The Hidden Epidemic: Diabetes
Could you or someone you love have diabetes? What you need to know about this often symptomless disease.
A Symptomless Disease
It's likely you already know someone with diabetes, especially when you consider that nearly 9% of women have it and the risk keeps rising with age. Shockingly, a third of those with the disease don't even know it.
Five years ago, when Esther Vega, 51, of Dover, New Jersey, began feeling habitually thirsty, she blamed her salty diet. She chalked up her exhaustion to the fact that she worked on her feet all day at a manufacturing plant. And when her nighttime trips to the bathroom became frequent, she figured it was all the water she was drinking. She never realized these three symptoms were typical of type 2 diabetes. But at her annual physical a few months later, a routine blood test found that her blood sugar level was through the roof. (Normal is less than 100 milligrams per deciliter, between 100 and 200 may signify prediabetes, and 200 mg/dL or more suggests type 1 or 2 diabetes.)
About 21 million Americans have type 2 diabetes, which is often symptomless. The majority of people have it for at least seven years before being diagnosed. And the number of sufferers is expected to grow—mainly because obesity, a major contributor to the diabetes epidemic, is on the rise. Approximately 127 million Americans, about 65% of all adults, are overweight or obese. (Overweight is defined as having a body mass index—a person's weight in kilograms divided by height in meters squared—of over 25. A BMI of 30 and over is considered obese.)
The Cause and Complications
In healthy individuals, carbohydrates from food are broken down into glucose (a sugar), which circulates in the blood. In response, the pancreas produces insulin, which aids cells in either using the glucose or storing it as energy. But in some people, because of genetics, obesity, or a hormonal imbalance, cells become resistant to insulin's help or the body doesn't make enough insulin, leading to higher blood sugar levels. Untreated, diabetes can cause serious complications such as blindness, loss of limbs and decreased kidney function. It also significantly increases the risk of heart attack and stroke, which kill 65% of people with diabetes. Diabetic women under 50, in particular, are more apt to suffer a heart attack—perhaps because the disease cancels out the protective cardiovascular benefits of estrogen.
Like Mother, Like Daughter
Esther's daughter, Michele, a 30-year-old mother of two, just happens to work as an assistant in an endocrinology office, where many diabetics are patients. After her mother's diabetes was discovered, the doctor she works for noticed dark patches on Michele's skin and some excess facial hair—symptoms of polycystic ovarian syndrome (PCOS), a hormonal disorder that hits an estimated 10% of women in their childbearing years. PCOS causes weight gain, irregular periods and infertility, and may lead to diabetes because sufferers' bodies have problems utilizing insulin.
Tests confirmed that Michele had PCOS, which explained why she gained weight easily and couldn't take it off. More bad news followed: A fasting glucose test (blood is drawn after not eating for eight hours) found that Michele had prediabetes, a diagnosis that comes with a 40% to 50% chance of developing full-blown type 2. Michele had a fasting blood sugar level of 101 mg/dL (100-125 mg/dL is prediabetic and over 125 mg/dL is diabetic).
Who's Most Susceptible
Unfortunately, both Esther and Michele can put a check next to virtually all of the risk factors for type 2 diabetes: They are both overweight and, prior to being diagnosed, didn't exercise. They have many close relatives with the disease—Esther's father had type 2 diabetes, as do her two sisters. Plus, they are Hispanic. High-risk ethnic groups include African Americans, Latinos/Hispanics, Native Americans and Asian Americans.
FC Tip: Experts recommend that any adult with a body mass index over 24 (visit familycircle.com/bmi to calculate yours) and who has a parent or sibling with diabetes should have a blood sugar test.
"Virtually every physician would agree that the ideal treatment for diabetes is exercise and eating right to lose weight," says Robert Rizza, M.D., past president of the American Diabetes Association. The same goes for preventing diabetes, especially in those with prediabetes.
A recent Diabetes Prevention Program study found that doing 30 minutes of moderate exercise a day, combined with losing 5% to 10% of body weight, reduced the risk of developing diabetes by 58%.
Dietary recommendations for diabetics are very similar to those for the general public, says David M. Nathan, M.D., director of the Diabetes Center at Massachusetts General Hospital in Boston. Diabetics should eat plenty of fruits and vegetables but limit white potatoes; replace unhealthy fats with vegetable oils; opt for whole grains; boost fiber intake; choose lean sources of proteins such as beans, nuts, fish and poultry; and limit salt and alcohol intake.
Type 2 diabetics sometimes need medication. Esther's blood sugar was so high by the time she was diagnosed, she was prescribed metformin (Glucophage) right away. This drug is almost always the first line of treatment for type 2.
To ensure that they are controlling their condition, diabetics typically have their average blood glucose levels measured every three months with the hemoglobin A1C test. This sophisticated blood test reveals the patient's average blood sugar level for the past two or three months. The goal is to get the A1C level below 6%—Esther's was 9.8% when she was diagnosed. Every percentage point drop reduces the risk of complications by 40%.
At the same time, diabetics are encouraged to watch their blood sugar on a daily basis through finger-prick tests. A recent study found that self-monitoring reduces the risk of fatal and nonfatal complications. At Esther's recent checkup her blood sugar was still very high. So she was started on a second medication. She also takes a statin to lower her cholesterol, since her father and brother died of heart attacks at a young age.
Meanwhile, Michele is making great strides toward preventing full-blown diabetes. She's made changes to her diet and heads out for 30-minute walks daily and jogs on a treadmill a few days a week. She knows getting her weight under control is a life-and-death issue.
"I see so many people dealing with the complications that I'm trying to avoid," says Michele. "Diabetes can shut your body down in so many ways—you can lose your kidneys, your eyesight. I want to see my 11- and 4-year-old daughters grow up."
Can I Still Eat Sweets?
Sugar does not cause diabetes. "In the past experts told diabetics (and often those at risk) to avoid sugar," says Ann Albright, Ph.D., R.D., president of health care and education at the American Diabetes Association. But we now know that it's the total amount of carbohydrates you consume that affects your blood glucose levels the most. While indulging in a piece of chocolate cake will raise your glucose numbers, so does nibbling on corn on the cob, a bag of chips, or a side of mashed potatoes.
"Moderation is key," says Albright. You can eat a treat, but make it a small portion and cut back on some of the other carbs you take in during that meal. For instance, if you're having a turkey sandwich for lunch (which contains about 30 grams of carbohydrates), swap your typical bread for two slices of low-calorie bread (so the sandwich will contain just 15 grams of carbs). That way you can still end your meal with two small chocolate chip cookies (which have 15 grams of carbs).
Also important to keep in mind is that sweets are typically high in fat and calories as well as carbs. So while trading bread for cookies occasionally may not influence your glucose levels much, doing so too often will increase your waistline. In addition, when you squeeze high-calorie, high-fat treats into your diet, chances are you're edging out more nutrient-rich foods that your body needs. "If you're cutting back on carbs, don't lose the healthy ones, such as fruits and veggies, whole-grain cereals and whole wheat breads, which are rich in fiber," says Albright.
Learning you have diabetes or are at risk of developing it should not take the joy out of eating, Albright stresses. "High-calorie foods, including desserts, can still be part of your meal plan. Just don't overindulge, and eat only the ones you really love."
FC Fact: Most healthy adults should take in about 45 carbohydrate grams per meal.
A Growing Problem Among Children
An active teen, Jessica Freidhoff, 15, of Saint Michael, Pennsylvania, didn't worry about her health. But because she was a bit overweight and her father, a type 2 diabetic, died of a blood clot at age 35, her pediatrician ordered a routine blood test to check her sugar level last November. The numbers came back very high—325 mg/dL. Jessica was diagnosed with type 2 diabetes and immediately put on insulin to stabilize her glucose levels.
The number of tweens and teens developing type 2 diabetes has been rising steadily in recent years, paralleling the rise in obesity. "Type 2 used to be a disease of middle age," says Harold Starkman, M.D., director of pediatric endocrinology and diabetes at Morristown Memorial Hospital in New Jersey. That's why it's typically called "adult-onset" diabetes, whereas type 1, an autoimmune disease, has always targeted young people. But type 2 is now becoming an epidemic among children as well as adults. In 1985, experts estimated that 1% to 2% of kids with diabetes had type 2. By 1995, the number stood at about 17%. Today it's thought that perhaps 30% to 50% of children with diabetes have type 2.
Kids who are overweight or obese or who have a parent or sibling with diabetes should be screened for it at age 8, and then annually if risk factors persist, according to the American Diabetes Association. Many children with type 2 don't experience any symptoms. "If you don't look for it, they can walk around with diabetes for years without knowing it," says Dr. Starkman.
One of the first signs of type 2 is a rash in the folds of the neck. Young girls may experience irregular periods or increased body hair and tend to be diagnosed earlier than boys.
Prevention is most important since once a child gets the disease he may have to spend 50, 60, or more years on medication. "Regular exercise and a healthy diet is key," says Neesha Ramchandani, a nurse practitioner and pediatric diabetes educator at Maimonides Medical Center in Brooklyn, New York. "The portions obese children eat tend to be double what they should be."
Since her diagnosis, Jessica has been vigilant about her diet. She measures her portions, counts carbs and trades processed carbs for whole-grain foods. After a few months her blood sugar levels improved, and she was able to go off insulin and take just the standard diabetes medication, metformin. She gets plenty of exercise walking twice a day and practicing as a majorette. If she continues to eat right and be active, her numbers may improve to the point that she can go off medication altogether.