Monday, August 24, 2009

DIABETES - Who's Next in Line ?

Nearly 8 percent of the U.S. population now has diabetes. Tens of millions are at risk. Are you?
by Phyllis Mcintosh

If you think diabetes doesn't concern you, think again: Almost 40 percent of Americans 20 and older suffer to some degree from elevated blood sugar levels. This means that around 122 million of us have either what is called prediabetes — having elevated glucose that is not yet high enough to qualify as diabetes — or full-blown diabetes itself.

"We're facing a diabetes epidemic that shows no signs of abating, judging from the number of individuals with prediabetes," says Catherine Cowie, Ph.D., of the National Institute of Diabetes and Digestive and Kidney Diseases.

As lead author of a study published this year in Diabetes Care she revealed that nearly 13 percent of adults in the U.S. age 20 and older have diabetes — although within that group fully 40 percent have not yet been diagnosed. Furthermore, the disease is rampant among the elderly: Nearly one third of those age 65 and older have the disease.

The most common form of diabetes, affecting about 95 percent of folks with the disease, is called type 2. It arises when the body does not produce enough of a hormone called insulin to keep blood glucose (sugar) levels normal, or when the body is unable to use the insulin it does produce properly — a condition known as insulin resistance.

Previously known as adult-onset diabetes, type 2 is no longer exclusively an adult disease. Although it remains most common in people older than 60, it is occurring more frequently among young people, a direct result, say experts, of skyrocketing rates of obesity and overweight among children and adolescents.

Kids as young as five have been reported to have type 2 diabetes, says David Kendall, M.D., medical director at the International Diabetes Center at Park Nicollet Health Services in Minneapolis.

Even more troubling is the fact that Cowie and colleagues discovered that although diabetes is relatively rare in kids ages 12 to 19, prediabetes afflicts 16 percent of them.

The good news is that we are learning more about the risk factors for type 2 diabetes and how to prevent it. And if you are already diagnosed, type 2 can often be controlled by following a healthful nutritional plan, exercising, losing weight and taking medications.

Type 1 diabetes is an autoimmune disease that affects up to 3 million people in the U.S. Since it causes the body to stop producing insulin almost completely, it must be treated with insulin injections. It's commonly diagnosed in children.

Type 2 diabetes is caused by a combination of genetic and environmental factors. In general, people who are 45 or older, are overweight and have a family history of diabetes are at greatest risk. Certain ethnic groups, such as African-Americans, Latinos and Native Americans, are especially prone to the disease.

The most serious warning signs are prediabetes and a cluster of risk factors collectively known as metabolic syndrome. Almost 30 percent of the adult U.S. population has prediabetes, according to Cowie's research; many will progress to type 2 within 10 years.

"It's important to know if you have diabetes or prediabetes, because there's so much you can do to preserve your health," says Joanne Gallivan, M.S., R.D., director of the National Diabetes Education Program (NDEP).

Untold millions more people have metabolic syndrome — a combination of risk factors such as obesity, low HDL (good) cholesterol, high triglycerides and high blood pressure — which puts them at risk of both diabetes and heart disease.

"The more of these you have, the higher your risk," says Dr. Kendall. "People at high risk should have their blood glucose tested early and often. While you can't do anything about your genetic makeup or family history, you can substantially modify your risk of developing diabetes by stepping up your activity level, eating a healthy diet rich in fruits, vegetables, and whole grains and restricting calories to lose weight.

A large study called the Diabetes Prevention Program showed that people with prediabetes can reduce their risk of developing diabetes by 58 percent just by losing 5 to 10 percent of their body weight and getting 30 minutes of moderate exercise every day.

If you or a loved one is diagnosed with diabetes, it's normal to occasionally feel angry, depressed or overwhelmed. Diabetes is a complicated disease that demands daily attention and significant lifestyle changes, so don't try to cope by yourself; get a team behind you.

Essential team members are your primary-care physician, who will coordinate your overall health care, make sure you get routine screenings and help you assemble the rest of your team, and a certified diabetes educator, usually a nurse or dietitian trained to help you manage your diabetes on a daily basis.

The educator will teach you how to monitor your blood sugar and explain what the numbers mean, instruct you on the symptoms of highs and lows, show you how to inject insulin if needed, and help you devise a meal plan and an exercise program.

When first diagnosed, you may see a diabetes educator three or four times or attend a group class for five or six sessions to learn the basics and then follow up as needed.

"Our most important role is to translate the information and put it into practical language/' says Nadine Uplinger, M.S., R.D., a certified diabetes educator and director of the Gutman Diabetes Institute at the Albert Einstein Healthcare Network in Philadelphia.

Who else might you want on your team? "It is great if you have someone on the team with a psychology or behavioral therapy background to help you cope with feelings of grief or depression,” Uplinger says.

“Physical activity and nutrition are the cornerstones of diabetes management for people with type 2," says Nadine Uplinger, M.S., R.D., a certified diabetes educator and director of the Gutman Diabetes Institute in Philadelphia. "Exercise lowers blood sugar and helps the body use whatever insulin you are still producing. Plus, it helps reduce your overall risk of cardiovascular disease." Although the recommendation is for 30 minutes of moderate activity five days a week, "it's important to start with what's attainable and work in increments," she adds. "With someone who hasn't been active at all, if you can get the person up and moving five minutes after a meal, that's where you start.” One of the most important dietary goals, Uplinger says, is to avoid going long periods without eating — crucial for maintaining blood glucose at an acceptable level. "We also emphasize eating more vegetables, whole grains, less fat and fresh fruit instead of juices," she says.

True, diabetes is a chronic illness that you must think about every day. But managing it will be easier if you keep a positive attitude, follow your treatment plan, keep good records and stay connected with your team. Support groups, which allow you to share experiences and gain useful tips, are also helpful.

But remember, you are the most important member of your team. You know best what you can and will do to manage the disease. And when you find ways to take an active role in managing your diabetes, you will control the disease instead of it controlling you.

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