Many Don’t Realize the Seriousness of Diabetes

Winston-Salem Journal, N.C.

02-17-09

Feb. 17–When the American Diabetes Association held a series of focus groups asking people to rank the severity of certain health problems, cancer and heart disease, predictably, ranked at the top of the list.

Diabetes fell to the middle of the pack.

Diabetes is a disease in which the body does not produce or properly use the hormone insulin. Insulin changes sugar, starches and other foods into energy. Although diabetes can create chaos in the body, many people don’t realize how serious it can be.

Diabetes is one of the strongest risk factors for heart disease, stroke and kidney disease. The risk of dying from heart disease or stroke is two to four times higher for diabetics than non-diabetics, said Dr. Heath Thornton. Thornton is a family-medicine doctor and an assistant professor of family medicine at Wake Forest University Baptist Medical Center.

Diabetics are at risk for blindness because the disease causes changes in the blood vessels of the eyes. They are at risk for amputation of their feet and legs because of poor blood flow and nerve damage.

Results of a recent study done by researchers at the medical center show that high blood-sugar levels in Type 2 diabetes can lead to memory decline and dementia, particularly Alzheimer’s dementia. The memory impairment can cause diabetics to have more trouble keeping up with their medications and controlling their diabetes. The study appears in this month’s issue of Diabetic Care. Dr. Jeff Williamson was the principal investigator for the study. He is a professor of internal medicine, the director of gerontology and geriatrics research, and the director of the Roena Kulynych Center for Memory and Cognition Research at the medical center.

Experts estimate that the average cost of diabetes care is $5,000 a year. The cost jumps when complications require hospitalizations and expensive after-care.

And diabetes is on the rise.

Doctors treated 16 million cases of diabetes in the United States in 2003, said Dr. Barry I. Freedman, the section chief for nephrology, kidney disease, and the John Felts professor of internal medicine/nephrology at the medical center.

If current trends continue, Freedman said, 29 million people will have diabetes by the year 2050. The highest rates of diabetes occur among American Indians, Hispanics and blacks. The rates in North Carolina are about the same as those in other Southeastern states, he said. Rates are high in many parts of the country and are increasing, he said.

Worldwide, Freedman said, 151 million people had diabetes in 2000. By next year, experts predict that number will rise to 221 million cases.

“For the kidney doctors and heart doctors, the neurology doctors that deal with strokes, this is pretty much our No. 1 problem,” he said.

Diabetes is divided into two main types. In Type 1, once known as juvenile diabetes, the body produces no insulin. Type 1 usually occurs in children and young people, and those who have it need insulin injections to live. Type 1 represents 5 percent to10 percent of diabetes cases.

In Type 2 diabetes, which represents 90 percent to 95 percent of diabetes cases, the body doesn’t produce enough insulin or is unable to use it properly. Sugar builds up in the blood instead of providing energy to the cells. Eventually, the buildup can affect the heart, kidneys, nerves and eyes.

Genetics play a part in developing Type 2 diabetes; it runs in families. A sedentary lifestyle and poor eating habits also contribute, and Type 2 is often linked to obesity. As people age and their bodies wear, their risk for diabetes rises, Thornton said. Freedman said that people who have diabetes in their families should keep themselves trim and fit, exercise and see their doctors routinely to keep tabs on their blood-sugar levels.

But doctors are now concerned with the increase in Type 2 diabetes among young people, who have become more prone to obesity, inactivity and diets high in carbohydrates.

Symptoms of diabetes, which often don’t appear until the disease is well-advanced, include fatigue, increased urination, increased thirst and increased appetite. Some people don’t find out that they have diabetes until they have had a stroke or developed a heart problem, Thornton said.

A diagnosis of diabetes, a chronic and expensive disease to manage, is a life-changing event. It can mean everything from giving up foods you love to following a regimen of frequent insulin injections and finger sticks to draw blood and check sugar levels.

Diet and exercise are often the first line of defense when diabetes is discovered early. Following doctors’ recommendations can often minimize the amount of drugs the diabetic has to take and reduce the disease’s long-term risks and effects. Drugs, including insulin and oral medications, can help keep diabetes under control.

Sonya Jeffries is a nurse practitioner and certified diabetes educator at the Diabetes Care Center at the medical center. She sometimes sees people who can’t bear the thought of sticking needles in their flesh. She counsels them to rotate the sites from which they obtain blood to test their sugar levels so that their fingers don’t become sore and introduces them to insulin pens, which deliver doses of insulin with the push of a finger.

The needle on the pen is small, and most people find the pen less intimidating than a syringe, she said.

Still, the pricks and injections can cause pain, and some people get tired of it.

“It gets to be frustrating,” Thornton said. “It’s not comfortable to prick your fingers a lot.” His daughter, who is 7 and has Type 1 diabetes, must check her blood eight to 12 times a day. Type 1 diabetes requires more frequent monitoring, he said.

“Kids adapt well to these sorts of things, but it is a struggle. They go through times of not wanting to do any of it but having to deal with the consequences of it, just as adults go into denial sometimes.”

The short-term consequences of not keeping diabetes in check can mean dangerous variations in blood-sugar levels. If the blood sugar goes excessively high, a process that usually develops over time, people can develop a condition called ketoacidosis, which is life-threatening and should be treated immediately. Symptoms of the condition include shortness of breath, breath that smells fruity, dry mouth, nausea and vomiting.

When blood sugar plummets, which can happen when diabetics skip meals or take too much insulin, the body can go into insulin shock. Symptoms include sweating, tremors, anxiety and dizziness and can escalate to delirium, convulsions and collapse.

“It can kill someone quite quickly before they get to the hospital,” Thornton said.

Insulin is the main drug associated with treating diabetes. But Freedman also talked about other treatments that can enhance the treatment of diabetics, such as taking ace inhibitors, drugs usually used to reduce high-blood pressure, and statins, usually used to treat high cholesterol.

“With proper attention to therapy very early on, when they first get the disease, it can make a tremendous impact on reducing the complications seen,” he said. “The key is to be aware of the problem and be aggressive in treating it early.”

Janice Gaston can be reached at 727-7364 or at jgaston@wsjournal.com.

For more information on diabetes, go to www.diabetes.org/home.jsp.

For more information on natural treatments for diabetes or pre-diabetes, or other health issues, call for an appointment!

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