Diabetes: a growing problem

It is exciting when a medical study ends early because the results are clear - and they are good.

In August 2001, the Diabetes Prevention Program did just that. In a study of over 3,200 people with impaired glucose tolerance (or “pre-diabetes”) simple lifestyle changes in diet and exercise reduced the risk of getting diabetes by 58 percent overall.

“Lifestyle intervention worked as well in men and women and in all the ethnic groups. It also worked well in people age 60 and older, who have a nearly 20 percent prevalence of diabetes, reducing the development of diabetes by 71 percent,” said the chair of the study, Dr. David Nathan of Massachusetts General Hospital in Boston.

Since it is thought that as many as 41 million people have pre-diabetes, much of it undiagnosed (Nutrition Action Healthletter, June 2004), that’s extremely good news.

Walking off the pounds
So what lifestyle changes were made? Participants did moderate intensity exercise like walking for 30 minutes each day and lost an average of 5 to 7 percent of their body weight through a low-fat diet.

Being overweight is one of the risk factors that is strongly associated with Type 2 or adult onset diabetes, the study pointed out. In fact, four out of five of those with the disease are overweight. Other factors mentioned were inactivity, family history and racial background. African American, Native American and Hispanic ethnic groups all have a higher risk for the disease.

In an article in the June 2004 Nutrition Action Healthletter the chair of the nutrition department at Harvard Medical School Walter Willett even offered hope for those who are unable to lose weight. “...we’ve also calculated that even without weight loss, the overweight can reduce their risk by 55 percent - and the obese by 30 percent - if they eat a healthy diet, stay moderately active, and don’t smoke,” he said.

18 million and growing
Should people be concerned about this disease? It is a major health problem in the U.S. affecting an estimated 18 million people. The disease can lead to serious and life-threatening problems including heart disease and stroke, kidney failure, blindness and limb amputations. Healthletter pointed out that even though death rates from heart disease have dropped 27 percent in women and 36 percent in men over the last 30 years, that’s not true of women and men with diabetes. Rates are up 23 percent in women and down only 13 percent in men who have diabetes.

Surprisingly, about a third of those estimated 18 million do not know that they have the disease, according to the Healthletter, and most people with pre-diabetes also don’t know it.

How can you tell if you might have the disease? According to Angie Johnson, Diabetes Collaborative team leader for the Scenic Rivers Health Systems at Bigfork, symptoms can include one or more of the following:

• more frequent urination
• being very thirsty
• blurred vision
• weight loss
• increased hunger
• increased and/or unexplained sense of fatigue
• skin infections
• wounds and bruises that don’t heal easily

But sometimes the disease does not show symptoms. There are three different kinds of blood tests that can be done to diagnose diabetes; a random test which can be done at any time, a test after an 8 hour fast, and a test two hours after a measured glucose (a sugar) drink is taken. The choice of test depends on several factors, but they all measure glucose in the blood because diabetes is the inability of the body to regulate the amount of this sugar in the system. Frank Vinicor, director of the Diabetes Program at the Centers for Disease Control and Prevention in Atlanta, suggests in the Healthletter article that everyone 45 years or older should have their blood tested every three years.

What is diabetes?
Cells in the body get the energy to do their jobs from the sugar glucose. Glucose enters the bloodstream from food that is digested, then crosses into cells with the help of the hormone insulin.

Insulin is produced by the pancreas, a gland behind the stomach. In type 1 diabetes, this insulin is not being produced. In the more prevalent type 2 (adult onset) diabetes, something has happened so that not enough insulin is produced or the cells have become resistant to it. As a result, glucose builds up in the blood and is discharged in the urine. But even though there is plenty of glucose there, the body cannot use it.

Vinicor explained in the Healthletter one way this can happen and why extra weight can be a problem. Fat cells are now recognized to produce their own hormones, he explained. As a self-protective mechanism, fat cells may make themselves resistant to insulin to keep sugar out. But as blood sugar climbs, the cells in the pancreas that make insulin work overtime, and eventually “peter out.”

It’s important to know that even once a person is diagnosed with diabetes, there are ways to control it through drugs, counseling support and lifestyle changes. “At every stage we have proven effective therapies,” Judith Fradkin, director of the Diabetes, Endocrinology, and Metabolic Diseases Division of the National Institute of Diabetes & Digestive & Kidney Diseases in the Healthletter article. Those therapies may not cure the disease, but they can prevent, delay or slow its progression to serious complications.

Controlling diabetes
What are some of the ways you may be counseled to control the progression of diabetes? Information provided by Johnson and Tricia Marconette, health educator at the Scenic Rivers Health Systems suggests exercise like walking (after being cleared to do so by your doctor), maintaining ideal body weight and stopping smoking. Good dental, eye and foot care are important. Blood sugar records using a glucometer may be suggested, and Johnson pointed out that if insurance does not cover the cost of the instrument and the patient cannot afford it, the clinic will find a way to get one. Taking a baby aspirin daily to prevent blood clots is also on the list.

Nutrition is important as well. Patients will be counseled about what foods and how much of them will provide the right balance in diet. Lean meat, fruit and vegetables, multigrain foods and 6-8 glasses of water daily are recommended. Fruit and fruit juices, as sources of sugar, may be limited as well as some carbohydrates.

So stay active and eat right! Sounds like a great way to enjoy the northwoods, as well as get some very big health benefits.