The bitter truths about diabetes
July 24, 2001 | 12:00am
The World Health Organization (WHO) estimates that as many as 140 million people today suffer from diabetes worldwide, and that this number will rise to 300 million by the year 2025. In the Asian region, diabetes has already become an enormous problem – and it’s getting worse. At least 30 million people in the Western Pacific area alone are suffering from diabetes, and most of them are in their productive years. In the Philippines, diabetes is one of the top 10 causes of mortality, and ranked as the eighth leading killer in 1996. The increase in diabetes has been attributed to changes in lifestyle related to urbanization and the aging of populations. It is particularly related to overnutrition, physical inactivity and obesity. Indeed, most scientists agree that we are in the midst of a diabetic epidemic!
Actually, the percentage of people who have diabetes has been continuously rising for decades. Health authorities are now alerting the public that there are huge numbers of undiagnosed and untreated diabetics out there. In fact, half of the diabetics are unaware that they have the disease and roughly 55 percent of known diabetics do not have their disease under good control. That’s critical because, left untreated, the disease takes a tremendous toll – it can lead to heart disease, stroke, blindness, amputations, kidney failure, nerve damage, gum disease, and possibly, even dementia. Once you have diabetes, there’s not much – except cancer – that you’re not at higher risk for. That is why it is such a dangerous disease to have.
In type 1 diabetes (formerly called juvenile-onset or insulin-dependent diabetes), the person’s pancreas is unable to secrete any insulin at all. In type 2 diabetes (formerly called adult-onset or non-insulin-dependent diabetes), the patient produces some insulin but not enough, and the body becomes resistant to insulin’s effects.
Type 2 diabetes usually starts with insulin resistance. In this condition, the pancreas secretes sufficient insulin, but the insulin doesn’t do its job very well. To compensate, the pancreas secretes more. The excess insulin manages to keep blood sugar levels within the normal range. But the high insulin is often accompanied by high triglycerides, high blood pressure and low HDL ("good") cholesterol, all of which raise the risk of heart attack and stroke.
In the early stage of type 2 diabetes, the pancreas continues to secrete some insulin but the insulin again doesn’t do its job very well. So, once more, the pancreas compensates by secreting more insulin, but this time, it is no longer sufficient in amount or fast enough to keep the blood sugar from rising. After a while, the pancreas may even lose the ability to secrete insulin which can result in even higher blood sugar levels.
"There’s a clear relationship between eye, kidney and nerve problems and a fasting blood sugar level of 126 or higher," says Frank Vinicor, director of the US Center for Disease Control’s diabetes program. "The higher the blood sugar levels – and the longer they’re high – the worse the damage." And how does high blood sugar cause harm? "The theory with the most credibility is that the glucose attaches permanently to the proteins in the retina, kidney and small blood vessels," explains Vinicor. "These protein-glucose linkages cause the proteins to function abnormally."
The ADA now advises anyone aged 45 or older to get a fasting blood sugar test once every three years, and more often if they are at high risk, especially if:
• You’re over age 45.
• You have a family history of diabetes (a parent or sibling with the disease).
• Your body mass index (BMI) is 25 or more. (The risk of diabetes starts to climb at a BMI of 22).
• You don’t exercise regularly.
• Your blood pressure is 140 over 90 or higher.
• Your HDL ("good") cholesterol is 35 or lower.
• Your triglycerides are 250 or higher.
• You’ve been told that you have impaired fasting glucose (between 110 and 125).
• You’re a woman who had gestational diabetes or who had given birth to a baby weighing nine pounds or more.
• You’re a woman with polycystic ovary syndrome.
But a fasting blood sugar under 126 doesn’t mean that you’re in the clear. New studies suggest that thousands of adults have blood sugar levels that are too low to be called diabetic but too high to be called healthy!
When you get a fasting blood sugar level, it tells your doctor how high your blood sugar was that day. But what about other days? A blood test for gycated hemoglobin, which is also called hemoglobin A1C or glycosylated hemoglobin, gives a longer-term read on your blood sugar. (Hemoglobin is the component of red blood cells that carries oxygen.) "Glucose attaches to the hemoglobin in red blood cells and stays there for several months," explains Maureen Harris of the US National Institute of Diabetes and Digestive and Kidney Diseases.
Right now, doctors use glycated hemoglobin only to monitor people who already have diabetes. They try to keep levels below 7, which means that seven percent of the patient’s hemoglobin A1C has glucose attached to it. But they don’t use glycated hemoglobin to diagnose diabetes, because right now, laboratories are not all using the same methods to measure it. That could change, as moves to standardize the procedure are now underway. "Glycated hemoglobin, or HBA1C, shows great promise in becoming the diagnostic method for diabetes in the near future," says Harris.
1. Watch your weight. Generally, people who are overweight have double the risk of diabetes compared to those with optimum weight. "Diabetes is the health condition most strongly linked to a BMI between 22 and 25," notes Harvard’s JoAnn E. Manson. If your BMI exceeds 25, your risk of heart disease, stroke and other health problems also rises.
2. Stay off the couch. No matter how much you weigh, "exercise will go a long way toward reducing the risk of diabetes," says Manson. And it doesn’t have to be strenuous, continuous, time-consuming or expensive. In several studies, any moderate exercise – even brisk walking – for 30 minutes a day, lowered the risk of diabetes by 30 percent," notes Manson.
3. Eat wisely. When it comes to your risk of diabetes, how much you eat matters more than what you eat. But some foods appear to lower the risk.
"Whole grains seem to be protective, possibly because they’re higher in fiber and magnesium," says Manson. What’s more, potatoes and refined grains like white bread, increase blood sugar quickly. And that’s not good. "Fruits and vegetables are also great because they’re high in magnesium, potassium and fiber," she adds. And those foods may help protect against obesity because they fill you up without too many calories.
How fats affect the risk of diabetes is still unclear. "Saturated and trans fat may be particularly detrimental," says Manson, "while mono- and polyunsaturated fats may lower the risk ... But that doesn’t mean you can pour on the olive or canola oil," she cautions. "If you’re at risk of diabetes, it’s best to maintain a low-fat diet because all fats are calorie-dense." Just don’t assume that a low-fat diet means unlimited quantities of low-fat cakes, cookies and ice cream, or even bread, potatoes and pasta. The idea is to spend your carbohydrates on vegetables, fruits and whole grains, which could also cut your risk of cancer, heart disease and stroke.
Manson aptly sums it up: "Preventing diabetes really comes down to lifestyle modifications like maintaining a healthy weight, staying physically active, and eating a healthy diet." Whether you are at risk of diabetes or you already have the disease, it is best to deal with it in a more focused, strict, consistent and aggressive manner. That’s the only way to fight this now relatively common condition. After all, diabetes is truly a dangerous disease!
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