Taking charge of diabetes

Thursday, April 27 2006, 02:57 PM EDT

Contributed by: R.J. Ignelzi

EARLY DIAGNOSIS

When Greg Sanchez and his 15-year-old son, Chris, used to go grocery shopping, it was the ol' grab 'n' toss routine. Grab a frozen pizza, some sugary cereal and a six-pack of Coke and toss it in the cart.

Now, since Sanchez was diagnosed with Type 2 diabetes, a trip to the market requires more time, thought and effort. But, it also offers this San Diego father and son hope for a long and healthy future.

"I've had to make changes in my diet. And, in Chris', too," says Sanchez, who has lost 12 pounds since January thanks to a more nutritious diet and walking program.

Instead of sugar-laden sodas, they've switched to diet drinks or water. Whole grain takes the place of white bread and pasta. And fried foods are out of the diet picture.

"We read the sides of the boxes now, and look at carbs and sugar and fat. Instead of just grabbing something off the store shelf because it looks good, we think about it first," says Sanchez, who sees his fight to control his diabetes as a challenge. "Diabetes is not going to beat me. I want to be around to be a granddad one day. I know I can do this."

RISK FACTORS FOR TYPE 2 DIABETES

Doctors are equally confident.

Diabetes is the fifth leading cause of death in the United States, according to the American Diabetes Association. The cause continues to be a mystery; scientists believe that autoimmune, genetic and environmental factors are involved in the development of the disease. However, doctors believe that diabetes can usually be delayed or even halted through weight control, exercise and medication.

"Diabetes is one of the most treatable diseases in the world. Especially if it's treated early," says Dr. Steven Edelman, a diabetic who is an endocrinologist and a medical professor at the University of California San Diego and Veterans Affairs Medical Center.

He points to a 2001 study of pre-diabetics, people with elevated glucose levels not high enough to be diagnosed diabetic but often developing into Type 2. The study compared those who followed a low-fat diet/exercise program with those who took just medication. At the end of three years, 22 percent of the medication-only group developed diabetes, while just 14 percent of the diet/exercise group did.

"We've seen that you can delay the onset of Type 2 diabetes even if you have evidence of it in your family." says Katie Croskrey, executive director of the San Diego unit of the American Diabetes Association. "And, the longer you can live without diabetes, the less chance you have of developing complications such as heart or kidney disease, blindness and nerve damage."

The ADA offers the following recommendations to prevent or delay diabetes and minimize the risk of complications:

- Control your weight.

"You don't have to lose that much weight to get fantastic effects," Edelman says, noting that a weight loss of 5 percent to 7 percent can bring down glucose blood levels significantly.

- Monitor your carbohydrate and sugar intake, especially if you are diabetic or pre-diabetic.

"You don't have to go on a strict diet or cut out all carbohydrates (just the refined ones). Eat two to three well-balanced meals a day and avoid sweets and fats as much as possible," Edelman says.

- Get tested if you're at risk. If there's a family history of diabetes, get a glucose blood test early and frequently.

- Get moving.

Lethargy, sleepiness can be signs of bigger problem
By R.J. Ignelzi Copley News Service Greg Sanchez thought he was simply feeling the effects of a hectic life. The 41-year-old San Diego accountant blamed his lethargy, irritability and sleepiness on a busy job and the stress that comes with being a single parent. It was only after he experienced an unquenchable thirst, the need to urinate more than 30 times a day and such extreme fatigue that he slept round-the-clock on the weekends that his roommate suggested he have his blood sugar measured. With a glucose blood level of 577, nearly six times the normal level, Sanchez got the diagnosis he dreaded: He was Type 2 diabetic. And, like one-third of the nearly 21 million Americans with the chronic disease, he'd probably been one for several years and didn't know it. "Type 2 diabetes (about 95 percent of all cases) is often asymptomatic, especially in the early stages," says Dr. James McCallum, an endocrinologist at Scripps Clinic in San Diego. "The blood sugar has to get up into the upper-level range before people have any symptoms, and then the symptoms are usually very subtle, and some don't have any symptoms at all." Because you can't rely on vague symptoms to tell you if you're diabetic, it's imperative to know if you are at risk for the disease. "Know the risk factors for diabetes. If you know you're at risk, get a glucose test or get a glucose meter and test once a month," says Dr. Steven Edelman, endocrinologist and medical professor at University of California San Diego and Veterans Affairs Medical Center. "One key thing we know: If you can make the diagnosis early enough, the treatments are much more effective. The next best thing to avoiding diabetes is catching diabetes early." The American Diabetes Association recommends that people be screened with a fasting blood glucose test every three years beginning at age 45. Screening should be considered at an earlier age or be carried out more frequently if diabetes risk factors are present. Sedentary lifestyles and poor diets have led to enormous increases in obesity in Americans of all ages and possibly to the growing number of diabetics. In the past three years, there has been a 14 percent increase in the number of Americans diagnosed with the disease, says the American Diabetes Association. Even though Sanchez was only in his early 40s, his ethnicity, family medical history, inactivity and excess 80 pounds put him in the high-risk category for the disease. He now knows that he, along with his doctors, should have been monitoring his blood sugar and general health long before he suffered extreme symptoms and high glucose levels. "I was shocked and overwhelmed when I was first diagnosed," Sanchez says. "Even though my mother and older brother had diabetes, I never really made the connection. I guess I wasn't that informed about it, so I didn't worry." He's determined not to let diabetes sneak up on his 15-year-old son, Chris. "He's scheduled to see the doctor soon and have his blood sugar tested," he says, noting that his son has joined him in his new healthy eating and walking program. "Even though Chris is thin and athletic, we both now know that he may be at risk and will have to be very careful." The following factors may put you at risk for Type 2 diabetes: - Family medical history. If a parent or sibling has diabetes, your chances of getting the disease are increased. "Be aware of any family ties to diabetes. It doesn't just have to be a parent who was diabetic. It can be an aunt, uncle, grandparent or cousin," McCallum says. - Race/ethnicity. African-Americans, Hispanics, American-Indians, Asian-Americans and Pacific Islanders are at particularly high risk for diabetes. - Age. Type 2 diabetes, which makes up about 95 percent of all cases, can develop at any age but most often appears after age 40. Risks grow with increasing age. - Obesity. Being overweight puts you at greater risk for diabetes and the complications of the disease. - Physically inactive. If you're not active, chances are you're overweight and have the high cholesterol/blood pressure that goes with it. - High cholesterol. If you have low HDL-cholesterol (the "good" one), high triglycerides or high blood pressure you are at increased risk. - Gestational diabetes. If you had gestational diabetes while pregnant or gave birth to a baby weighing 9 pounds or more, you're at risk for developing Type 2 diabetes.

Dr. James McCallum of Scripps Clinic has three words of advice for people with a predisposition to diabetes: "Exercise, exercise, exercise," he says. "Exercise not only helps manage weight, but it also helps the body be more efficient at using fuels and makes you less insulin-resistant."

The ADA recommends exercising at least 30 minutes a day, five times a week.

"You don't have to run marathons, just do something physical every day," McCallum says.

- Be diligent about testing and taking your prescribed medication if you're diabetic.

Are you at risk? Take the test
Find out your diabetes risk score with the American Diabetes Association's diabetes risk test. My weight is equal to or above that listed in the chart below. Yes: 5 pts No: 0 pts I am under 65 years of age and I get little or no exercise during a usual day. Yes: 5 pts No: 0 pts I am between 46 and 64 years of age. Yes: 5 pts No: 0 pts I am 65 or older. Yes: 9 pts No: 0 pts I am a woman who has had a baby weighing more than 9 pounds at birth. Yes: 1 pt No: 0 pts I have a sister or brother with diabetes. Yes: 1 pt No: 0 pts I have a parent with diabetes. Yes: 1 pt No: 0 pts Scoring: 3-9 points: Low risk. 10 or more points: High risk. At-Risk Weight Chart Height Weight 4'10" 129 4'11" 133 5'0" 138 5'1" 143 5'2" 147 5'3" 152 5'4" 157 5'5" 162 5'6" 167 5'7" 172 5'8" 177 5'9" 182 5'10" 188 5'11" 193 6'0" 199 6'1" 204 6'2" 210 6'3" 216 6'4" 221 Symptoms of a 'silent killer' Type 2 diabetes is called the "silent killer" since many people experience very subtle symptoms or no symptoms at all. Some common symptoms include: Frequent urination Excessive thirst Unexplained weight loss Extreme hunger Sudden vision changes Tingling or numbness in hands or feet Excessive fatigue Very dry skin Cuts and bruises that are slow to heal Recurring skin, gum or bladder infections - - - The types of diabetes Most information about the risks, prevention and treatment of diabetes refers to the most common form, Type 2. However, there are two other types of diabetes, Type 1 and gestational, and a prediabetes condition. - Type 1 diabetes, once called juvenile diabetes because it's commonly diagnosed in ages 10 to 15, is an autoimmune disease in which the body attacks the cells that make insulin. Symptoms are the same as those from Type 2, but more severe. People are born with a predisposition to the disease and produce little or no insulin, so they must take daily insulin via injections or pump. Glucose, our body's basic fuel, can be used by cells only in the presence of insulin. Although there's no way to prevent Type 1, the complications - heart attack, stroke, kidney disease, blindness, limb amputation - often can be prevented with proper insulin replacement therapy, a healthy diet and exercise. This type accounts for 5 percent to 10 percent of all diagnosed cases. - Type 2, previously called adult-onset diabetes, usually (but not always) occurs in middle age or older adults and accounts for 90 percent to 95 percent of the cases. With Type 2, the pancreas continues to manufacture insulin, but the body develops a resistance to its effects, resulting in an insulin deficiency. It's possible to postpone or even prevent Type 2 in many people through weight loss, exercise and/or medication. It tends to run in families, but obesity and inactivity hasten its development. Left untreated, Type 2 diabetes can lead to the same long-term complications as seen with Type 1. - Gestational diabetes develops in 2 percent to 5 percent of all pregnancies, but usually disappears when the pregnancy is over. During pregnancy, gestational diabetes requires treatment to normalize maternal blood-glucose levels to avoid complications in the infant. After pregnancy, 5 percent to 10 percent of women with gestational diabetes are found to have Type 2 diabetes. - Prediabetes, often considered the early stage of Type 2 diabetes, is a condition in which glucose levels are higher than normal, but not high enough for a diagnosis of diabetes. The American Diabetes Association estimates that 41 million Americans have prediabetes. Two million of those prediabetics are overweight adolescents, ages 12 to 19.

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