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Weston Murphy, 5, who has Type 1 diabetes, pricks his finger to test his blood at his home in May 2015 in Plainfield, Ill. About 1.6 million Americans have Type 1 diabetes. Type 2 disease is more common, affecting more than 30 million nationwide and most of the more than 300 million worldwide with diabetes. Besides short-term complications from poorly controlled blood sugar, both types raise long-term risks for damage to the kidneys, heart and eyes. 
Type 2 diabetes, formerly known as adult-onset diabetes, is a relatively silent disease.
The initial symptoms can be subdued, and the disease often manifests in ways that are difficult for people to connect back to their body’s blood sugar.
A foot might start to feel numb, or a person might have blurry vision or very dry skin. They might have more infections than usual or be more hungry or thirsty.
Those subdued symptoms are in part why roughly 1 in 5 of those who develop type 2 diabetes don’t know they have it, according to the Centers for Disease Control and Prevention.
“Diabetes is really insidious because it doesn’t have many warning signs,” said Joseph Grandpre, the state chronic disease epidemiologist with the Wyoming Department of Health. “Most people are unaware they have diabetes until they go into the doctor for something else like an eye checkup.”
“We rarely catch it early,” he said.
Type 1 diabetes is closely linked to genetics. Type 2 diabetes develops over time and occurs when the body can no longer use insulin effectively and keep a person’s blood sugar at normal levels.
Type 2 diabetes accounts for somewhere between 90 and 95% of all cases, according to the CDC.
The subtlety of type 2 diabetes makes it difficult to track, and unlike cancer, Wyoming has no registry to collect the number of diabetes cases in the state each year. Instead, Grandpre and his team undertake an annual telephone survey in which they ask respondents about their health behaviors and factors, including if they have ever been diagnosed or told by a medical provider that they have diabetes.
Though the data can vary from year to year, Wyoming’s surveillance system shows a growing burden in the state.
In 2019, 7.8% of Wyoming adults 18 years and older reported having diabetes. In 2021, that number increased to 8.8% of adults, according to Department of Health data.
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“As with the rest of the nation, the trend has been climbing over the last 10-15 years,” Grandpre said.
When diabetes monitoring in Wyoming first started in 1994, just 3.4% of adults reported having diabetes. A decade and a half later roughly 7% of those 18 and older had been diagnosed with diabetes.
Over the last 20 years, the number of adults diagnosed with diabetes has more than doubled in the U.S., according to the CDC. Diabetes is the seventh leading cause of death nationwide and the leading cause of kidney failure, lower-limb amputations and adult blindness.
Though the state does not track lower-limb amputations, the national trend likely holds true in Wyoming, Grandpre said.
“We’re seeing young kids now having type 2 diabetes where they’ve worn out their pancreas in 10 or 12 years, which you would never have seen,” Grandpre said. “In the 1980s and the ’70s, no one under 40 had type 2 diabetes.”
The growing prevalence of diabetes in Wyoming comes down to two factors – age and obesity, Grandpre said.
As a person ages, their body starts to deteriorate and their pancreas regulates blood sugar less effectively, making them more at risk for diabetes. Grandpre compared it to wearing out the tread on a car tire.
Wyoming’s elderly population, which includes those 65 years and older, grew by nearly 3.6% from 2020 to 2021, according to U.S. Census Bureau data, more than 10 times the growth of the state’s overall population.
Wyoming has one of the highest proportions of Baby Boomers (those between the ages of 57 and 75 in 2021) and lowest proportions of Generation X residents (those between the ages of 41 to 56 in 2021) of any state, leading to increased risk of diabetes in the state and higher rates of the disease.
Like age, obesity is also increasing.
“Obesity and diabetes go hand in hand,” Grandpre said. “As our prevalence of obesity increases, so does our in our prevalence of diabetes.”
Obesity in Wyoming has more than doubled since 1994, according to Department of Health data. Nearly a third of the state’s adult population was considered obese in 2021.
To head off rising diabetes rates, the Department of Health has turned to statewide prevention campaigns and education.
The department operates a yearlong diabetes prevention program for those at risk of type 2 diabetes, including the roughly 50,000 people in Wyoming who have prediabetes, which is when a person’s blood sugar levels are higher than normal, but not high enough to meet the threshold for diabetes.
The state’s diabetes prevention initiative has 14 in-person programs across the state where those at risk can learn more about healthy lifestyle habits, said Amber Nolte, the chronic disease prevention program manager for the Department of Health.
In 2021, the department also launched a free virtual program where residents can access educational videos and app-based coaching while getting paid cash for weight loss.
“It focuses on healthy eating [and] exercise. There’s a couple modules on how to properly grocery shop and how to read a nutrition label on food,” Nolte said. “It really is just supposed to give you the lifestyle tools to prevent diabetes on your own.”
Since the inception of the state’s diabetes prevention program five years ago, participation has increased, but the Department of Health still has work to do, Nolte said.
“What we really have to promote is awareness that prediabetes is even a thing,” she said. “Many people don’t know that being obese or aging really affects their risk of developing this.”
The first step for anyone concerned about diabetes is to take an online prediabetes test at www.findoutwy.org, Nolte said. If the test determines that a person is at risk, they should then see their doctor.
Prevention efforts are not a panacea for Wyoming’s rising diabetes rates, Grandpre said. They will not completely erase a person’s risk of developing the disease since age is a factor. But they do make a difference.
“We’re not necessarily going to prevent everyone from getting cancer, diabetes and heart disease,” Grandpre said. “But the longer we can delay them then the better quality of life you have [and] the less time that you have to deal with it.”

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Weston Murphy, 5, who has Type 1 diabetes, pricks his finger to test his blood at his home in May 2015 in Plainfield, Ill. About 1.6 million Americans have Type 1 diabetes. Type 2 disease is more common, affecting more than 30 million nationwide and most of the more than 300 million worldwide with diabetes. Besides short-term complications from poorly controlled blood sugar, both types raise long-term risks for damage to the kidneys, heart and eyes. 
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