, amputations and kidney failure among diabetics. The ADA mentions S. 755, which would be a powerful prevention step as a part of Medicaid. They believe that while there are costs involved in preventative medicine it may actually decrease the long-term financial burden.

Medicare Assistance
Individuals who qualify for Medicare can take advantage of a “Welcome to Medicare” visit that allows specific screenings at no cost. This is provided within the first six months of sign up and can be very useful in defining issues of importance in long-term managed care including, but not limited to, diabetes. The ADA remains in strong support of this program.

Gestational Diabetes
The ADA is in support of legislation that would seek to help medical personnel, “Understand and reduce the incidence of gestational diabetes.” Studies point out that as many as eight out of every one hundred pregnant women will be diagnosed with gestational diabetes. Many of those women will eventually be diagnosed with Type 2 diabetes. The hope is that by better understanding and treating gestational diabetes the better the odds are that it can either be avoided or it’s present and future complications minimized.

Diabetes And The Liver: The American Diabetes Association (ADA) indicates the greatest incidence of liver disease is found among those who also have diabetes. More than 12% of those who have diabetes will die from complications involving their liver, yet it is rare to hear the issue raised in mainstream discussions. This article will seek to explore the relationship between diabetes and liver health.

ADA reports indicate the following as a primary list of liver issues common among diabetics.

• Abnormal liver enzymes
• NAFLD
• Cirrhosis in diabetes
• Hepatocellular carcinoma in diabetes
• Acute liver failure
• Hepatitis C in diabetes

Let’s take a look at each of these individually.

Abnormal Liver Enzymes – This is a sign physicians often review when diagnosing liver disease among those who abuse alcohol, but increasingly it is also a sign of potential liver damage due to onset diabetes. This condition can also be accelerated when using cholesterol-reducing medications or various NSAID based medications.

NAFLD – This abbreviation stands for non-alcoholic fatty liver disease. The treatment for this disease is often the exact same treatment as properly maintained blood glucose in Type 2 diabetics. One of the most radical forms of this disease is non-alcoholic steatohepatitis (NASH). This condition is usually discovered when a doctor is working to treat or diagnose a separate condition. Confirmation of this disorder can take several months and will only be properly diagnosed once a liver biopsy is conducted.

Cirrhosis In Diabetes – It is increasingly common for liver issues to be evident in diabetic patients. Interestingly a diagnosis of cirrhosis may be a precursor to a diagnosis of diabetes. The combination of the two medical issues is increasingly discovered in tandem.

Hepatocellular Carcinoma In Diabetes – This form of liver cancer seems to indicate that the presence of diabetes can contribute a 2-3-fold increase in the potential of development. Reports indicate that diabetes is a risk factor apart from any other existing medical history.

Acute Liver Failure – This diagnosis indicates a rapid deterioration of the functionality of the liver. It can be common in diabetics to also see an accompanying renal (kidney) failure.

Hepatitis C In Diabetes – When Hep C is diagnosed it is not uncommon to discover diabetes is close behind. It isn’t crystal clear whether Hepatitis C contributes to onset diabetes or if the diabetes worked to create and environment for Hepatitis C. Science Daily reports, “Patients who have chronic hepatitis C with advanced fibrosis have twice the risk of developing liver cancer if they also have diabetes.”

The truth is there is debate over the proverbial topic of which came first, the chicken or the egg. In this case it’s a question of whether liver issues precede diabetes or if diabetes works to create an environment conducive to the development of liver disorders.

What is known is that many of these disorders can be held in check. When it comes to prevention of liver disease in diabetics the Mayo Clinic offers the following steps.

• Tight control of blood sugar levels
• Maintaining a healthy weight
• Reducing high cholesterol
• Avoiding excessive consumption of alcohol

A recent government finding concluded that Type 2 diabetic patients had 80% more liver fat than non-diabetic counterparts in their same age groups. This finding is significant in demonstrating the link between diabetes and chronic liver ailments. Obesity may contribute to onset diabetes, but its continued existence can lead to additional and very serious liver complications.