Diabetes: Diabetics Need to Fight

by Food and Drug Administration (FDA)

Actress Mary Tyler Moore battles it. Country singer Mark Collie has it. Rhythm and blues singer Patti LaBelle was diagnosed with it recently.

Celebrities like Moore, Collie and LaBelle are just three well-known faces amid the 16 million Americans suffering from diabetes mellitus, a chronic disease in which the pancreas produces too little or no insulin, impairing the body's ability to turn sugar into usable energy.

In recent years, the Food and Drug Administration has taken steps that make it possible for people with diabetes to maintain better control of their disease. In the early 1990s, the agency, along with the U.S. Department of Agriculture, put in place food labeling regulations that, among other things, require labels of most packaged foods to provide nutrition information. So, people with diabetes can now learn about the nutritional content of almost all the foods they eat.

More recently, FDA has approved a fast-acting form of human insulin and several new oral diabetes drugs, including Glucophage (metformin), Avandia (rosiglitazone) and Actos (pioglitazone), drugs that improve sensitivity to insulin. These drugs are designed to help Type II diabetics make better use of the insulin produced by their bodies.

While it is treatable, diabetes is still a killer. The seventh leading cause of death in America, diabetes claims an estimated 80,000 lives each year.

Philip Cryer, M.D., a professor at Washington University School of Medicine in St. Louis and past president of the American Diabetes Association, believes that most people simply don't understand the magnitude of the diabetes problem. "Diabetes is an increasingly common, potentially devastating, treatable yet incurable, lifelong disease. It's the leading cause of blindness in working-age adults, the most common cause of kidney failure leading to dialysis or transplants, and is a leading cause of amputation," he says. "The most recent estimate we have of diabetes' cost [in terms of] direct medical care is [more than] $90 billion dollars annually — more than heart disease, cancer, or AIDS."

But, the increasing emphasis on the importance of a healthy diet, the availability of glucose monitoring devices that can help diabetics keep a close watch over blood sugar levels, and the wide range of drug treatments enable most diabetics to live a near-normal life.

Two Types of Diabetes

There are two main types of diabetes, Type 1 and Type 2. Insulin-dependent, or Type 1, diabetes affects about 5 percent of all diabetics. It's also known as juvenile diabetes because it often occurs in people under 35 and commonly appears in children or adolescents. For example, Mary Tyler Moore, a Type 1 diabetic who is international chairman of the Juvenile Diabetes Foundation, was diagnosed in her late 20s, following a miscarriage. A routine test found her blood sugar level was 750 milligrams per deciliter (mg/dl), as compared with the normal level, 70 mg/dl to 105 mg/dl. And Collie has been diabetic since age 17.

In Type 1 diabetes, the insulin-secreting cells of the pancreas are destroyed, with insulin production almost ceasing.

Type 1 diabetics must inject insulin regularly under the skin. Insulin cannot be taken by mouth because it cannot be absorbed from the gastrointestinal tract into the bloodstream. Doses range from one or two up to five injections a day, adjusted in response to regular blood sugar monitoring. Insulin regulates both blood sugar and the speed at which sugar moves into cells.

Symptoms of untreated insulin-dependent diabetes include:

• continuous need to urinate
• excessive thirst
• increased appetite
• weakness
• tiredness
• urinary tract infections
• recurrent skin infections, such as boils
• vaginal yeast infections in women
• blurred vision
• tingling or numbness in hands or feet.

If Type 1 diabetes goes untreated, a life-threatening condition called ketoacidosis can quickly develop. If this condition is not treated, coma and death will follow.

Type 2, or non-insulin-dependent, diabetes is the most common type. It results when the body produces insufficient insulin to meet the body's needs, or when the cells of the body have become resistant to insulin's effect. While all Type 1 diabetics develop symptoms, only a third of those who have Type 2 diabetes develop symptoms. Many people suffer from a mild form of the disease and are unaware of it. Often it's diagnosed only after complications are detected.

When they occur, Type 2 symptoms may include frequent urination, excessive thirst, fatigue, an increase in infections, blurred vision, tingling in hands or feet, impotence in men, and absence of menstrual periods in women.

Type 2 diabetes usually develops in people over 40, and it often runs in families. For instance, Patti LaBelle was diagnosed with Type 2 diabetes at age 50; her mother died of the disease.

Type 2 diabetes is often linked to obesity and inactivity and can often be controlled with diet and exercise alone. Type 2 diabetics sometimes use insulin, but usually oral medications are prescribed if diet and exercise alone do not control the disease.

Malfunction in Glucose Metabolism

In a normal body, carbohydrates (sugars and starches) are broken down in the intestines to simple sugars (mostly glucose), which then circulate in the blood, entering cells, where they are used to produce energy. Diabetics respond inappropriately to carbohydrate metabolism, and glucose can't enter the cells normally.

Insulin — a hormone that is made in the pancreas and released into the bloodstream and carried throughout the body — enables the organs to take sugar from the blood and use it for energy. If body cells become resistant to insulin's effect or if there isn't enough insulin, sugar stays in the blood and accumulates, causing high blood sugar. At the same time, cells starve because there's no insulin to help move sugar into the cells.

Diabetes is diagnosed by measuring blood sugar levels. This can begin with a urine test sampled for glucose because excess sugar in the blood spills over into the urine. Further testing involves taking blood samples after an overnight fast. Normal fasting blood glucose levels are between 70 mg/dl and 105 mg/dl; a fasting blood glucose measurement greater than 126 mg/dl on two separate occasions indicates diabetes.

Diabetes can result in many complications, including nerve damage, foot and leg ulcers, and eye problems that can lead to blindness. Diabetics also are at greater risk for heart disease, stroke, narrowing of the arteries, and kidney failure. But evidence shows that the better the patient controls his or her blood sugar levels, the greater the chances that the disease's serious complications can be reduced.

About the Author

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