Diabetes Reaching Epidemic Proportions

By Jan Howard

Diabetes is a common chronic disease with lifetime effects that is increasing in the United States and the world, and all people are at risk.

“Diabetes Care and Management” was the topic discussed recently at the Newtown Senior Center by John Leopold, RN, MSPH, a diabetes and wound care clinical specialist and program manager with the Danbury Visiting Nurse Association of Danbury.

“The complications [of diabetes] are severe,” Mr Leopold said. “It can cause debilitating conditions and early death.”

The risks of diabetes, however, can be mitigated through good management, he said. “There are things you can do to prevent long-term complications. It may be possible to delay or even prevent diabetes.”

Diabetes is the sixth leading cause of death in the United States. Almost ten percent of people over 20 and 20 percent of the people over age 65 are affected.

“Awareness is important,” Mr Leopold said. “Diagnosed diabetes increased by 50 percent from 1990 to 2000.”

That percentage is both good news and bad news, he said. “It means there has been earlier detection, but that it is also more common.”

Diabetes is a relative lack of insulin in the body. “Diabetes doesn’t mean the body is not producing insulin, it’s just not producing enough.”

Insulin, he said, lets glucose enter the cells. If it is not working appropriately, the cells do not get enough glucose.

In diabetes, the body progresses from a high level of insulin to less because the pancreas is not operating properly, he explained. “Diabetes is caused by some defect in the insulin process.”

Management of diabetes should include diet, exercise, and medications to make insulin function better.

There are varying forms of diabetes. Type I diabetes begins at youth and is a total lack of insulin. “The pancreas stops working completely,” he said. “Years ago it was similar to a death sentence. Children with Type I diabetes are now getting insulin for life.”

In Type II diabetes, the pancreas is producing some insulin. Other forms of diabetes include drug induced diabetes and gestational, which can occur during pregnancy.

“Diabetes is a manageable but not curable disease,” Mr Leopold said.

Long-term complications related to diabetes are blindness, amputation, cardiovascular problems, kidney problems, and depression/anxiety.

Diabetes is the leading case of blindness in ages 20 to 74. It is also responsible for 60 percent of nontraumatic amputations. There is a two to four times increased risk of cardiovascular problems. It is also a leading cause of kidney problems.

In relation to depression/anxiety, Mr Leopold said, “It changes our lives and our relationships with our family and food. You are managing a condition that is time consuming to manage.”

Short-term complications include hyperglycemia (high blood sugar), hypoglycemia (low blood sugar), and increased risk of severe infections. A diabetic is three times more likely to die of flu or pneumonia.

High blood sugar, or hyperglycemia, can occur as a result of diabetes. It varies from person to person, and there are different goals for different times of the day, he said. Before meals, blood sugar should register 80 to 100; two hours after meals, it should register 160 to 180.

“It gets very personal,” Mr Leopold said. “Diabetes is so complicated.”

 Hypoglycemia can occur with people who are already being medicated. “It can come on very quickly,” he said.

There is an increased risk of infection because people with higher blood sugar have an immune system that is not functioning effectively.

Diabetes can be prevented or delayed through early recognition and appropriate management, Mr Leopold said.

Approximately 5.9 million people do not know they have it. Risk factors include age, obesity/sedentary lifestyle, race/ethnicity, family history, history of giving birth to a baby over nine pounds, or diagnosed gestational diabetes.

“People need to be aware of the need to be screened for this,” he said. “The risk increases as you get older. Race and ethnicity are a risk factor.” He added that people of Spanish and African American heritage are more at risk.

The likelihood of getting diabetes increases if there is a family history of it.

The symptoms can be very subtle, Mr Leopold said, including excessive thirst, urination, and hunger, weight loss, fatigue, blurred vision, tingling in the feet, and wounds that do not heal.

“Diagnosis is simple,” he said. This includes a blood test to see if blood sugar is elevated and further tests after drinking something sweet.

The American Diabetes Association recommends screening at three-year intervals beginning at age 45 and earlier than age 45 if there are risk factors, such as family history of diabetes.

Control of diabetes is not that easy, Mr Leopold said, but achieving specific blood glucose goals will reduce the risk of complications, such as eye and kidney disease.

Diabetes can be controlled through medication, by injection of insulin, or through medications that stimulate the pancreas or make it more sensitive to the insulin there.

The first two primary choices to control diabetes are diet and exercise. “You have to do something to change your exercise pattern and eating habits to change the glucose level,” he said.

Mr Leopold explained that the body turns food into glucose or sugar. Carbohydrates, such as peas, rice, pasta, bread, and potatoes, are changed most rapidly, he noted.

“It is most important to control carbs, sweets, and milk,” he said.

Other aspects of diabetes management include checking blood pressure and cholesterol and regular screenings for complications as well as flu and pneumonia vaccinations. Screening and care could prevent up to 90 percent of diabetes-related blindness. Only 60 percent of people with diabetes receive annual dilated retinal exams.

“People with diabetes usually check their own blood sugar,” Mr Leopold said. “How often is determined by the degree of diabetes and the medications they are on.” However, he said, a doctor should check blood sugar, an A1C test, every three months up to one year.

“The ABCs of diabetes are A1C, blood pressure, and high cholesterol,” he said. Uncontrolled blood pressure and cholesterol need to be considered in how a diabetes patient is being controlled, he added.

Patients with diabetes should also have regular screenings with a podiatrist every three months, he said.

Control of diabetes is a partnership. “You should work closely with your health care provider,” he said. “Ask your doctor regarding screenings.”

“Can we prevent diabetes? The jury is still out, but it can be delayed,” Mr Leopold. “A research study of 3,000 people at known high risk showed that through diet and exercise, their risk was reduced by 58 percent. Over age 65, it was 71 percent.”

Mr Leopold recommended moderate exercise, such as walking 30 minutes a day five times a week, plus weight loss of five to ten percent. “You don’t have to be the skinniest person on the block to delay diabetes,” he said.

“We know definitely it can be delayed,” Mr Leopold said.

Information on diabetes can be obtained from the American Diabetes Association at www.diabetes.org, the Center for Disease Control at www.cdc.gov/diabetes, the National Institutes for Health, healthcare providers, or Mr Leopold at 203-730-5232.