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Millions suffer from diabetes; millions more at risk

February 9, 2013
By Tiffany Shaw , For the Mirror

Nearly 26 million Americans suffer from a disease that affects their entire bodies from head to toe, and another 79 million have a condition that puts them at higher risk for developing it.

With numbers like that, it's hard to ignore the problems that come from diabetes.

The statistics from the American Diabetes Association are sobering when compared to the rates of other diseases, and they say the numbers are only growing, as more Americans become overweight and raise their risks for the disease.

Article Photos

Photo courtesy Altoona Regional Health System
Clinical manager Dave Bickers, CRNP, WOCN, and patient Bernard “Bubba” Smith of Everett at the entrance of the hyperbaric oxygen chamber. Altoona Regional’s Wound, Ostomy and Hyperbaric Medicine department offers hyperbaric therapy through two state-of-the-art total body chambers. Hyperoxygenation of wound tissue can promote and accelerate wound healing.

Diabetes - in its simplest definition -?is excess sugar in the blood. Because blood flows to every single organ and every part of the body, diabetes can negatively affect the whole body if it's not diagnosed and treated properly.

Dr. Haleh Haerian, an endocrinologist at Blair Medical Associates, Altoona, said diabetes is a disorder that disrupts how the body uses glucose, or sugar. All the cells in the body need sugar to work normally and use the help of a hormone called insulin to get the sugar into the cells.

"One can consider insulin as a key that opens a door to let the sugar in the cells," Haerian said. "If there is not enough insulin, sugar builds up in the blood and the cells starve from lack of nutrition. That is what happens to people with diabetes."

She said there are two types of diabetes. In type 1, the patient's pancreas does not make enough insulin. In type 2, the body becomes resistant to insulin and does not respond well to insulin, so the body's cells are not opening to the sugar.

About 90 percent of people with diabetes have type 2, Haerian said.

That's good news and bad news. The good news is that type 2 can sometimes be prevented before it becomes full-blown diabetes by lifestyle changes, and once it is diagnosed, it can be treated by the same changes along with medication. The bad news is that it affects the entire body and can lead to disastrous consequences if it is not managed consistently.

There are some risk factors that raise a person's chance of developing type 2, said Pat Rose, a certified diabetes educator at Altoona Regional Health Systems.

"There is a really strong genetic predisposition," Rose said. "If you have a family history, you are more likely to develop it."

Dr. Haerian said someone with a first-degree relative who has type 2 diabetes is five to 10 times more likely to also develop it. The rate is higher in certain ethnic groups, including people of Hispanic, African and Asian descent, she said.

The other two major risk factors are being overweight and lack of physical activity, Rose said.

While anybody can develop diabetes, those at risk should be screened regularly with a simple fasting blood test that will measure the amount of sugar in the blood, she said. Type 2 can develop for a long time without symptoms, but the most common signs are drinking a lot, eating a lot, frequent urination, weight loss and fatigue.

Dr. Haerian also recommended that adults at higher risk should be tested. They include adults with a body mass index over 25 who have one or more additional risk factors such as family history, lack of exercise, high blood pressure, high cholesterol or gestational diabetes.

She recommended testing begin after age 45 for adults without any of those risk factors.

Rose said even those at higher risk can take action to prevent developing diabetes or try to head it off when it is in the pre-diabetes stage, as recognized by the ADA.

"It requires some work," Rose said.

Haerian said that the problem might start in the body as many as 10 to 20 years before diabetes is ever diagnosed. She explained that the body can gradually become resistant to the effects of insulin, meaning more and more insulin is needed to do the same job. As long as the pancreas is able to meet those demands, the blood sugar will stay normal and cells will be fed.

"It takes several years for the pancreas to finally not be able to meet the body's demand, both due to progressive increase of demand and to exhaustion of an overworked pancreas," she said. Most people will not be diagnosed for another five to 10 years when enough sugar builds up and insulin production declines.

But the preventative measures can slow down the progression, prevent or delay the development of diabetes, Haerian said.

That comes back to the work of the patient.

"You do need to learn how to meal plan and learn the importance of become more active," Rose said.

Even a small amount of weight loss, maybe as little as seven percent of body weight, can make a difference and prevent diabetes, she said.

"Maintain a healthy weight and be physically active most days for about 30 minutes. Make healthy food choices," Rose said.

Since diabetes affects the way the body uses sugar, that is one of the things that needs to be regulated, especially after diabetes is diagnosed. But Rose stressed making lifestyle changes now that will make the entire body healthier, whether a patient is at risk for diabetes or already has it.

"People have to learn how to meal plan, not to go on a diet. It's a four-letter word - diet - that a lot of people think has to do with losing weight and then going back off it. This is meal planning that has to be a lifestyle change," she said.

That's exactly what is taught by Dona Baughman, clinical nutritional manager and registered dietician at Altoona Regional Health Systems.

"Almost every food you eat has an effect on blood sugar," she said. "People with normal blood sugar, their bodies will adapt and keep it where it needs to be. People who can't produce insulin or who are not producing enough, they have to watch how it will affect blood sugar."

The first thing she recommends to patients is to control the intake of carbohydrates such as bread, cereal, starches and fruits because they have immediate effects on blood sugar, but they can also lead to weight gain in the future. Balancing foods will lead to more consistent blood sugar and healthy weight.

"Carbohydrate consistency is the key," Baughman said. "Each meal should have the same amount of carbohydrates, and it should be the same from one day to the next so the body can predict that you're going to eat and what it needs to produce."

She tells patients to eat the same amount of carbohydrates, whether they are coming from an apple or a brownie, because the body will use the sugar the same way. However, she wants her patients to learn that the apple is a better choice overall because it has more nutrients and healthy things like fiber while the brownie doesn't. Fiber has also been shown to help control blood sugar.

"We try to steer people to better foods and better choices," she said.

Part of that is teaching people to make the food choices long-term and manageable in everyday life, including understanding and changing portion sizes.

"It's a process," she said. "You are making changes you can keep forever."

Along with better eating choices, Rose recommended people get more active doing physical activities. She provides pedometers to the patients she counsels to help them see that even adding extra steps each day can slowly build exercise.

Along with lifestyle changes in eating and exercise, Dr. Haerian said there several different oral medications are available to treat type 2 diabetes. Some work to reduce the insulin resistance, while others increase insulin production. There are also three injectable medicines that increase insulin production while they help weight loss. Of course, there are the insulins themselves which Haerian said come in many different forms and may need to be injected.

In order to know if the treatment is working, patients can use a blood glucose monitor at home to check their blood sugar levels while the doctor will do blood tests every three months to evaluate if the treatment is effective, Haerian said.

Since diabetes affects the entire body, if blood sugar is not managed properly, it can lead to many different complications. Rose said the most common are cardiovascular disease, peripheral artery disease, cerebral vascular disease as well as eye, kidney and nerve damage. She said diabetes is the leading cause of non-traumatic limb amputation in America as well as the leading cause of blindness in people ages 20 to 74.

Some of those complications are seen every day by Dave Bickers, manager of wound, ostomy and hyperbaric medicine at Altoona Regional Health System. He said many of the things he sees could have been prevented with better maintenance of blood sugar.

"We usually end up seeing people after problems with diabetes," he said. "Diet and education, trying to prevent this end of it, really is the key to preventing the complications of diabetes."

The most common problem he sees are diabetic foot ulcers which can be very common in people with uncontrolled diabetes. Those ulcers may take three to six months to heal, even with specialized care every other week at the hospital.

"The main thing we see for diabetics is when the blood sugar is too high, it affects your ability to heal," Bickers said. "The body's natural healing mechanism is slowed down by too much sugar in the blood. The sugar gets in the way of healing."

That's why diabetes raises the risk of peripheral vascular disease, he said. While artery disease is often thought of blocking blood flow in and around the heart, in diabetics, that blood flow also decreases to the rest of the body, especially the hands and feet, Bickers said.

"It slows the healing process there on top of hardening the arteries so there's less blood which makes it even harder to heal," he explained.

Along with that comes damage to the nerves, or neuropathy, which causes a patient to lose feeling and sensation to extremities, he said.

"A lot of diabetics we see can't feel their feet," he said.

Since they can't feel their feet, they may not realize they are developing a sore or painful spot which can grow into an ulcer. And since blood flow is already decreased, a small sore can grow to become a big problem very quickly since it won't heal naturally, Bickers said.

On top of that, diabetes can actually change the way the body is supposed to react to an illness or injury.

"Diabetes will actually mask infection," Bickers said. "You might have an infection in the body and while a normal person would have a fever and be sick, a diabetic might not show a temperature until two days later and by then, the infection has time to grow much worse. By the time you see the infection, it's a really bad infection."

Besides wounds, coronary artery disease is more common among diabetics as well as the risk for stroke, blindness and kidney disease, he said.

"It's sped up by not keeping blood sugars under control. If you aren't paying attention to [blood sugar], it just really is a way to speed up trouble," Bickers said. "It really is a terrible disease. It affects every part of your body."

Rose said many of the complications can ultimately be avoided if a diabetes patient works at helping him or herself.

"Diabetes is self-managed for the most part," she said, adding that the patient has the power to help themselves get well if they follow the course. She recommended those diagnosed with diabetes should attend educational classes to learn about diet and managing their diabetes.

"The issue is control. You are in control of it," Rose said.

Once diagnosed, maintaining blood sugar is the key. Rose said patients should make sure to attend all their doctor appointments where they will be screened for complications and check their own blood sugar as instructed.

If someone is diagnosed with diabetes, Rose said they should get education about it and make the lifestyle changes to better their treatment. If someone is at risk and wants to prevent diabetes, they should make those same healthy changes.

"You can see it change for the better. These are things we should have been doing all along anyway," Rose said. "It's about deciding what you want to do and making a plan to do it."

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