Diabetes - "Silent Killer"
Type 1 diabetes mellitus - diabetes, for short. This
chemical disorder disrupts the body's ability to utilize
certain nutrients, primarily a blood sugar called glucose.
Treatment for diabetes is made more difficult because a
person can have the disease a long time before it is
diagnosed. "Because the early symptoms are relatively
mild," notes Asiaweek magazine, "diabetes often goes
unrecognized." Hence, diabetes has been dubbed the silent
killer.
Why Serious
Diabetes has been called "a disorder of the very engine of
life," and for good reason. When the body cannot metabolize
glucose, a number of vital mechanisms can break down,
sometimes with life-threatening consequences. "People don't
die directly from diabetes," says Dr. Harvey Katzeff, "they
die from complications. We do a good job of preventing
complications, but a poor job of treating [them] once they
occur."
Diet and Exercise
Although Type 1 diabetes cannot be prevented, scientists
are studying the genetic risk factors and are trying to
find ways to suppress an immune attack. "With type 2, the
picture is much brighter," says the book Diabetes - Caring
for Your Emotions as Well as Your Health. "Many of those
who might be genetically susceptible avoid showing any sign
of this disease simply by eating a balanced diet and
exercising regularly, thereby staying physically fit and
keeping their weight within normal limits."
Underscoring the value of exercise, the Journal of the
American Medical Association reported on a large study
involving women. The study found that "a single bout of
physical activity increases insulin-mediated glucose uptake
[by the body's cells] for more than 24 hours." Hence, the
report concludes that "both walking and vigorous activity
are associated with substantial reductions in risk of type
2 diabetes in women." The researchers recommend at least 30
minutes of moderate physical activity on most if not all
days of the week. This can include something as simple as
walking, which, says the American Diabetes Association
Complete Guide to Diabetes, "is probably the best, safest,
and least expensive form of exercise."
However, exercise by people with diabetes should be
professionally supervised. One reason is that diabetes can
damage the vascular system and nerves, thus affecting blood
circulation and feeling. Hence, a simple scratch on the
foot may go unnoticed, get infected, and turn into an ulcer
- a serious condition that may lead to amputation if not
treated immediately.
Insulin Therapy
Many with diabetes must supplement their diet and exercise
program with daily testing of glucose levels along with
multiple insulin injections. As a result of improved health
through diet and a good routine of exercise, some with Type
2 diabetes have been able, at least for a time, to
discontinue insulin therapy. Karen, who has Type 1
diabetes, found that exercise increases the efficiency of
the insulin she injects. As a result, she has been able to
cut her daily insulin requirements by 20 percent.
If insulin is needed, however, there is no reason for the
sufferer to feel discouraged. "Going on insulin does not
imply failure on your part," says Mary Ann, a registered
nurse who cares for a number of diabetes patients.
"Whatever form of diabetes you have, if you carefully
control your blood sugar, you will minimize other health
problems later." In fact, a recent study revealed that
people with Type 1 who kept strict control of their
blood-sugar levels "had drastic reductions in the
occurrence of diabetic eye, kidney, and nerve diseases."
The risk of eye disease (retinopathy), for instance, was
cut by 76 percent! Those with Type 2 who keep tight control
of their blood-sugar levels enjoy similar benefits.
To make insulin therapy easier and less traumatic, syringes
and insulin pens - the most common tools used - have
microfine needles that give minimal discomfort. "The first
shot is usually the worst," says Mary Ann. "After that,
most patients say they hardly feel a thing." Other methods
of injection include automatic injectors that shoot a
needle into the skin painlessly, jet injectors that
literally fire insulin through the skin by means of a fine
jet blast, and infusers that employ a catheter that stays
in place for two or three days. About the size of a pocket
pager, the insulin pump has gained popularity in recent
years. This programmable device dispenses insulin through a
catheter at a steady rate according to the body's daily
needs, making insulin administration more precise and
convenient.
Keep Learning
All told, there is no blanket therapy for diabetes. When
considering treatment, each individual must take into
account a number of factors in order to make a personal
decision. "Even though you may be under the care of a
medical team," says Mary Ann, "you are in the driver's
seat." In fact, the journal Diabetes Care states: "Medical
treatment of diabetes without systematic self-management
education can be regarded as substandard and unethical
care."
The more those with diabetes learn about their disease, the
better equipped they will be to manage their health and
increase their prospects of living a longer, healthier life.
The Role of Glucose
Glucose fuels the body's trillions of cells. To enter the
cells, however, it needs a "key" - insulin, a chemical
released by the pancreas. With Type 1 diabetes, insulin is
simply not available. With Type 2, the body makes insulin
but usually not enough. Moreover, the cells are reluctant
to let insulin in - a condition called insulin resistance.
With both forms of diabetes, the result is the same: hungry
cells and dangerous levels of sugar in the blood.
In Type 1 diabetes, a person's immune system attacks the
insulin-producing beta cells in the pancreas. Hence, Type 1
diabetes is an autoimmune disease and is sometimes called
immune-mediated diabetes. Factors that can trigger an
immune reaction include viruses, toxic chemicals, and
certain drugs. Genetic makeup may also be implicated, for
Type 1 diabetes often runs in families, and it is most
common among Caucasians.
With Type 2 diabetes, the genetic factor is even stronger
but with a greater occurrence among non-Caucasians.
Australian Aborigines and Native Americans are among the
most affected, the latter having the highest rate of Type 2
diabetes in the world. Researchers are studying the
relationship between genetics and obesity, as well as the
way excess fat seems to promote insulin resistance in
genetically susceptible people. Unlike Type 1, Type 2
diabetes occurs mainly in those who are over 40 years of
age.
About 90 percent of those with diabetes have Type 2.
Previously, this was referred to as "non-insulin dependent"
or "adult onset" diabetes. However, these terms are
imprecise, for up to 40 percent of those with Type 2
diabetes require insulin. Furthermore, an alarming number
of young people - some not even in their teens - are being
diagnosed with Type 2 diabetes.
The Role of the Pancreas
About the size of a banana, the pancreas lies just behind
the stomach. According to the book The Unofficial Guide to
Living With Diabetes, "the healthy pancreas performs a
continuous and exquisite balancing act, managing to sustain
smooth, stable blood-sugar levels by releasing just the
right amount of insulin as glucose levels wax and wane
throughout the day." Beta cells within the pancreas are the
source of the hormone insulin.
When beta cells fail to produce enough insulin, glucose
builds up in the blood, causing hyperglycemia. The opposite
- low blood sugar - is called hypoglycemia. In concert with
the pancreas, the liver helps manage blood-sugar levels by
storing excess glucose in a form called glycogen. When
commanded by the pancreas, the liver converts glycogen back
into glucose for use by the body
The Role of Sugar
It is a common misconception that eating a lot of sugar
causes diabetes. Medical evidence shows that getting fat -
regardless of sugar intake - increases the risk among
genetically susceptible individuals. Still, eating too much
sugar is unhealthy, since it provides poor nutrition and
contributes to obesity.
Another misconception is that people with diabetes have an
abnormal craving for sugar. In reality, though, they have
the same desire for sweets as most others. When it is not
controlled, diabetes can lead to hunger - but not
necessarily for sugar. People with diabetes can eat sweets,
but they must factor their sugar intake into their overall
diet plan.
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