Good Control or Else

Diabetes Survival Guide: Understanding the Facts About Diagnosis, Treatment, and Prevention
by Stanley Mirsky, M.D., Joan Rattner Heilman

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Uncontrolled diabetes - consistently high blood sugars - can eventually affect every system of the body, resulting in many exotic varieties of diabetic complications. For example, people with diabetes are 21?2 times more likely to suffer from strokes and 2 to 4 times more likely to develop cardiovascular disease. Over 60 percent of diabetics have high blood pressure and 60 to 70 percent have nerve disease. Diabetes is the leading cause of new cases of blindness in adults and of end-stage kidney disease. It is the primary cause of amputations, an estimated 82,000 of them in the U.S. in 2002. That's ten times the number of amputations for other reasons.

Those are frightening facts, but here's the good news: Control your diabetes - in other words, maintain your blood sugar at consistently normal levels - and you can avoid or minimize all of these nasty complications. A thirty-year study of 4,400 diabetics revealed that those people who had held their blood-sugar levels to below 300 mgs had three times less risk of complications after fifteen years of the disease than those with higher levels. Those with a level below 250 mgs had five to twenty times less risk. And those who kept their blood sugar below 120 on diet alone had almost no risk of complications at all.

In 1998, the United Kingdom Prospective Diabetes Study strongly proved and confirmed an earlier DCCT study that intensive treatment - be it with oral agents (sulfonylureas or metformin) or insulin - reduced diabetic complications equally but metformin seemed to be better for the heart. The study also showed reducing blood pressure greatly reduced complications.

In a study of the Pimas, it was found that complications occurred in the group with fasting sugars above 140 and above 200 two hours after eating. The higher the sugar, the more likely the complications, and follow-up data found that a long period of intensive control delayed the onset of complications for many years even when that control was later abandoned.

More recently, in December 2005, a long-awaited federally funded landmark study reported in the New England Journal of Medicine presented solid evidence that stringent blood sugar control can cut the risk of heart disease nearly in half, at least for type 1 diabetics. Type 2s are the subject of a similar large trial sponsored by the National Institutes of Health, with results expected in 2009.

Nobody's Perfect

Of course, life is not fair. Some people who pay no attention to their control never develop complications in spite of their lack of vigilance, while others who exercise great care do get them in later years. But, in general, it is true that greater control means a better, healthier, longer life.

Nobody's perfect, and you won't be either. You will not always follow your diet plan, you will succumb to temptation now and then, you'll forget to test your blood sometimes, you will let your control get out of hand. But if this becomes your pattern and not just an occasional slip-up, you will undoubtedly pay the piper later. All the health problems associated with diabetes are hastened and exacerbated by poor control.

Who's In Charge Around Here?

You are. Your doctor will diagnose and prescribe and direct your treatment, but you are the only one who can live your own life. You're the one who puts the food into your mouth, decides how much exercise to get, takes the blood tests every day, handles the crises of hypoglycemia and high blood sugar. You can get direction and advice from your doctor and this book, but you are in charge of yourself.

This does not mean you are out there all on your own. It is very important that you see your doctor frequently, whether or not you take insulin. The doctor monitors your blood-sugar control in order to prevent complications in the future, picks up early changes, works with you on problems concerning diet, exercise, lifestyle, or whatever, and advises you on handling illnesses.

If you are a diabetic who is regulated by diet alone, see your doctor at least every three months. Don't go whenever you feel like it, or only when trouble brews. Go regularly on a scheduled basis.

If you take oral agents or insulin, make an appointment even more often, depending on your condition. Once every one to three months is right for most people. Never skip or postpone an appointment if you can possibly avoid it. And don't hesitate to call your physician if you see a change in the results of your home glucose monitoring.

To find a doctor who can give you good care, call your local chapter of the American Diabetes Association or the Juvenile Diabetes Foundation. You will be given the names of several doctors in your area who are the most knowledgeable about diabetes. This is a specialized field, and many general physicians are not qualified to handle your problems. Your future will be much brighter if you find a doctor who is.

It's a Balancing Act

Living with diabetes means a constant balancing act between the food you eat and the insulin you produce yourself or take by injection, along with the exercise you get. Insulin provides the mechanism for burning the food for energy to run your complex body. Exercise lowers your blood-sugar level. If you eat more food, you will need more insulin and exercise. If you eat less food, you will require less insulin and exercise. That's simple. What's hard is always having to think about this balancing act, especially at times when, often through no fault of your own, this balance is thrown out of kilter.

For many people, one of the most trying aspects is the need to be consistent, to lead a structured life. Especially if you take insulin, you soon discover that you must eat a preordained amount of carbohydrate, that you must eat on time, take your medication on schedule, take constant blood tests, check in with your doctor regularly. While everyone else, it seems, can stay up all night partying, eating pizza, and drinking sodas, stuffing themselves one day and fasting the next, paying no attention to medicines or doctors, you, if you are on NPH insulin, must plod along, day after day, on three meals plus two snacks.

That can be difficult, but it will pay off. Consistency isn't such a tremendous price to pay for feeling well now and in the future. It will eventually become a lifestyle you can live with.

Copyright © 2006 by Stanley Mirsky. Excerpted by permission of Ballantine Books, a division of Random House, Inc. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.

About the Author

Stanley Mirsky, M.D., is a practicing internist and diabetologist, a past president of the American Diabetes Association of New York State, and a board member of the Joslin Diabetes Center. He was named Endocrinologist of the Year for 2005 by the Mount Sinai School of Medicine. He lives in New York City.

Joan Rattner Heilman is an experienced health writer who has authored hundreds of articles and several books including Estrogen, What Every Woman Should Know: Staying Healthy After 40, and The Complete University Medical Diet. She Lives on Long Island.