Issue Date: November 30, 2003
The diabetes epidemic and you
Researchers remind me of the "ghost of Christmas yet to come" from Charles Dickens' "A Christmas Carol." Remember him? He showed Ebenezer Scrooge what would happen if he didn't change his ways. Well, diabetes researchers are giving us a glimpse of our future, too. If we choose not to heed their warnings, there'll be serious trouble.
We've got to stop passing bad habits on to our children.
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According to the Centers for Disease Control and Prevention, one in three U.S. children born in 2000 will develop diabetes if they follow the current trend of overeating and remaining inactive. As it is, from 1990 to 2000, the number of adults with diabetes rose by a striking 49%, affecting people from all backgrounds. Most everyone knows someone with diabetes.
Its toll can be measured in economic and human terms. A study published in "Diabetes Care" in March estimated that costs attributable to diabetes in 2002 were about $132 billion. Direct medical costs totaled $92 billion; indirect costs (from absenteeism, restricted activity, disability, etc.) ran about $40 billion. People with diabetes had medical expenditures 2.4 times higher than those expected to be incurred by a similar group of people without diabetes.
Our population is aging; baby boomers outnumber Gen-Xers, and we're spending massive sums on an illness our children won't be able to pay for down the road. And that's just the dollar cost. The human costs are just as staggering. As a person becomes physically limited by diabetes, others must take up the slack, so diabetes affects families and friends, too.
And although diabetes affects all ages and all types of folks, the rates of increase are higher among certain minorities. The most recent statistics indicate that 13% of African Americans, 10% of Hispanics and 15% of Native Americans have diabetes. Additionally, 20% of U.S. citizens above age 65 have diabetes.
What's more, we are passing down bad habits to our kids, dooming future generations to the same fate. Nearly 1 million children have Type 1 diabetes, and more than ever are developing Type 2, once found almost exclusively in overweight adults.
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What to do
Now that I've rattled you with frightening statistics, it's time to ask yourself a question: Are you at risk for diabetes? Risks include increasing age (over 40), being overweight, family members with diabetes, physical inactivity and, for women, a history of gestational diabetes. The more of those criteria you meet, the likelier you are to develop diabetes.
So what's a concerned person to do? First, if you don't have diabetes, work on your habits so that you don't get it. Regular exercise and weight control are effective. That goes for the kids, too. If you notice them getting a little round at the waist or spending too much time in front of the TV, get them on the move!
If you already have diabetes, don't give up. If you require insulin, numerous types are available; your doctor can work with you on the most appropriate approach for you. If you don't require insulin, many oral medications are quite effective. And don't forget that leading a more healthful lifestyle makes it easier to control your blood sugar and improve your long-term odds. Finally, all diabetics should have regular checkups to monitor for early complications of the illness.
The ghost of the future is only telling us how things will be if we don't change our ways. If Scrooge can change, so can we!
Contributing Editor Tedd Mitchell, M.D., directs the Wellness Program at the renowned Cooper Clinic in Dallas.
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What is diabetes?
"Sugar diabetes" (diabetes mellitus) occurs when the body either doesn't produce enough insulin or cells in the body become more resistant to it. Insulin is a hormone, made by the pancreas, that moves sugar from the bloodstream into the body's cells, where it's used as fuel. Think of the insulin as a "key" that the sugar can use to "unlock" the doors to cells.
There are three main types of diabetes:
Type 1 diabetes. This used to be called juvenile diabetes, because it typically occurs in children and young adults. In this form, the pancreas quits producing insulin, so sugar in the bloodstream doesn't have a "key" to unlock doorways to the cells. So blood-sugar levels rise while the cells starve because they can't get fuel. The cells resort to burning other things for fuel; the result is diabetic ketoacidosis, which can be fatal. The treatment is insulin.
Gestational diabetes. This type occurs in pregnant women and usually disappears after delivery. But it's ominous: Women who experience it are more likely to develop Type 2 later.
Type 2 diabetes. This used to be called adult-onset (or non-insulin-dependent) diabetes. By far the most common form, it's an epidemic. The pancreas produces insulin, but in some cases not enough. The cells themselves become resistant to the insulin. As a result, even though the "keys" are available in the blood, they don't work on the "locks" of the cells, so blood sugar drifts up, out of the normal range. The usual complications include heart and vascular disease, kidney disease, eye and immune-system problems, and nerve damage.
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