Diabetes Denial

[Guest guest]

Diabetes Denial

By , November & December 2005

Five million Americans have this disease and don’t know it. Are you one of

them?

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When Mendosa was diagnosed with diabetes in 1994, his blood sugar was

triple the normal level. The Colorado writer had probably already had the

disease

for several years—during which it may have been silently chipping away at

his eyesight, kidney function, and cardiovascular health. " I didn't know

anything

about diabetes, " recalls Mendosa, 70. " But when I learned it was a chronic

condition that often led to terrible complications, I was scared. "

Traumatic as it was, Mendosa's experience was not unusual. The diabetes rate

is skyrocketing, especially among people over 40, and of the 18.2 million

Americans

estimated to have the disease, 5.2 million don't even know they have it. The

longer diabetes goes without treatment, the greater its potential for harm.

Though there is no cure yet, doctors are learning more about the disease

every day. Many people with diabetes don't even need medicine—and those who

do

have new options. There's even help for people who find managing the disease

too confusing or inconvenient.

Of course, all those advances can't help you if you don't know you have the

disease. So find out what your blood sugar level is, and if you have

diabetes,

get serious about controlling it.

Do You Have It?

Though early diabetes may have no symptoms, possible warning signs include

excessive thirst and urination, daytime fatigue, and blurred vision.

Web-Exclusive Diabetic-Friendly Recipes

Fresh Jicama Salsa

Smothered Baked Portobello Mushroom

Southwestern Bruschetta

Spicy Salsa Chicken Grill

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Latino Dishes From AARP Segunda Juventud (in English and Spanish)

The most common test for diabetes may not be the most accurate one. The

fasting plasma glucose test—in which blood is drawn after at least eight

hours without

food—is relatively cheap and easy, and it's recommended by the

American Diabetes Association

(ADA). But some studies suggest this test may miss up to half the people

with type 2 diabetes. In that form of the disease, the body's tissues

gradually

become less able to use the hormone insulin to take in glucose from the

blood for fuel. (Type 1 diabetes, in which the pancreas stops producing

insulin,

is usually diagnosed by young adulthood.)

In most cases, the first sign of type 2 diabetes is high blood sugar after

meals, also called postprandial hyperglycemia. Only later in the disease

does

blood sugar remain high after hours of fasting. That's one reason many early

cases of type 2 diabetes go undetected.

More sensitive is the oral glucose tolerance test—essentially a treadmill

test for your pancreas. You fast overnight, have blood drawn, then drink a

sugar

solution and wait. Over the next few hours, more blood is drawn

periodically. It's more expensive and more of a hassle than the fasting

test, which is

partly why some experts—including those at the ADA—oppose its widespread

use. But many other experts, including several consulted for this story,

consider

it to be the gold standard for diagnosing diabetes.

First Resorts: Diet and Fitness

If you have high blood sugar and are overweight or sedentary, brace yourself

for a lecture from the doctor. Losing weight and exercising, though not

high-tech,

are two very effective means of getting blood sugar under control.

After he was diagnosed, Mendosa dieted and started a walking program,

bringing his blood sugar back to normal within six months. " In a way, my

diagnosis

was the best thing that could have happened to me, " he says.

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Even if you don't have diabetes, tests might detect prediabetes: blood sugar

that is elevated but not yet diabetic. This diagnosis is an opportunity:

weight

loss and exercise can prevent diabetes in people with prediabetes. " So many

people feel that lifestyle changes are futile, " says Riddle, M.D.,

professor of medicine at Oregon Health & Science University. " They sure

aren't futile in the early stages. "

In a nationwide trial called the Diabetes Prevention Program, people with

prediabetes reduced their risk of developing type 2 diabetes by more than

half

simply by losing weight and exercising. The results were so compelling that

the study was halted a year early, in 2001.

The study's most surprising finding concerned participants 60 and over.

Researchers expected older people to have a harder time sticking to the diet

and

exercise program. In fact, they adapted better than younger participants did

and benefited more from the changes they made, reducing their risk of

diabetes

by a stunning 71 percent.

Exercise actually reduces blood sugar—and helps prevent diabetes in those at

risk.

" It was completely counterintuitive, " says , M.D., of Harvard

Medical School, a principal investigator for the study. " We thought, They're

older,

their lifestyles are much more ingrained. But in fact, just the opposite

occurred. "

Besides helping with weight loss, exercise boosts the body's ability to

control blood sugar. " When you exercise, glucose is taken up by the

exercising muscle, "

says Horton, M.D., director of clinical research at the

Harvard-affiliated Joslin Diabetes Center. In other words, you can reduce

your blood sugar

by going for a brisk walk. Also, exercise changes the muscle to make it more

sensitive to insulin.

Since exercise is also known to improve your mood, it's especially valuable

if you have diabetes, because being depressed can keep you from taking care

of yourself—a potentially dangerous situation.

When to Add Drugs

While a healthy lifestyle might be the best treatment for a while, it is

essential for people with diabetes to be vigilant and to act swiftly if

medicine

is needed.

" Moving on to the next step of therapy—from lifestyle to the first pill and

from one oral drug to two—has traditionally taken too long, " says Riddle.

" During

that time, the harmful effects of the high blood sugar are just marching

right along. "

The blood marker to watch is glycosylated hemoglobin (abbreviated as HbA1c,

or simply A1c)—the amount of glucose that is attached to hemoglobin, a

protein

in red blood cells. The higher the A1c, the higher blood glucose has been

over the previous two or three months. Even if your blood sugar is usually

under

control, unnoticed spikes can cause A1c to rise. People without diabetes

typically have an A1c in the 4 to 6 percent range. Those with diabetes can

minimize

the risk of heart disease and of eye, nerve, and kidney damage by keeping

A1c below 7 percent.

As if the long-term benefits of keeping blood sugar down aren't motivation

enough, there are immediate payoffs as well. " The chronic complications take

years and years to develop, " explains Edelman, M.D., a professor of

medicine at the Univer- sity of California, San Diego, who has diabetes

himself.

" What I call the acute complications affect quality of life on a day-to-day

basis. " In addition to excessive thirst and urination, daytime tiredness,

and

blurry vision, symptoms could include poor wound healing, problems with

sleep, and cognitive impairment. Even a small improvement in A1c can reverse

this

trend—and it can do so in a matter of weeks or even days.

The Latest Treatments

If you need drugs to control blood sugar, there are more options than ever.

Since 1995 at least seven new oral medications have become available. These

include drugs that lower the liver's glucose output, such as Glucophage

(metformin); drugs that slow carbohydrate digestion, such as Precose

(acarbose)

and Glyset (miglitol); drugs that raise cells' sensitivity to insulin, such

as Actos (pioglitazone) and Avandia (rosiglitazone); and drugs that

stimulate

insulin secretion, such as Starlix (nateglinide) and Prandin (repaglinide).

New this year are Symlin (pramlintide) and Byetta (exenatide). These drugs

have to be given via injection, but like metformin—and unlike most other

oral

diabetes drugs—they have the added benefit of promoting weight loss. Symlin

boosts insulin's effect; Byetta boosts insulin secretion.

There have also been tremendous improvements in insulins. Fast-acting

insulins, given just before meals, work in minutes, while slow-acting

insulins, given

just before bed, help keep blood sugar steady overnight. Insulin needles

have gotten smaller, and insulin pens can deliver a precise dose with the

press

of a button. External insulin pumps free people from the hassle of multiple

daily injections. Coming down the pike: inhaled insulin, an insulin patch,

and an implanted insulin pump.

Next Steps

For all these advances, the rate of preventable complications from diabetes

is still frustratingly high. Some patients don't know how to stay healthy;

others

know but can't motivate themselves to do it. Meeting with a certified

diabetes educator (CDE) can help. CDEs don't just educate patients in

self-care;

they also help patients identify roadblocks and overcome them. Medicare

provides for 10 hours of diabetes training in the first year and two hours

of follow-up

training each year after that.

" So many people can manage and plan for their retirement, " says Hertzel

Gerstein, M.D., professor of medicine at McMaster University in Ontario,

Canada.

" Managing diabetes today is an investment in your future health. "

Mendosa agrees. Once a business journalist, he now writes about diabetes

full-time. " The only real problem with diabetes is the complications, " he

says.

" It's much, much easier to prevent than to cure. So you've got to control

the disease yourself, and you've got to control it now. "

North Carolina freelancer contributed to our special report on

"

You're Wiser Now "

in the September & October 2005 issue.