Recent
Advances Help In The Management Of Diabetes
November
Is Diabetes Awareness Month
A
diagnosis of diabetes is never easy. First, there is the realization
you are confronting a potentially life-threatening disease.
Then
comes instruction that you should pay close attention to your
diet, exercise routine, medication, and insulin levels. If you
do so faithfully, you can keep such complications as heart and
kidney disease, nerve damage, and blindness at bay.
Yet
several advances in recent years - ranging from better blood
sugar monitoring devices to solid research showing that a healthful
diet and regular exercise offer great benefits - have eased
the burden of managing the disease.
That
is a message health experts will share during November, which
has been designated Diabetes Awareness Month.
While
the cause of diabetes remains under study, physicians know it
is triggered by the body's inability to produce or properly
use insulin - a hormone needed to convert sugar, starches, and
other food into energy for cells.
About
17 million people in the US have diabetes, according to the
American Diabetes Association (ADA), although
one-third of them are unaware they have it.
Of
those 17 million, about 5 percent to 10 percent have type 1,
previously called juvenile diabetes, while the remainder have
type 2 diabetes.
In
type 1 diabetes, the body does not produce insulin. This requires
people to inject insulin daily to survive and to keep their
levels of blood sugar - called glucose - under control.
If
glucose levels get too high, it increases the risk of complications
such as blindness or kidney problems.
In
type 2 diabetes, the body does not make enough insulin or the
cells do not process the insulin. These individuals are advised
to lose excess weight, eat a healthy diet, and exercise regularly.
Some are put on oral medication or insulin to manage blood sugar
levels.
Monitoring
Improves with New Technology
In
years past, diabetics had just one choice for measuring their
blood sugar - pricking their finger or forearm with a special
needle called a lancet to get a drop of blood, then placing
the blood on a test strip to be read by a monitor.
But
in the past few years, advances in blood glucose monitoring
devices have made the task much less of a nuisance, says Dr.
Gerald Bernstein, past president of the ADA
and an associate clinical professor of medicine at the Albert
Einstein College of Medicine in New York City.
"The
major advance is the fact that you need much less blood," Dr.
Bernstein says. "And it's less painful."
And
most monitors now give you a reading very quickly, down from
about a minute's wait to only five seconds. That time savings
can add up in the course of a day, especially if someone needs
to test their blood six to 10 times daily.
The
time difference "makes a substantial difference to people,"
Dr. Bernstein says.
Another
advance: The GlucoWatch. This wristwatch-like glucose monitoring
device was approved by the US Food and Drug Administration for
adult use in 2001 and for children and teens in 2002. It works
by extracting fluid through the skin and measuring the glucose
in the fluid. It can produce up to six painless measurements each
hour for 13 hours.
"I
don't recommend it for everybody," says Dr. Lyle Mitzner, an
endocrinologist and diabetes specialist at The Joslin Diabetes
Center in Boston.
Typically,
he will recommend it for some patients with type 1 diabetes
because they tend to have more fluctuations in blood sugar.
But he sometimes will advise a type 2 patient to try it, too,
if he or she is having trouble controlling blood sugar levels.
Standard
Medications Are Tried and True
Drs.
Bernstein and Mitzner agree there have been no major advances
recently in diabetes medication, with insulin or oral medications
prescribed as they have been for years.
Oral medications
work in a number of ways, such as stimulating the pancreas to
produce more insulin, Dr. Bernstein says.
A
newer option to insulin injections or oral medication is the
insulin pump. The beeper-sized device continuously delivers
insulin to the body through a flexible tube, and can be programmed
to deliver an extra dose at meal time.
There
is universal agreement among experts on the role that lifestyle
can play in managing - and helping to prevent - the disease.
In
2001, a major study called the Diabetes Prevention Program was
stopped early because it found the benefits of lifestyle changes,
such as losing weight and exercising, were overwhelmingly positive.
It looked at 3,234 people with a condition called impaired glucose
tolerance, which often precedes diabetes.
The
researchers compared lifestyle changes to drug treatment with
an oral diabetes medication and with placebo (inactive substance)
pills.
While
29 percent of the group taking placebo pills developed diabetes
during the study's three-year follow-up, only 14 percent of
the lifestyle group and 22 percent of the medication group did.
This
led the researchers to conclude that lifestyle changes can delay
or even prevent diabetes.
The
best advice, Dr. Bernstein says, is to keep your weight down.
"Maintain
as close to an ideal body weight as possible," he says. That
means keeping your body mass index (BMI) - a measure of height
to weight - below 25, considered the cutoff for a healthy weight.
A
man or woman who is 5-foot-5 and weighs 150 pounds has a BMI
of 25.
Regular
exercise is also crucial, and Dr. Bernstein tells people it
can be as simple as walking every day or every other day for
30 minutes at a time.
In
the future, Dr. Bernstein says, there may be alternate ways
to deliver insulin. One system under review is inhaled insulin,
in which a portable device contains a powdered mist of insulin.
Another
possibility is a device that looks like an asthma medication
inhaler that would let people breathe in insulin. They would
probably use it before each meal to control blood sugar levels,
says Dr. Bernstein.
Always
consult your physician for more information.
Online Resources
(Our Organization
is not responsible for the content of Internet sites.)
American
Diabetes Association
Centers
for Disease Control and Prevention (CDC)
Diabetes
Care
National
Diabetes Education Program
National
Institute of Diabetes & Digestive & Kidney Diseases
(NIDDKD)
National
Insitutes of Health (NIH)
National
Library of Medicine, at NIH
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November 2003
Recent
Advances Help In The Management Of Diabetes
Monitoring
Improves with New Technology
Standard
Medications Are Tried and True
US
Statistics on Diabetes
Who
Should Be Tested?
Online
Resources
US
Statistics on Diabetes
The National
Diabetes Information Clearinghouse of the National Institutes
of Health (NIH) reports the following:
Non-Hispanic
Caucasians: 11.4 million. 7.8 percent of all non-Hispanic Caucasians
have diabetes.
Non-Hispanic
African Americans: 2.8 million. 13 percent of all non-Hispanic African
Americans have diabetes. On average, non-Hispanic African
Americans are two times more likely to have diabetes than non-Hispanic Caucasians
of similar age.
Hispanic/Latino
Americans: 2 million. 10.2 percent of all Hispanic/Latino
Americans have diabetes. On average, Hispanic/Latino Americans
are 1.9 times more likely to have diabetes than non-Hispanic Caucasians
of similar age. Mexican Americans, the largest Hispanic/Latino
subgroup, are two times more likely to have diabetes than non-Hispanic Caucasians
of similar age. Similarly, residents of Puerto Rico are two
times more likely to have diagnosed diabetes than US non-Hispanic
Caucasians. Sufficient data are not available to derive more
specific current estimates for other groups.
American Indians
and Alaska Natives who receive care from the Indian Health Service
(IHS): 105,000. 15.1 percent of American Indians and
Alaska Natives receiving care from IHS have diabetes. At the
regional level, diabetes is least common among Alaska Natives
(5.3 percent) and most common among American Indians in the
southeastern US (25.7 percent) and in certain tribes from
the Southwest. On average, American Indians and Alaska Natives
are 2.6 times more likely to have diabetes than non-Hispanic Caucasians
of similar age.
Asian Americans
and Native Hawaiian or other Pacific Islanders: Prevalence
data for diabetes among Asian Americans and Native Hawaiians
or other Pacific Islanders are limited. Some groups within these
populations are at increased risk for diabetes. For example,
data collected from 1996 to 2000 suggest that Native Hawaiians
are 2.5 times more likely to have diagnosed diabetes than Caucasian
residents of Hawaii of similar age.
Who
Should Be Tested?
Experts suggest that
adults age 45 years and older be tested for diabetes. If their
blood glucose is normal at the first test, they should be tested
at three-year intervals.
According to the National
Institute for Diabetes & Digestive & Kidney Diseases
(NIDDK), people under age 45 should be tested if they
are at high risk for diabetes. These high-risk factors include:
-
being more than
20 percent above ideal body weight or having a body mass
index (BMI) of greater than or equal to 27. BMI is the ratio
of weight in kilograms to height in meters squared (kg/m2
).
-
having a mother,
father, brother, or sister with diabetes
-
being African
American, Alaska Native, American Indian, Asian American,
Hispanic/Latino American, or Pacific Islander American
-
giving birth to
a baby weighing more than 9 pounds or having diabetes during
pregnancy
-
having blood pressure
at or above 140/90 millimeters of mercury (mmHg)
-
having abnormal
blood lipid levels, such as high density lipoprotein (HDL)
cholesterol less than 35 mg/dL or triglycerides greater
than 250 mg/dL
-
having abnormal
glucose tolerance when previously tested for diabetes
The NIDDK
states that diabetes can be detected by any of three positive
tests. To confirm the diagnosis, there must be a second positive
test on a different day:
-
a casual plasma
glucose level (taken at any time of day) of 200 mg/dL or
greater when the symptoms of diabetes are present
-
a fasting plasma
glucose value of 126 mg/dL or greater
-
an OGTT value
in the blood of 200 mg/dL or greater measured at the 2-hour
interval
Always consult your
physician for more information.
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