Stealthy Killer

Diabetes attacks more Americans at a younger age.



Diabetes is a stealthy disease that silently takes over a person's body from head to toe and turns it against itself. By the time diabetes announces itself with even subtle symptoms, it already has left its fingerprint of damage on vital body systems such as the kidneys, liver, pancreas, eyes, cardiovascular and circulatory systems. It's an efficient and potentially deadly disease that is taking its toll on Americans at an alarming and rapidly increasing rate.

There is good news; many of the estimated 766,000 new cases detected each year could be prevented, and just changing diet and exercise habits could significantly improve the condition of diagnosed diabetics.

"Just in Louisiana, there are 208,000 people who have diabetes," says Dr. Keith Van Meter, medical director for Van Meter & Associates and section head of emergency medicine at Louisiana State University (LSU) Medical School. That represents 7 percent of the state's population. Nationally, figures show that 5.9 percent of the population -- 15.7 million people -- has been diagnosed with diabetes and an equal number has the disease but doesn't know it.

"[Health experts] project that the incidence of diabetes in the population in a decade, at least in a score of years, will double," Van Meter says. "It's on an upward trajectory because of dietary habits and inactivity among Americans as a population. Excessive calories (resulting from overconsumption and the prevalence of convenience and fast foods) are probably going to bring the numbers of diabetics up."

Worldwide, diabetes is increasing at more than twice the world population growth rate and almost five times the population growth rate in this country, according to a comprehensive market analysis by Front Line Strategic Management Consulting Inc. In the United States, more than 500 people die from diabetes and another 2,100 people are diagnosed with the disease every day.

There are two major categories of the disease: Type I is an autoimmune illness in which a person's body doesn't produce insulin and that hormone must be taken, usually by injection. Type II, which accounts for about 95 percent of cases, results when the body doesn't produce enough insulin or cannot adequately utilize it. Insulin is a hormone that helps the body turn sugar into energy. Although there are hereditary genetic risk factors, current reports, statistics and research point to obesity and lack of exercise as the prime causes. Worse, Type II, once referred to as "adult-onset diabetes," is becoming frighteningly prevalent among children.

"It is believed that most of the increase in Type II diabetes comes from obesity," says Dr. Robert Richards, an endocrinologist at LSU Health Sciences Center. "Unfortunately, many children in adolescence are developing Type II diabetes. Both types of diabetes are associated to a person's genes, so there is a hereditary component, but both forms also are associated with environmental factors ... obesity and diet." Exercise becomes a large component of preventing or managing the disease, because it not only helps to take off weight, it makes the rest of the body's systems work better.

"If a person exercises enough, he or she could eat anything," Richards says. "One thing I have yet to see is an obese marathon runner."

Interestingly, medical professionals across the board don't recommend any kind of dramatic, quick-results diet with unpalatable food and unsatisfying portions. In fact, a study in September's Diabetes Care reports that eliminating saturated fats (eating vegetable or polyunsaturated fats instead) reduces the risk of diabetes in post-menopausal women by 16 percent (polyunsaturated fat) to 22 percent (vegetable fat). The American Diabetes Association (ADA) points out that losing between 5 percent and 7 percent of a person's body weight and exercising a half-hour five days a week can reduce an overweight person's risk of developing the disease by 55 percent.

"The American Diabetes Association does not make an official diet recommendation," says LSU's Richards. "It recommends to eat a 'prudent diet' and exercise. People overall need to adhere to a balanced diet, taking from each of the main food groups and restricting the intake of fat and calories.

"We consume too many calories. One of the culprits ... is the percentage of fast foods in our diets. They are high in fat content ... which has a much higher caloric density (calories per gram) than other foods."

Stephenie Bickham, deputy director of the New Orleans Department of Health, says part of the trick is educating people who have diabetes or are at risk for developing it about the importance of keeping their weight down as well as ways to make healthy foods jibe with the area's culinary tastes.

"Being a diabetic does not require a special diet; it's just a diet we should all be eating all the time," she says. "If we all ate as a diabetic eats, we'd have a lot fewer cases of diabetes nationwide, and certainly here."

The incidence of Type II diabetes locally has prompted Bickham to recommend people, especially those with a family history of the disease, be medically tested as often as twice a year. Richards and Van Meter agree that everyone should add a glucose tolerance test to their annual medical exams.

"New Orleans is in the top numbers of places that have the highest amount of cases of Type II diabetes in the nation," Bickham says. "If you have a high incidence of diabetes in the family, every time you have an opportunity -- free screenings are offered quite often -- take advantage of it. It's just a finger-prick. (The disease) can just crop up in a few months." By the time recognizable symptoms -- blurred vision, a need to drink lots of fluids, frequent trips to the bathroom, night sweats, sudden fluctuations in weight -- present themselves, a person's diabetes already is fairly advanced.

"If you're very thirsty, urinate a lot and in large quantities and start to lose weight inexplicably, the disease is pretty far down the road already," Dr. Van Meter says. "However, it still can be modified more often than not, by diet and medication."

Families and medical professionals traditionally have seen Type II diabetes in adults, but American children today eat more high-calorie foods, are less physically active and tend to be more overweight than in the past. The more obese a person is, the earlier they tend to develop diabetes -- 82 percent of diabetics are obese -- and younger adults diagnosed with diabetes are more likely to develop cardiovascular disease earlier in life, according to an ADA-funded study by the Kaiser Permanente Center for Health Research.

Making dietary and fitness corrections earlier can save a lifetime of dangerous diseases and conditions that substantially reduce the quality of life for diabetics. Diabetes can cause patients to go blind, develop kidney disease and problems with the pancreas, suffer hard-to-heal wounds that can lead to amputation, develop cardiovascular disease, and suffer heart attacks and strokes.

"Upwards of two-thirds, definitely 60 percent-plus, of diabetics will get cardiovascular complications, and only 33 percent of the diabetic population recognizes that," Van Meter says. "They tend to think of the [kidney, eye and circulation problems] ... but they often just don't think about the accelerated cardiovascular disease component."

All of the complications are bad -- kidney failure sometimes requires dialysis and even organ transplant -- but cardiovascular diseases are the most deadly.

"Cardiovascular disease is a major problem in diabetics," Richards says. "A diabetic person is more likely to have a heart attack and more likely to die from it; it's estimated that about 75 percent of all diabetics die from cardiovascular disease." He cites similar circumstances for diabetics who develop cerebrovascular disease. "Diabetics are more prone to have strokes [often called brain attacks]," he says. "And if they have strokes, they are more likely to die from the strokes."

Other ominous complications come if the pancreas wears itself out trying to make up for the body's inability to produce or adequately utilize insulin. Van Meter says diabetics increasingly are becoming candidates for combination kidney-pancreas transplants.

Neuropathy and poor circulation, also complications of diabetes, can cause a lack of feeling and restricted blood flow to the lower extremities, leading to undetected wounds that often get infected before they are noticed. A lack of healthy blood flow to the infected region further deters healing and can lead to amputation.

"Some people are really good about making the changes they need to make in order to improve their chances," the city Health Department's Bickham says. "The danger is not realizing the long-term effects diabetes has on the body. Often that doesn't really set in until they have a family member who has to go through the removal of a body part before they realize."

It doesn't have to be a debilitating disease, she emphasizes. "Diabetes is an illness that can be lived with. It can be changed, taking it one step at a time and paying attention to all the aspects: eat healthy, take the medication, and exercise. All of those interlink with each other to make a complete circle. Sometimes (through compliance) you can take yourself out of the circle of diabetes altogether."

Even patients who have sustained damage may be able to repair or strengthen themselves through exercise, even if they are only able to gradually build up the regimen to a quick-paced 30-minute walk.

"[Aerobic exercise] very basically puts in reverse what happens to the population susceptible to Type II diabetes," Van Meter says. "If it's done early enough, it allows a restation of some of the complications that come from diabetes and probably still gives the chance of adding on years to a diabetic's life."

To some degree, society has progressed technologically and agriculturally faster than our bodies can make metabolic changes to accommodate a less active lifestyle and easier "harvesting of calories," he says.

"It takes about 10,000 years for a gene expression shift to make a real change in our metabolism, or even our physiologic system. Our ancestors in early human times definitely had less accessible food sources and had to exercise much harder than we do today just to get the food. If you think of it, society largely became agrarian 10,000 years ago at the earliest and there probably has not been time (for the body's genetic code) to adjust to the high caloric intake of organized society" and the low activity rate. Additionally, it's time the public changes its views that "super sizing" portions is a good value. "It's been an American tradition to load the plates up, and a sign of health has been your ability to finish off everything on the plate."

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