INTERNATIONAL: DIABETES
Cause: Insulin, produced in the pancreas, helps blood sugar get into cells, which use it for energy. If the body can’t produce or use insulin effectively to prevent a buildup of sugar in the blood, diabetes results. Pre-diabetes is when blood sugar levels rise to higher than normal, but not high enough to be called diabetes.
Diabetes comes in two major forms:
Type 1, an autoimmune disease, result in losing insulin-producing cells in the pancreas, usually in children and young adults, who need daily insulin shots, and
Type 2, which is 90% of diabetes, and is associated with obesity, inactivity, and reduces ability use insulin effectively.If body size increases, the pancreas churns out more insulin. Eventually, it can’t keep up with demand and sugar levels build up in blood.
Result: sugar levels in blood clog vessels the way gummy oil clogs car engines, reducing circulation that affects the body from brain to feet. Diabetes doesn’t kill, but uncontrolled diabetes causes heart disease risk, damages kidneys, eyes and nerves and can lead to blindness, amputated limbs, kidney failure and dialysis, nerve failure and amputated limbs, increased infection, death.
Treatment: In 1993 it became clear that lowering blood sugar prevented or delayed complications, and in the past decade doctors learned managing blood pressure and cholesterol reduced complications. Treatments improve and decrease incidence of people blind, losing limbs or in dialysis. By reducing high blood pressure and cholesterol and keeping blood sugar levels as close to normal as possible, diabetics can forestall many disabling complications. Simpler, more accurate blood tests and better drugs have improved treatment, says John Buse, endocrinologist at University of North Carolina at Chapel Hill, but soaring rates of diabetes threaten to overwhelm medical systems.
Reasons for improved treatment:
a. more awareness led to more screening and earlier diagnosis
b. Now there are six types and several classes of drugs. Some boost insulin production, others reduce need for more insulin or lower risk of complications, others act to keep blood sugar levels steady without causing weight gain or hypoglycemia
c. High-tech meters and monitors measuring blood sugar, and insulin pens, pumps and jets, facilitate tighter control. Injected insulin is now so easy that inhaled insulin was pulled from shelves for poor sales.
d. Early, intensive treatment helps. Diet and exercise consistently.
Well-informed patients are highly motivated and treatments ‘so well tolerated that avoidance of complications is a reasonable expectation,’ says Buse.
Five YMCAs in Indianapolis pilot an Indiana University (IU) program to prevent or delay diabetes in people with pre-diabetes. They have 16-week classes for groups of 10-12 people to implement lessons learned from the Diabetes Prevention Program (DPP) published in 2002, which stated people with pre-diabetes can reduce risk of developing diabetes if they reduce body weight by 5-10% and exercise 30 minutes a day. People can head off risk if they’re heavy and inactive—they can control weight. Obesity affects type-2 diabetes because the body’s demand for insulin increases beyond supply, says American Diabetes Association endocrinologist John Buse.
Most people with diabetes-2 have the body of a SUV but the pancreas of a small sedan. Buse says if they shrink their frame, their pancreas will be fine. By getting fit, losing weight and reducing stress, people can use insulin more efficiently and they’ll feel the difference. ‘I have patients tell me that they believe they’re healthier for having been diagnosed with diabetes. If they hadn’t been slapped in the face, they’d never have taken control, reduced their weight and increased their exercise.’ They recommend exercise, eating chicken and fish rather than red meat, writing down what you eat.
Prospects: IU diabetes researcher David Marrero, who helped develop the pre-diabetes program, says ‘it’s better to catch the horse before it gets out of the barn. Diabetes is reaching epidemic proportions’ and the people with pre-diabetes are 3-4 times those with frank diabetes diagnosis. Meanwhile, diabetes-2 now inflicts about 250 million people worldwide—by 2025, 380 million. Blacks, Latinos and Asians have higher genetic risk of diabetes than do whites. Increasing fatty diets in those communities, with resulting obesity (says Judith Fradkin, director of the National Institute of Diabetes and Digestive and Kidney Diseases at the National Institutes of Health) helped trigger a diabetes explosion now killing 3.8 million per year, almost as many as malaria and AIDS combined. We must change behavior, as we did for smoking, or we’ll have a society of fatter, sicker people. The problem will ‘get worse before it gets better’, says Ann Albright, director of Center of Disease Control’s diabetes division, while policies are made and people ‘access new technologies and diabetes education.’
You don’t have to only drink water and eat toothpicks the rest of your life. Just choose food more healthfully. Only half your calories should be from carbohydrates, which appear in whole grains, vegetables, fruits, desserts, other sweets, so it’s wiser to spend this on vegetables and fruits rich in fiber, vitamins and other nutrients, says registered dietitian and exercise physiologist Ann Albright, hed of diabetes divisuion of Centers for Disease Control and Prevention, and president of Healthcare and Education for American Diabetes Association (diabetes.org). They suggest ‘rate your plate’ when you sit to eat: draw an imaginary line through the center of your plate, and divide one section in two. One quarter is for grains: brown rice, whole-wheat noodles, etc. One quarter is for protein—lean meats (examples, pork loin, sirloin), fish (twice or thrice a week), poultry (remove the skin from chicken or turkey), beans, tofu, etc. Half the plate should be vegetables picked from a rainbow of colors, and include non-starches like spinach, carrots, broccoli, green beans. You can add non-fat milk and a small whole-grain roll or piece of fruit. See recipe.
Sheri Colberg, associate professor of exercise science at Old Dominion University at Norfolk, Virginia, and co-author with endocrinologist Steven Edelman of Fifty Secrets of the World’s Longest Living People with Diabetes, says ‘these peole have gone…to the point of embracing diabetes’, saying, ‘“Diabetes saved my life. I look around and see people so unhealthy, and I’m healthy.”’ She says heeding that wake-up call is crucial, or diabetes can shorten life by twelve years and complications can reduce life’s quality for the last twenty years of life. Now, people can get a diabetes reading in seconds, new insulin pumps work with glucose meters to allow on-spot adjustments and tighter control of sugar levels. Learn about diabetes and share information. Exercise. Be physically active, on the go, or have a structured exercise program. Eat well and in moderation.
USA: Docosahexaenoic acid (DHA) and eicosatentaenoic acid (EPA) are two omega-3 heart-healthy fats helping prevent heart attacks, and are most often found in fish or pill supplements. Sometimes companies claim milk, eggs, yogurt, cereal, orange juice, butter substitutes, mayonnaise and other products help, but these contain OTHER omega-3 fats less heart-healthy. American Dietic Association registered dietitian Katherine Tallmadge says they make huge claims for tiny benefits. Center for Science in the Public Interest nutritionist Bonnie Liebman reviewed omega-3 food claims and published results in a recent cspinet.org article. She says the advertisements mislead consumers. For instance, a carton of yogurt has less DHA than a teaspoon of salmon, and a bottle of mayonnaise has another omega-3 fat, alpha-linolenic acid (ALA), and ALA increases prostate-cancer risk. So if product packaging says omega-3 but doesn’t say DHA or EPA, it’s probably ALA and you get that better from walnuts, ground flaxseeds and tofu. Studies suggest you need 500 milligrams a day of DHA or EPA, and you’ll get that by eating fatty fish twice weekly. Patients with coronary heart disease should double the dosage, says the American Heart Association.