Fighting Diabetes: A Question of Balance
By: Source: AARP Bulletin Today Date Posted: 2003-09-02 15:40:00-04:00
America is in the midst of an epidemic of diabetes that may cut the life expectancy of diabetic 50-year-olds by as much as 10 years—but there's good news for those who make lifestyle changes.
Experts now believe that the onset of type 2 diabetes, the most common variety, can be delayed or even prevented altogether by moderate weight loss and increased exercise.
Anne Daly of the American Diabetes Association contends that lifestyle changes can prevent up to 60 percent of new diabetes cases.
"The prescription isn't a magic pill," Daly says. "Diabetes prevention is about exercising instead of flopping in front of the TV, about eating fruits and vegetables instead of fast-food burgers."
Such news couldn't come at a better time: According to a government report released in January, U.S. diabetes cases rose an alarming 6 percent in 1999, bringing the total number of American diabetics to a record 16 million.
Since 1990, reports the Centers for Disease Control and Prevention (CDC), the prevalence of diagnosed type 2 diabetes has jumped by one-third—a trend particularly marked in younger age groups. An earlier CDC survey showed that from 1990 to 1998, diabetes jumped by 76 percent for people in their 30s, 40 percent among those in their 40s and 25 percent in their 50s.
Nearly 10 percent of Americans in their 50s and more than 18 percent in their 60s have type 2 diabetes.
There are two kinds of diabetes—the relatively rare type 1, which typically afflicts people below age 30, and type 2 diabetes mellitus, which used to be called adult-onset diabetes but is now appearing even among children and teens.
The incidence of type 1 has remained stable, but type 2, which accounts for more than 90 percent of all cases, is responsible for the current diabetes explosion.
"What is so alarming is that people are developing [type 2] diabetes at ever-younger ages," says Robert Sherwin, M.D., an endocrinologist at the Yale University School of Medicine and president of the American Diabetes Association. "And it generally takes 10 to 15 years for life-threatening complications to emerge. This is a time bomb."
And it's expensive. The annual cost of medical care for diabetics—who may suffer complications that include heart disease, stroke, blindness, kidney failure and leg and foot ulcers leading to amputation—is quadruple that for nondiabetics.
"If there had been this kind of an increase in cancer rates," adds Sherwin, "we'd be hearing calls for an all-out war on the disease."
A number of factors may be contributing to the reported rise in type 2 diabetes. Screening, for example, has expanded markedly in recent years.
Heredity also plays a role; some individuals and ethnic groups, including blacks, Hispanics, Indians and Asians, are more genetically susceptible than others.
But experts are convinced that obesity and an increasingly sedentary American lifestyle are the real culprits.
"Genetic change can't possibly account for this kind of an increase," emphasizes Michael Engelgau, M.D., chief of the epidemiology and statistics branch of the CDC's diabetes division.
In the CDC survey, the incidence of diabetes among the obese (defined as more than 30 pounds overweight) was nearly four times that among people of normal weight. And the soaring rate of diabetes is virtually identical to the one-third rise in the proportion of overweight Americans since 1991.
Early Warning Signals
If you have one or more of the following symptoms, the American Academy of Family Physicians recommends that you ask your doctor to test your blood glucose levels immediately:
- • frequent urination
- • constant thirst or hunger
- • blurred vision
- • numb or tingling hands and feet
- • slow healing of cuts and bruises
- • frequent skin infections that you haven't experienced in the past.
Even if you are symptom-free, have your blood sugar checked if you have one or more of the following risk factors:
- • obesity
- • an immediate or close relative with type 2 diabetes;
- • member of a high-risk ethnic group (African American, Asian American, Hispanic, Indian)
- • history of gestational diabetes that reversed itself after pregnancy
- • high blood pressure
- • elevated LDL cholesterol
Diabetes rose in every age and ethnic category, most sharply among the best-educated Americans—more than 63 percent among those with some college—compared with about 33 percent for high school graduates.
"These findings certainly indicate that education doesn't automatically translate into a healthy lifestyle," Engelgau notes.
WHAT DIABETES DOES TO THE BODY
People with diabetes are unable to properly metabolize glucose, the sugar molecule that provides the body's basic energy supply. Glucose builds up in the bloodstream, the kidneys work harder in order to get rid of the excess and muscle and nerve cells don't have enough energy to work efficiently.
Thirst and lethargy are two early, often unnoticed, symptoms. The excess blood sugar weakens and clogs blood vessels throughout the body; diabetes doubles the risk of heart disease for men and quadruples it for women.
Controlling long-term type 2 diabetes usually requires a combination of insulin—the hormone that regulates glucose metabolism—other drugs, regular self-monitoring of blood sugar, exercise, diet modification and careful medical supervision.
Proper treatment is often delayed because diabetes isn't diagnosed until a patient is already experiencing significant complications.
EARLY DETECTION
But it doesn't have to be that way. A simple blood sugar test can detect high glucose levels that identify diabetes in its early stages. Just as important, the test can alert a patient to a borderline condition, in which glucose levels are not high enough to be considered diabetic, before diabetes sets in.
A fasting blood glucose level of 126 (milligrams per deciliter) defines diabetes, while a reading from 110 to 126 is considered borderline.
In many instances, changes in diet and exercise will push borderline blood sugar down into a normal range. "Huge numbers of people would never develop diabetes if they lost 20 or 30 pounds," emphasizes Bruce Bagley, M.D., a primary-care physician in Albany, N.Y., and chair of the board of the American Academy of Family Physicians.
A 1997 report by the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus recommended that everyone—with or without known risk factors—have a blood glucose test at age 45 and every three years thereafter.
Those with known risk factors—a family history of the disease, high blood pressure and elevated LDL cholesterol and triglycerides—need to be tested before age 45 and at briefer intervals.
Medicare does not pay for glucose screening tests in patients without established risk factors. Some private health insurance plans do pay, some do not.
Samuel Dismond Jr., M.D., former chief of staff at Hurley Medical Center in Flint, Mich., encourages patients to request screening even if insurance doesn't cover the cost.
"The sooner people know that they need to make lifestyle changes," he emphasizes, "the better chance there is of warding off these terrible complications down the road." Dismond suggests, too, that anyone with high blood pressure be screened for diabetes.
It's also important to pay close attention to the less-than-dramatic early symptoms of increased thirst and changes in urinary patterns. [See Early Warning Signals.] According to Dismond, 50-something men are particularly likely to ignore frequent urination because the symptom is so often caused by an enlarged prostate, a common condition in older men.
"Women are much quicker to come in and ask what's going on when they run to the bathroom more often," says Dismond. "Men just assume that their prostate is responsible—and it often is. But that's something that shouldn't be taken for granted."
THE BEST PREVENTION: A HEALTHY LIFE
For those at high risk who haven't developed diabetes, there is encouraging news from a wide variety of studies that is borne out in everyday medical practice. Exercise (as little as a half-hour a day) and a healthy diet—high in fruits and vegetables, low in saturated fat—greatly reduce the odds of developing full-blown diabetes.
Daly notes that many overweight patients become discouraged because they think they have to lose all of the extra pounds. But, she notes, losing only 5 to 10 percent of body weight can make a significant difference.
"When I see a client who's 80 pounds overweight according to standard tables," says Daly, "she's likely to be depressed because losing 80 pounds seems impossible. But I tell her, 'Look, you can make a difference by losing just 10 pounds.'"
Exercise—for reasons that are not fully understood—seems to play an independent role in diabetes prevention. Among Amish families in Pennsylvania—who are just as likely to be overweight as other Americans—the diabetes rate is only half of that in the general white population. The big difference is that the Amish live without cars or television.
Diabetes specialists are hopeful that the alarming statistics in the recent CDC reports will serve as a wake-up call for prevention and early medical intervention.
"The seriousness of this disease has been understated precisely because it takes so long for complications to become life-threatening," says Daly. "When a 50-year-old is diagnosed with cancer, well, you know that it has to be treated promptly or you're not going to be on the earth a year from now."
This article previously appeared in the AARP Bulletin. Since its original publication, there may have been some medical developments in this area. Therefore, consult your physician for the latest information and advice on treating this particular condition. The information in this article is intended only to describe this medical issue in general terms. This information should not be used as advice regarding your particular condition. Only your physician can give you proper medical advice.
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