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Issue Date: June 16-20, 2008
Diabetes
Early heart attacks and disability may be the price kids pay in this epidemic.
Dr. John B. Buse is president of medicine and science for the American Diabetes Association in Alexandria, Va., and a professor of medicine at the University of North Carolina, Chapel Hill.
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Nearly 21 million adults and children in the United States have diabetes, but only 14.6 million have been diagnosed, according to the American Diabetes Association. Almost one-third of the people who have diabetes don't know they have it.
"The epidemic of diabetes threatens the solvency of our entire health care system," says Dr. John B. Buse, president of medicine and science for the American Diabetes Association (diabetes.org). "Now that we have kids getting type 2 diabetes, the concern is that they will be having heart attacks in their 40s and early disability. The management of people with diabetes already accounts for one in five health care dollars, and health care expenditures are growing very rapidly. If this epidemic persists, driven by excess weight and obesity, it may bankrupt the health care system in this country."
We asked Buse to dispel some of the common myths people believe about diabetes.
Myth: Taking insulin is very bad. It can even cause blindness.
Reality: All of the studies indicate that, in trials where people have either been treated with insulin or been given pills and lifestyle intervention, the groups that got insulin have done much better. What we believe causes complications in diabetes -- the blindness, the kidney failure, the amputations -- is your average level of blood sugar and how long you've had that level. It's poor blood-sugar control over long periods that's associated with high risk of those disabling complications, not the drug you take.
Myth: Children get only type 1 diabetes, and adults get type 2 diabetes.
Reality: I don't think many people still believe that diabetes in children is always type 1, but many still believe that if you are an adult with newly diagnosed diabetes, then you must have type 2.
However, it's clear that for about 10% of adults with new diabetes, even 70- and 80-year-olds, the major problem is that they do not make enough insulin. And I would say that is type 1 diabetes. From a treatment point of view, if you're insulin-deficient and you do not respond to tablets, you must go on injections of insulin -- and if you take insulin shots, then you have type 1 diabetes.
Myth: Diabetes medicines make you fat.
Reality: Don't blame the medicine: The truth is that uncontrolled diabetes tends to minimize weight gain because you excrete sugar in your urine. If you eat 2,000 calories a day, and each day you lose 100 calories of sugar in urine, then the net result is that your body really absorbs only 1,900 calories. Losing 100 calories a day translates into nearly 1 pound per month. So if someone has poorly controlled diabetes (to the point he is losing sugar in the urine), and then we control his diabetes with medications but he doesn't change his diet at all, he'll gain a modest amount of weight (because he'll no longer lose that 100 calories a day in urine).
Myth: It's your own fault if you have diabetes.
Reality: A lot of people think people with type 2 diabetes did it to themselves. But nobody with diabetes has it because he wants to have it. We think the same genetics that helped our ancestors survive spells of famine now make it possible for people to put on weight quickly when there is plenty of food around and to lose weight slowly during lean times. In our current environment, where very little physical labor is required of us day to day and where there is plenty of food available, those same genes can lead to diabetes. People with diabetes aren't bad or lazy. They are not self-indulgent people. They are people whose bodies are genetically designed for a different environment.
Bottom Line: Better treatments, including stem cell therapy, are coming, but in the meantime, people should do their best to manage their diabetes. Through diet, exercise and, if needed, insulin injections, chances are better than ever they'll keep all of their limbs, maintain good vision, have excellent kidney function, and avoid heart attacks and strokes so that when things do get easier for diabetics, they'll be able to live to a ripe old age. Help is on the way.
"The epidemic of diabetes threatens the solvency of our health care system."
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