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Hope for those living with—or worried about developing—diabetes
By Cynthia McFarland - Tuesday, October 25, 2016
First, the good news: Over the last few years, the number of new cases of diabetes in the United States has shown a modest decline. People with diabetes are living longer because of improvements in managing the disease. One of the key reasons that people with diabetes are living longer is that there has been a steady decline in the death rate due to cardiovascular disease. Improvements have also been seen in the tools and medications that people with diabetes can use to manage the disease.
Now, the bad news: There are still 1.4 million new cases of diabetes diagnosed every year, and even though we now have better ways to manage diabetes, the financial burden of doing so has increased.
Less common than type 2, about 5 percent of people with diabetes have type 1. Type 1 diabetes was previously known as “juvenile diabetes” because it’s most often diagnosed in children and young adults. In simple terms, the food you consume is broken down into glucose, which provides the energy your body needs to function properly. The body uses insulin to burn that glucose. When someone has type 1, his or her body does not produce insulin.
How it’s treated: Insulin therapy is necessary. Additional medication/treatments may also be used.
Most common form of diabetes. When someone has type 2, their body makes insulin but might not make enough and does not use it properly. When the disease first starts, the pancreas produces extra insulin but eventually can’t make enough to maintain normal levels of blood glucose. Glucose then builds up in the blood, where it causes a host of problems rather than going into the cells and providing energy. Type 2 diabetes is generally progressive, with the body’s ability to produce its own insulin declining over time.
How it’s treated: Lifestyle changes (diet and exercise). Medication and/or insulin may also be necessary if lifestyle changes aren’t adequate to regulate blood glucose levels. There is no cure, so it’s all about management.
“Two things you can’t control, which are very important factors, are genes and increasing age. You can’t avoid your genetics or getting older. If you don’t have the genes, you’re not going to develop type 2 diabetes,” notes Matt Petersen, managing director of medical information for the American Diabetes Association.
Certain racial and ethnic groups are at somewhat higher risk and therefore more susceptible to developing type 2 diabetes. These include African-Americans, Hispanics, American Indians, Asian-Americans and Pacific Islanders.
“You can only develop type 2 diabetes if you have the genetic predisposition, but lifestyle generally plays a role,” Petersen explains. “Our genes haven’t really changed over the last few decades, but lifestyle has changed. Americans have a great abundance of cheap and tasty calories and are now heavier than ever before; they’re also more sedentary. If anything, genetics are to blame for diabetes, but being overweight and sedentary are triggers.”
Petersen notes that it’s unfair to say people won’t get type 2 diabetes if they just take better care of themselves, but neither should the benefits of lifestyle changes be ignored. Research has shown that improving diet and losing even a small amount of weight can delay the development of type 2 diabetes among at-risk adults by as much as 40 to 60 percent.
Lifestyle modifications can also help someone who has been diagnosed with diabetes keep it under control without medication for some time.
“Usually, in time, this begins to fail and medication is necessary simply because diabetes is a progressive disease,” Petersen observes.“It’s, unfortunately, not the case that if you just maintain your weight and stay active this will keep you from needing medication forever, but it will be helpful. Healthy eating and physical activity are common elements in treating diabetes, cancer and heart disease, and even if you need medication, it’s not a time to stop a healthy lifestyle.”
Reason For Concern
Having diabetes puts you at risk for a number of health problems, including:
Cardiovascular disease:Adults diagnosed with diabetes are nearly twice as likely to be hospitalized with a heart attack or stroke. Two out of three people with diabetes have high blood pressure, which increases the risk of cardiovascular disease.
Eye damage: Diabetes can lead to a number of vision problems, including glaucoma, cataracts and disorders of the retina, including macular edema. Diabetes is the leading cause of blindness in working-age adults.
Kidney disease:Diabetes can damage the kidneys, causing them to work harder and, in some cases, to eventually fail altogether, requiring dialysis.
Neuropathy: Nearly half of all people with diabetes have some form of nerve damage, which, in serious cases, can lead to amputation.
Research shows that an ulcer precedes most lower-limb amputations in people with diabetes. That’s why it’s so important to prevent wounds in the first place.
“Diabetes causes damage to nerves, and this really shows up in the extremities, especially in the feet where people lose sensation,” explains Petersen. “Pain is the body’s way of letting us know something is going wrong. A person with diabetes may not be conscious of a small wound, because they don’t feel it, so a little infection can develop and progress because the wound isn’t healing as well. An unfortunate double whammy is that diabetes also causes poor circulation and damage to blood vessels, which really impedes wound healing.”
If you have diabetic neuropathy, you may not even feel a problem starting, so inspect your feet daily. Use a hand mirror if you’re unable to see the bottom of your foot, or have someone else do it for you. Get prompt medical treatment for any potential problem.
Don’t go barefoot! Wear well-fitting closed-toe shoes, even indoors.
Wear comfortable socks without bulky seams.
Wash your feet daily and dry thoroughly, especially between toes.
Keep toenails evenly clipped.
Use moisturizer on your feet, but avoid lotion between toes.
Smooth—don’t cut!—calluses with a pumice stone or emery board.
Inspect your feet closely each day; see your doctor right away if you find chafing, blisters, redness, irritation or calluses.
If you get a wound, follow your doctor’s orders closely and observe carefully for any signs of infection.
“Amputation is one of the most frightening and life-impairing things that can happen to people with diabetes,” Petersen notes. “By inspecting your feet every day and being careful, you can reduce the chance of an infection leading to amputation by as much as 85 percent.”
Twenty years ago, there were only two oral medications to treat type 2 diabetes. Today, there are 12 different classes of medications to address the disease. There are also new oral medications that have been proven to lower the risk of cardiovascular disease.
“These diabetes medications work in different ways, so we have more tools. This has made it easier to control diabetes simply because we have more choices,” says Petersen. “Often, you can use two medications together to get twice the benefits because they work in different ways.”
Of course, the most effective drug for controlling diabetes is insulin, and there are new types of synthetic insulin—from fast-acting to long-lasting—that provide more flexibility to manage and treat diabetes.
“A lot of people have the sense that if they have to start using insulin they’ve failed, but using it can mean bringing your diabetes under excellent control,” says Petersen. “Because the natural progression of the disease puts you at much higher risk of complications, if you get to the point where you need insulin, it can be a lifesaver. It’s not a cure, and it carries its own risks, but insulin is the only drug that can always bring blood glucose down to normal levels.”
And if you thought insulin is only administered via syringe, think again. There are now small devices (the size of a flip phone or pager) that have a tiny tube that’s inserted under the skin. The device can be programmed to deliver accurate amounts of insulin to meet your specific needs.
Petersen says the next exciting development for diabetics will be the release of a system that combines a continuous glucose meter and a glucose pump that will automatically release insulin as needed. Think of it as an artificial pancreas outside the body.
“There’s been a tremendous amount of energy going into developing these over the last few years. We are ‘this close’ to having it on the market,” notes Peterson.
“Trials still have to be wrapped up, and we need FDA approval, but I believe we’ll have these on the market within the next two to three years. It’s still not perfect or a cure, but it will greatly ease the ability of people to manage their diabetes and is very relevant to everyone who has type 1 diabetes and to many people with type 2 diabetes who use insulin.”
Lower Your Risk
Take proactive steps to reduce your risk for developing type 2 diabetes.
Lose the weight. Maintaining an appropriate body weight range is the No. 1 thing you can do to avoid diabetes. About 85 percent of people who are diagnosed with type 2 diabetes are overweight or obese. Talk to your doctor about developing a realistic plan to lose weight.
Don’t smoke. This seems like a no-brainer, but there are still people who think they can do other things to improve their health without giving up cigarettes. Don’t kid yourself. Smoking raises your blood pressure and your bad cholesterol, damages your lungs and reduces the amount of oxygen needed by your organs to function normally. Because people with diabetes are already at higher risk for cardiovascular disease, smoking is especially bad for them.
Eat healthy. It’s about making smart food choices, not starving yourself. For example, the largest portion of your meal should be non-starchy vegetables. Cut back on starchy veggies (corn, potatoes, etc) and include lean protein and small amounts of healthy fats.
Get moving. Regular exercise improves blood flow and helps lower blood glucose. Research has shown that light activity spread throughout the day is more beneficial for lipid and glucose metabolism than working out intensely for an hour or two. This is good news for people who physically aren’t able to exercise vigorously, and it pretty much cancels out any excuse you might come up with for not exercising. Look for ways to incorporate more physical movement into each day. Even the smallest activities start adding up.
Watch what you’re drinking. Many people consume hundreds of calories a day in beverages alone.
Prediabetes occurs when your blood sugar level is higher than normal but not high enough to warrant a diagnosis of actual diabetes.
Prediabetes is a wake-up call, because, if not addressed, you have a higher risk of developing type 2 diabetes within the next five to 10 years.
You may be able to change your lifestyle and avoid—or at least delay—developing diabetes by getting your blood sugar number down to a normal level. These lifestyle changes include eating right, regular physical activity and maintaining a healthy weight. You don’t need a total metamorphosis to see improvement. Just dropping 10 to 15 pounds can make a difference!
Schedule a diabetes screening test if you have any of the following risk factors.
(You can also go to diabetes.org/risktest for an online risk assessment.)
The following symptoms can indicate you have progressed from prediabetes to type 2 diabetes, so see your health care provider right away if you notice these signs:
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