Diabeta

You can fight this disease by getting off the couch and eating healthier foods.

Diabetes is "the epidemic of our times," according to the Centers for Disease Control and Prevention. Sixteen million Americans--about 6 percent of the population have the disease, and of those, 90 percent have Type 2 diabetes.

To understand diabetes, you first must know what it is. There are two types--called Type 1 and Type 2. Type 1 diabetes develops most often in children or young adults and happens when the body stops producing insulin, a hormone necessary for drawing energy from food. Without insulin injections, Type 1 diabetics can't survive. Type 2 diabetes--the one baby boomers need to be aware of--generally develops in people over age 40. Their bodies make insulin, but stop using it effectively. Most Type 2 patients do not require daily insulin, but about 40 percent do.

Though most people associate diabetes with insulin shots, that unpleasant task pales in comparison to the disease's complications, including heart disease, stroke, blindness, amputation, and kidney failure. And then there's death. Diabetes kills someone every three minutes, a rate 30 percent higher than in 1980. This year, 200,000 people will die from the disease.

The good news is that exercise and the right diet can prevent or delay Type 2 diabetes--or at least control it enough that insulin shots and drugs aren't necessary. Another good thing about the disease may be this: It seems ideally suited to scare Americans, almost a third of whom are considered obese, into finally keeping their New Year's resolutions.

Stressed genes, stretched jeans

Excess food, a sedentary lifestyle, and an aging population are the main reasons Type 2 diabetes has become an alarmingly common American disease, say diabetes experts. And yet an estimated half of the people who have Type 2 don't even know it. There are symptoms for Type 2 (see chart, below), but oftentimes they aren't obvious and years can go by before the disease is finally detected.

DIABETES SYMPTOMS

Type 1 Diabetes:

* Frequent urination

* Extreme thirst

* Extreme hunger

* Weight loss

* Extreme fatigue

* Irritability

* Flu-like symptoms in children

Type 2 Diabetes:

* Frequent urination

* Extreme thirst

* Extreme hunger

* Repeated or slow healing of skin, gums, bladder, or vaginal infections

* Weight loss

* Blurry vision

* Dry, itchy skin

* Tingling or loss of feeling in hands and feet

* Extreme fatigue

* Irritability

People with Type 2 diabetes don't immediately cease insulin production. Their bodies become less efficient at producing and using insulin. It the disease goes untreated, the body eventually will fail to make insulin altogether, as in Type 1. When insulin can't do its job well, blood glucose levels rise.

"Glucose is very toxic," says Dr. Gerald Bernstein, director of the Diabetes Management Program at Beth Israel Medical Center in New York City. "If we were talking about lead in the body, it would attract more attention. Glucose does the same thing. It rots tissue." Virtually every tissue in the body is at risk.

Yet diabetes has never much alarmed the public, Dr. Bernstein says. "Diabetes doesn't seem as significant to people as a heart attack that can kill you on the spot, whereas diabetes is going to take 20 or 30 years."

It certainly disturbed Linda Brown of Port Deposit, Maryland. The 53-year-old had lost her mother to diabetes, but didn't recognize any of the symptoms in herself, aside from thirstiness. Then, one day, she slipped into a diabetic coma. "When I woke up in the hospital and they told me I had diabetes, I said, `But how?'"

Probably not by gobbling too much sugar. While that was once widely thought to cause diabetes, sugary foods' main detriment to a potential diabetic is that, like other high-calorie foods, it's fattening. In a genetically susceptible person, extra fat cells, inactivity, and aging can weaken the body's responsiveness to insulin. That, coupled with poor insulin production, can lead to Type 2. Linda had been both inactive and overweight when she got sick.

"People assume they're not at risk for Type 2 if they don't know of a family member who had it," says Dr. Caren Solomon, assistant professor of medicine at Harvard Medical School. "But it's so common now that it's something all patients and doctors should be thinking about."

People who should be screened with a fasting blood glucose test at least every three years include:

* Anyone over age 45.

* Anyone who is overweight, especially those who have an "apple"-type physique (fat concentrated in the torso). This body type seems to increase insulin resistance.

* A woman who has had polycystic ovary syndrome or diabetes during pregnancy. If a woman was never tested for gestational diabetes, a baby weighing more than nine pounds at birth can be a clue that she may have had it.

* Members of some minority groups. African Americans, Asian Americans, Hispanics, and Native Americans are disproportionately vulnerable to diabetes.

Sadly, the disease is now taking hold among children, too, most likely because of inactivity and obesity. "Of the new cases of diabetes in children, up to 30 percent are Type 2," says Dr. Bernstein. "It used to be one to two percent."

Fighting it off, fighting back

There's a message here for parents, says Dr. Alan Moses, chief medical officer at Boston's Joslin Diabetes Center. Teach your kids to be active. "When you're 25 or 30, it's much harder to start," says Dr. Moses.

Harder, but crucial. A recent study of 41,811 men, between the ages 40 and 75, showed that those who watched the most TV had a two to three times greater risk of developing Type 2 diabetes. Watching TV doesn't contribute to diabetes; sitting around does.

Just modestly increasing activity reduces your risk of developing Type 2 by 20 percent, according to the TV study. No one knows exactly how, but exercise helps your body use glucose. Any type of exertion is a boon, say diabetes experts, even if for only one day a week. For marked benefit, try brisk walking for 30 minutes every other day. Because exercise burns calories and leads to weight loss, it's doubly beneficial. Lose and keep off 10 pounds and you slash the risk of developing Type 2 by 30 percent.

Rima Kittner, 55, of Berkeley, California, hated exercise before her Type 2 diagnosis. "But going blind, having your feet cut off, being in constant unremitting pain? Oh, no, thank you," she says, describing her motivation for gradually adding 2 miles of walking to her daily routine. So far, she hasn't needed to take insulin or diabetic medications, and she feels "a hundred times better" than before her diagnosis.

Her life isn't carefree, of course. Rima burst into tears the first time she tested her blood sugar. It's a bothersome daily ritual critical to helping patients eliminate fluctuations in blood glucose levels. A large 1998 study confirmed what doctors had suspected: Keeping blood sugar controlled decreases the risk of diabetic complications-by up to 25 percent.

As for diet, most newly diagnosed diabetics are surprised to learn they don't have to give up sugar or other specific foods. Instead, through blood testing and consultations with doctors and nutritionists, diabetics calculate how various foods affect their glucose levels. Then they create a daily diet budget, by calories or by types of food, and aim to stay within that budget each day.

"It takes a lot of spontaneity out of your life," says Rima. "But unlike other diseases, you really are in control of it."

Medication helps

Within the next decade, researchers may understand how to cure diabetes. In the meantime, science is already using prescription drugs to reshape the lives of diabetics. There are five classes of diabetes medications available in pill form, each acting on the body differently. They are:

* Sulfonylureas (common brand names include Micronase, Glucotrol, and DiaBeta). These pills help the body make insulin and are the most widely prescribed diabetes medications.

* Metformin (brand name Glucophage). This drug helps the body use insulin better and is most often prescribed for overweight people.

* Troglitazone (brand name Rezulin). This pill helps the body respond to insulin better and is given to patients who need a lot of insulin in a single day.

* Alpha-glucosidase inhibitors (brand names include Precose and Glyset). This drug slows down the absorption of sugar.

* Repaglinide (brand name Prandin). This is a pill taken at meals to control blood sugar. Dosage can be adjusted based on how much you eat.

Another is a class of drugs called thiazolidinediones or TZDs. These reduce insulin resistance, helping diabetics who can't control their blood sugar with other drugs. TZDs might protect: against heart disease too. Unfortunately, the first FDA-approved TZD, Rezulin, has caused liver toxicity in a small percentage of users. The newer ones, Avandia and Actos, are hoped to be safer.

One promising--but not yet fully tested--strategy is hormone replacement therapy for postmenopausal women. "It'll probably improve both blood glucose control and cardiovascular risk factors in diabetic women," says Dr. Karen Friday, associate professor of medicine at Tulane University. "And it may actually prevent diabetes."

There also are different insulin delivery systems, such as a pump that delivers insulin continuously beneath the skin. An insulin pump can be worn outside the body like a pager or be surgically implanted in it. Researchers are working on inhaled forms of insulin delivery as well as an insulin skin patch.

Diabetics already can buy prescription insulin "pens," such as the Humulin 70/30 Pen and NovoPen. These resemble fountain pens and make dosing easier and injecting less conspicuous and painful.

DIABETICS: ARE YOU WATCHING YOUR HEART?

Most diabetics--80 percent--die from heart disease. A 1998 study in the New England Journal of Medicine expressed that reality in stork terms. A Type 2 diabetic who has never had a heart attack has the same risk of having one as a non-diabetic person who already has suffered a heart attack, the study reported.

Here's why: Insulin resistance is linked to risk factors for coronary artery disease, including high blood pressure, increased triglycerides, decreased "good" HDL cholesterol, and increased "bad" LDL cholesterol. Also, unregulated glucose in the bloodstream can contribute to clogged arteries. With many diabetics overweight and eating poorly, heart disease is practically insured. Diabetes makes women especially vulnerable, overriding the protective benefits they usually derive from estrogen in their bodies.

What's a diabetic to do? Start exercising, lose weight, eat right, and control your blood glucose. Talk to a doctor about whether you should take cholesterol-lowering medications, and make sure your blood pressure stays under control. If you smoke, quit. If you are postmenopausal, consider hormone replacement therapy. Also, ask your doctor if you should take a daily aspirin. Good, old, inexpensive aspirin is thought to lower a diabetic's risk of cardiovascular disease and lower the risk of amputation.

COPYRIGHT 1999 Meredith Corporation