UAB experts are on the lookout for new ways to manage this potentially devastating condition
By Tom Weede
In one of the more alarming health trends of this new century, diabetes is now a disease without borders, affecting more than 170 million people and threatening to hit double that number by 2030. “The disease has become an epidemic not just here in the United States, but all over the world,” says UAB endocrinologist Carlos R. Arguello, M.D., who has seen the results firsthand.
It’s a serious problem, especially when you consider that diabetes can lead to lower-limb amputations, blindness and kidney failure, as well as heart disease and stroke risk. What’s more, here in the U.S. an estimated 41 million people aged 40 to 74 have pre-diabetes. Even during this early stage, a person has a heightened risk of heart disease.
But for all of the dire numbers, there is good news: Taking action now—starting to exercise and improving your diet—may delay or even prevent the most common form of the disease. “What we call ‘therapeutic lifestyle changes’ have been shown to be more effective in preventing diabetes than even taking medications,” Dr. Arguello says.
Dissecting Diabetes
Diabetes is a disease that disrupts how the body regulates blood sugar, or glucose, which comes from the food we eat. Normally, the body uses insulin to shuttle glucose from the bloodstream into cells, where the glucose is converted into energy.
But when a person has diabetes, this process runs into trouble. With type 1 diabetes, the body’s own immune system destroys the ability of the pancreas to produce insulin. As a result, a patient requires insulin injections to make up for its absence.
With type 2 diabetes, which accounts for 90 percent to 95 percent of diabetes cases, the body’s cells are resistant to insulin. Because of this, glucose has difficulty getting into the cells and instead builds up in the blood. The pancreas tries to remedy the situation by making more insulin— but eventually it becomes exhausted and many people with type 2 diabetes will require additional insulin by injection.
Before a person gets type 2 diabetes, they usually have pre-diabetes, where blood glucose levels are above normal but below the threshold considered a diagnosis of diabetes. “Most of the patients who have this condition have a high risk of developing diabetes in the future,” Dr. Arguello says.
A Silent Disease
Symptoms of diabetes include excessive thirst or urination, weight loss, tingling or loss of feeling in the feet, slow-healing sores and blurry eyesight. But signs may not show up right away or at all—in fact, more than 6 million Americans have diabetes but don’t even know they’re afflicted. “Don’t wait until you have symptoms to be diagnosed,” Dr. Arguello warns. “Do something before you have the
problem.”
By being aware of the disease early, you may be able to prevent progression to full type 2 diabetes. That’s why it’s important to begin screening at age 45, and every three years after that. If you have a risk factor for the disease, you should be screened even sooner. In addition to being overweight, these risk factors include high blood pressure, low HDL (“good”) cholesterol, elevated triglycerides, diabetes in your family history, a history of gestational diabetes (a form of the disease during pregnancy) and having a baby weighing more than 9 pounds at birth. Some groups are at increased risk for diabetes and pre-diabetes—older individuals, as well as Latinos, African Americans, Asian Americans/Pacific Islanders and Native Americans.
To determine a diagnosis, doctors typically check blood glucose levels with a fasting plasma glucose test or an oral glucose tolerance test, which is done two hours after the patient consumes a glucose-based beverage.
Small Changes, Big Payoff
Medications can help lower blood glucose, but more importantly, a patient with either diabetes or pre-diabetes can help control their blood sugar through exercise and good nutrition. “The rise in type 2 diabetes is in large part brought about by another epidemic, which is obesity,” Dr. Arguello says. “In fact, there’s no drug or combination of drugs that will control diabetes without the patient watching his or her diet and being active. This is the backbone of diabetes management.”
At The Kirklin Clinic® at UAB, patients can work with their doctor and nutritionist to make better nutritional and other lifestyle choices. “We teach patients to have a balanced diet and decrease their caloric intake,” Dr. Arguello says, “while still eating adequate amounts of all the three major nutrients—carbohydrates, fat and protein.”
If you’re overweight, losing even just 7 percent to 10 percent of your body weight will improve blood sugar levels, especially if you include exercise, says UAB’s Cathy E. Crawford, M.S., R.D., CDE, diabetes and nutrition education coordinator at The Kirklin Clinic®. In a recent large study, overweight patients with pre-diabetes who were assigned to a program of reduced calorie intake and 150 minutes of weekly exercise decreased their chances of progressing to full diabetes by 58 percent.
Looking Ahead
For those people who aren’t helped by diet and exercise alone, several new diabetes treatments are on the horizon. The Food and Drug Administration recently approved the first inhalable form of insulin (although long-term safety studies are ongoing), and other insulin delivery systems being developed include insulin patches. Also, some drugs currently used to control glucose levels in people with type 2 diabetes have shown promise in animal research in preserving insulin-producing beta cells in the pancreas.
And at the UAB Endocrinology and Lipid Clinic, doctors and dietitians are providing patients with comprehensive treatment to manage not just diabetes, but other associated diseases that can bring complications, such as high cholesterol. “Although a patient with diabetes does have a problem,” Dr. Arguello says, “we try to help them control the disease, so they can continue to live a good life.” For more information about diabetes, log on to our Web site at
uabhealth.org/diabetes or call UAB HealthFinder at
(205) 934-9999 or
1-800-UAB-8816.
Debunking Diabetes
Here are a few diabetes myths—and realities—according to the American Diabetes Association.
MYTH: A person who has diabetes shouldn’t eat sweets or chocolate.
REALITY: Sweets and desserts are not “off limits” any more than they would be to non-diabetics, as long as they’re consumed as part of an overall healthy diet.
MYTH: Eating excessive sugar can cause diabetes.
REALITY: The disease results from a mix of genetics and lifestyle choices. At the same time, extra weight does heighten the risk for type 2 diabetes— and balanced nutrition and physical activity are important in controlling your weight.
MYTH: A person who has diabetes should reduce consumption of starches—for example bread, pasta and potatoes.
REALITY: Starchy foods play a role in healthy nutrition—but the key is portion control. Whole-grain cereals, pasta, breads and rice, as well as starchy veggies such as potatoes, peas, corn and yams are fine. In fact, whole-grain starches provide fiber to help maintain intestinal health.