The Medical Minute: Information
on type 2 diabetes
December 1, 2004
By John Messmer
An epidemic of cardiovascular disease is developing
right now, but it won't be noticeable for another decade
or two. This epidemic will result in death and disability
for millions and increase the cost of health-care by
billions. The good news is that it is mostly preventable,
but we must begin to work on the problem today.
The problem is type 2 diabetes. There are more than
18 million diabetics in the United States today. Worse,
the number of diabetics has more than doubled since
1980. Many diabetics are undiagnosed because there are
no symptoms until damage has occurred, and this takes
many years. There are more than 16 million people with
impaired glucose tolerance or prediabetes. Prediabetics
are not safe because damage to the heart and blood vessels
begins in the prediabetic stage.
Type 2 diabetes does not require insulin until late
in the course and has previously been a disease of adults.
Good statistics are not yet available, but increasing
numbers of teenagers with type 2 diabetes are being
diagnosed. These children will face heart attacks, strokes,
kidney failure and amputations in their 40s if the diabetes
is not stopped. Because younger women are diabetic,
there could be more birth defects and miscarriages because
these risks are increased in diabetic pregnancies.
There is a very simple reason for this epidemic --
obesity. Type 2 diabetes is caused by obesity about
90 percent of the time. Those with type 2 diabetics
in the family, particularly a parent or sibling, have
greater risk. Latino, Native-American, African-American,
Asian-American and Pacific Islander ethnic groups also
have higher risk.
Diabetes alone is bad enough, but many diabetics also
have dangerous cholesterol profiles. Typically there
is too much triglyceride and not enough HDL or "good"
cholesterol. While diabetics often have low levels of
LDL or bad cholesterol, this is deceiving since the
presence of increased glucose levels makes the LDL stickier
and more likely to clog the arteries causing heart disease,
strokes and poor circulation. Diabetes is so dangerous
to the cardiovascular system that doctors treat diabetics
as though they already have had a heart attack because
they have as much risk as someone who has already had
a heart attack.
Many diabetics smoke. That's about as dangerous as
playing Russian roulette with three bullets instead
of one. Diabetics who smoke scare doctors. Here's why:
a 50-year-old nonsmoking man with slightly high cholesterol
who is overweight but still does not have diabetes has
a 10 year risk of heart disease of about 10 percent.
(The lowest risk he could possibly achieve if everything
were perfect is 2 percent.) If he develops diabetes,
his risk increases to 16 percent. Add smoking and the
risk is 25 percent. That's only the risk of heart disease
-- smoking accelerates the damage to the blood vessels
everywhere with added risks of stroke, amputations and
erectile dysfunction even if the diabetes is mild.
How the diabetes problem be fixed? Diabetes can be
prevented in most cases, or put off until later years,
by maintaining a normal weight. Normal weight is a body
mass index (BMI) of between 20 and 25. For a 70-inch
tall man, that means less than 175 pounds; less than
160 pounds for a 67-inch woman. BMI can be calculated
at http://nhlbisupport.com/bmi/bmicalc.htm
If someone already has diabetes or impaired glucose
tolerance (prediabetes), his or her doctor probably
has measured his or her fasting glucose, hemoglobin
A1c and possibly glucose two hours after eating (2 hour
postprandial). There are recommended goals for these
tests that are associated with reduced risks of complications.
The risks only are reduced, not eliminated, as long
as blood sugars remain above normal. The American Diabetes
Association says there is no safe blood glucose level
that is still above normal. Only normal glucose returns
risk to normal. For most diabetics and people at risk
for diabetes, that means a normal BMI.
What is the best way to reach a normal weight? There
are various diets and programs, medications and surgical
approaches to weight loss, but which one is best? Although
people can debate the relative merits of low-carbohydrate
versus low-fat diet with or without medication or gastric
bypass for weight loss, all successful programs have
one common feature -- fewer calories. People who are
overweight, like two-thirds of Americans, eat too much.
It is not possible to become overweight any other way.
Start by eliminating foods that the body doesn't need
-- snacks, desserts and second helpings. Do not substitute
healthy foods, even fruit, for these -- people must
eat less to lose
weight. Next, reduce regular meal servings a bit.
Remember to be consistent. If people cut back all week
then eat more one day, they probably will not lose any
weight and will likely become frustrated at the attempt.
Read labels to see what has calories. Just because something
is healthy does not mean it can be consumed freely.
If it has calories, it counts. Exercise helps, but eating
less is most important.
Type 2 diabetes is a disabling, deadly and costly disease
that is preventable in most people. Maintain a normal
weight. Start today to eat properly. During this holiday
season, remember to give the gift of good health.
Source:http://live.psu.edu
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