More Americans than ever have diabetes, and the number continues to grow -- but the disease is often preventable.
The technical term for diabetes is diabetes mellitus. The disease referes to the body's problems with insulin, a hormone produced in the pancreas. Insulin plays a vital role in metabolism -- in helping glucose (sugar) to move out of the blood into cells, which use the glucose for fuel. In type 1 and type 2 diabetes, there's a need to control glucose levels in the blood.
About 90 percent of all people with diabetes have type 2. Until several years ago, type 2 diabetes mostly occurred in overweight adults older than 45. Today, however, women and men in all races and ethnic groups, along with children and adolescents, are developing it.
Type 1 is also often called juvenile diabetes because most people with type 1 diabetes develop it before age 30. In this form of the disease, the insulin-producing beta cells in the pancreas have been destroyed.
Symptoms may include high levels of blood sugar, high levels of sugar in the urine, frequent urination, extreme hunger, extreme thirst, extreme weight loss, weakness and fatigue, moodiness and irritability, or nausea and vomiting.
Treatment: Insulin is received via injections or insulin pumps.
Possible complications of poorly controlled diabetes include kidney disease; eye damage; heart problems; compromised nerve function in the arms, hands, legs, and feet that can set the stage for ulcers and amputations; coma and death.
In type 2 diabetes, the pancreas may be producing insulin; however, there are insulin-resistance problems in the body that interfere with insulin's ability to do its job.
Symptoms may include increased thirst; frequent urination; increased appetite accompanied by weight loss; edginess; fatigue; nausea; repeated hard-to-heal infections; tingling or numbness in the hands or feet; high levels of sugar in the urine; or dry, itchy skin.
Treatment: Ten percent of type 2 patients rely on diet and exercise to manage their disease. Fifty percent are treated with oral medications; 30 percent with a combination of insulin and oral medications; and 10 percent with insulin alone.
Possible complications are the same as for type 1 diabetes.
Diabetes has risen at a startling rate: 30 percent in the past decade. The epidemic seems linked to a major risk factor: obesity, or being overweight by about 30 or more pounds. The rate of obesity in the United States has increased by 57 percent since 1991. Simply put, Americans sit too much and eat too many fatty foods. We pay a heavy price: spiraling health-care costs and, for those with diabetes, a lifetime of increased risk for complications such as blindness, kidney failure, heart attack, and stroke.
The statistics seem grim. But they are reversible. Type 2 diabetes is preventable, and certainly treatable, especially when you exercise and stick to a low-fat diet.
Some diabetes risk factors cannot be controlled, especially those that are hereditary, points out David S.H. Bell, M.D., of the University of Alabama at Birmingham. Hereditary factors that increase your risk include:
The following health-related risk factors often can be controlled, though your susceptibility to them may be inherited:
About 8.1 million women and about 7.5 million men have diabetes. There's a higher incidence of type 2 diabetes in women than in men, probably because females more often tend to be overweight, says Dr. Bell. Childbearing also increases a woman's risk for diabetes.
Some women develop gestational diabetes, which occurs in 2 to 5 percent of all pregnancies. Women with gestational diabetes may avoid having to take insulin injections if they do not eat certain foods, such as table sugar, honey, brown sugar, corn syrup, maple syrup, molasses, soft drinks, fruit drinks, fruit packed in syrup, cake, cookies, ice cream, candy, jams, and doughnuts. It is also recommended that fruit juices be limited to 6 ounces and taken with meals. If you are diagnosed with gestational diabetes, you'll likely be referred to a registered dietitian. Working with your obstetrician, the dietitian can plan a diet that provides your baby with adequate nutrition while omitting foods that increase your blood sugar levels.
Gestational diabetes disappears when a pregnancy is over. However, about one-third of women with gestational diabetes will develop type 2 diabetes later on, says Dr. Bell. Many of these women can prevent this from happening if they keep their weight down -- after pregnancy -- by following a diet low in fat and calories, and exercising.
Moms who have given birth to a large baby -- one weighing more than 10 pounds -- are at increased risk for developing diabetes later in life.
If you are a diabetic woman who wants to bear children, seek expert medical advice before getting pregnant. "Generally, it's better for pregnancy to occur when you're younger and in the early, controlled stages of diabetes," says Dr. Bell. "However, at any age you'll need high-risk pregnancy management, which might include an endocrinologist working with your obstetrician."
Women with diabetes, especially type 2, are at risk for heart problems. "Women who are not diabetic typically do not get heart disease until they're in their 60s," explains Dr. Bell. "However, with diabetic women, this can occur a lot earlier." That's why it's essential that your doctor apply what Dr. Bell calls the Big Three: (1) Treat the blood sugar problems associated with diabetes; (2) treat lipids -- the cholesterol and triglycerides; and (3) work with you to keep your blood pressure under control.
Traditionally, pediatricians have seen type 1 diabetes in children, not type 2. In fact, type 2 used to be referred to as "adult-onset diabetes." But the lines are blurring because of an increase of type 2 diabetes in children and adolescents. Why? Too much junk food and television and too little exercise, says James R. Gavin III, M.D., of the Howard Hughes Medical Institute in Chevy Chase, Maryland, and a former president of the American Diabetes Association.
You can fight this epidemic by exercising with your children and minimizing fast food dinners and snacks. Stock the fridge with fruits and vegetables, and put beans, grains, cereals, low-fat dairy foods, lean meats, chicken, and fish on the family menu.
If your children have diabetes, ensure they get cholesterol and other blood fat tests, a yearly dilated eye exam, a foot exam to check circulation and nerves, a urine test to check kidney function, and regular dental checkups. They need to have their blood pressure checked regularly; if elevated, it should be treated.
Researchers are developing innovative treatments that make diabetes easier to manage.
New drugs such as Actos (pioglitazone) and Avandia (rosiglitazone) lower insulin resistance. Drugs like Starlix (nateglinide) and Prandin (repaglinide) help the pancreas make more insulin. "These are tremendous aids in treating type 2 diabetes," says Dr. Bell.
The hemoglobin A1c test, a valuable but underused tool, makes a big difference in treatment. The test can tell the doctor how high the patient's blood sugar has been, on average, over the last two to three months. This provides a better picture of the degree to which the kidneys, heart, nerves, and eyes have been exposed to high blood sugar. Surprisingly, only 40 percent of patients with diabetes get the hemoglobin A1c test once a year, says Bell. If you are diabetic, talk to your doctor about taking the test.
Everyone with diabetes must measure blood glucose with finger-stick tests -- on a daily basis or even hour by hour -- so they know how food, exercise, and medication affect their blood sugar. In 2001 the Food and Drug Administration approved a noninvasive meter resembling a wristwatch that uses low-frequency electrical current to measure glucose. For now this and similar new meters must still be used alongside finger-stick testing, but the days of numerous pricks and sore fingers may end soon.
For those who must take insulin, the chore of injection has gotten quicker and less painful with inventive gadgets. For example, a disposable, penlike injector that contains insulin and small needles tucks in a pocket.
The insulin pump, an improved insulin-delivery method used mainly by type 1 diabetic patients, is available in sizes as small as a pager.
The insulin inhaler is another innovation. However, more studies are needed to investigate how inhaling insulin directly into the lungs affects lung tissue, says Bell. Gavin does not believe these inhalers will replace insulin injections for most patients over the long term.
For now, medications, regular checkups, nutrition, and exercise are the best ways to manage diabetes, and live a full life.