DIABETES-The Silent Killer
The Challenge of Treatment
“There’s no diabetes that’s not bad. It’s all serious.”
—Anne Daly, American Diabetes Association.
“YOUR blood tests came back with significant abnormalities. You need immediate medical attention.” The doctor’s words hit Deborah like a sledgehammer. “That night, I kept thinking there must have been a lab error,” she says. “I told myself I just couldn’t be sick.”
Like many people, Deborah thought that she was reasonably healthy, so she ignored the nagging symptoms. She blamed her persistent thirst on the antihistamines she was taking. She attributed the frequent urination to an excess intake of water. And the tiredness
—well, what working mother does not get exhausted?
But then a blood test confirmed that diabetes was the culprit. It was difficult for Deborah to accept the diagnosis. “I told no one about my illness,” she says. “At night, when the family was asleep, I would stare out at the darkness and cry.” Upon learning that they have diabetes, some, like Deborah, experience a flood of emotions, including depression and even anger. “I went through a tearful period of denial,” says Karen.
These are natural responses to what seems an unfair blow. With support, however, those with diabetes can adapt. “My nurse helped me to accept my condition,” says Karen. “She assured me that it was OK to cry. This emotional outlet helped me to adjust.”
Diabetes has been called “a disorder of the very engine of life,” and for good reason. When the body cannot metabolize glucose, a number of vital mechanisms can break down, sometimes with life-threatening consequences. “People don’t die directly from diabetes,” says Dr. Harvey Katzeff, “they die from complications. We do a good job of preventing complications, but a poor job of treating [them] once they occur.”
Is there hope for those who are afflicted with diabetes? Yes
—if they recognize the seriousness of the disorder and submit to a program of treatment.
Diet and Exercise
Although Type 1 diabetes cannot be prevented, scientists are studying the genetic risk factors and are trying to find ways to suppress an immune attack. (See the box below“The Role of Glucose,” ) “With type 2, the picture is much brighter,” says the bookDiabetes
—Caring for Your Emotions as Well as Your Health. “Many of those who might be genetically susceptible avoid showing any sign of this disease simply by eating a balanced diet and exercising regularly, thereby staying physically fit and keeping their weight within normal limits.”
Underscoring the value of exercise, the Journal of the American Medical Associationreported on a large study involving women. The study found that “a single bout of physical activity increases insulin-mediated glucose uptake [by the body’s cells] for more than 24 hours.” Hence, the report concludes that “both walking and vigorous activity are associated with substantial reductions in risk of type 2 diabetes in women.” The researchers recommend at least 30 minutes of moderate physical activity on most if not all days of the week. This can include something as simple as walking, which, says theAmerican Diabetes Association Complete Guide to Diabetes, “is probably the best, safest, and least expensive form of exercise.”
However, exercise by people with diabetes should be professionally supervised. One reason is that diabetes can damage the vascular system and nerves, thus affecting blood circulation and feeling. Hence, a simple scratch on the foot may go unnoticed, get infected, and turn into an ulcer
—a serious condition that may lead to amputation if not treated immediately.
Still, an exercise regimen can help one to manage diabetes. “The more researchers study the benefits of regular exercise,” says the ADA Complete Guide, “the better the news gets.”
Many with diabetes must supplement their diet and exercise program with daily testing of glucose levels along with multiple insulin injections. As a result of improved health through diet and a good routine of exercise, some with Type 2 diabetes have been able, at least for a time, to discontinue insulin therapy.* Karen, who has Type 1 diabetes, found that exercise increases the efficiency of the insulin she injects. As a result, shehas been able to cut her daily insulin requirements by 20 percent.
If insulin is needed, however, there is no reason for the sufferer to feel discouraged. “Going on insulin does not imply failure on your part,” says Mary Ann, a registered nurse who cares for a number of diabetes patients. “Whatever form of diabetes you have, if you carefully control your blood sugar, you will minimize other health problems later.” In fact, a recent study revealed that people with Type 1 who kept strict control of their blood-sugar levels “had drastic reductions in the occurrence of diabetic eye, kidney, and nerve diseases.” The risk of eye disease (retinopathy), for instance, was cut by 76 percent! Those with Type 2 who keep tight control of their blood-sugar levels enjoy similar benefits.
To make insulin therapy easier and less traumatic, syringes and insulin pens
—the most common tools used— have microfine needles that give minimal discomfort. “The first shot is usually the worst,” says Mary Ann. “After that, most patients say they hardly feel a thing.” Other methods of injection include automatic injectors that shoot a needle into the skin painlessly, jet injectors that literally fire insulin through the skin by means of a fine jet blast, and infusers that employ a catheter that stays in place for two or three days. About the size of a pocket pager, the insulin pump has gained popularity in recent years. This programmable device dispenses insulin through a catheter at a steady rate according to the body’s daily needs, making insulin administration more precise and convenient.
All told, there is no blanket therapy for diabetes. When considering treatment, each individual must take into account a number of factors in order to make a personal decision. “Even though you may be under the care of a medical team,” says Mary Ann,“you are in the driver’s seat.” In fact, the journal Diabetes Care states: “Medical treatment of diabetes without systematic self-management education can be regarded as substandard and unethical care.”
The more those with diabetes learn about their disease, the better equipped they will be to manage their health and increase their prospects of living a longer, healthier life. Effective education, however, calls for patience. The book Diabetes
—Caring for Your Emotions as Well as Your Health explains: “If you try to learn everything at once, you are likely to get confused and not use the information effectively. Besides, much of the most useful information you will need to learn isn’t found in books or pamphlets. It has to do with . . . how your blood sugar varies with changes in routine. This can be learned only over time, through trial and error.”
For example, by careful monitoring you learn how your body reacts to stress, which can cause your blood-sugar level to shoot up. “I’ve lived with this diabetic body for 50 years,” says John, “and I know what it is telling me!” “Listening” to his body has paid off, for John is still able to work full-time
—even though he is over 70 years of age!
The Importance of Family Support
Not to be overlooked in treatment of diabetes is support from the family. In fact, one reference notes that “the quality of a family’s life together is perhaps the largest single factor” in managing diabetes in children and young adults.
It is beneficial when family members learn about diabetes, even taking turns attending medical appointments with the sufferer. Knowledge will help them to be of support, recognize important symptoms, and know how to respond. Ted, whose wife has had Type 1 diabetes since the age of four, says: “I can tell when Barbara’s sugar level goes down too low. She will get quiet in the middle of a conversation. She perspires profusely and gets angry for no reason. And her reactions slow down.”
Similarly, when Catherine, John’s wife, observes John becoming pale and clammy and when she sees a change in his disposition, she presents him with a simple math problem. John’s confused response tells Catherine that it is time to take any decision-making out of his hands and act quickly to remedy the situation. Both John and Barbara deeply appreciate having informed marriage mates whom they love and fully trust.
Loving family members should strive to be supportive, kind, and patient
—qualities that can help an ill person face life’s challenges and can even influence for the better the course of their disease. Karen’s husband reassured her of his love, which made a big difference. Karen relates: “Nigel said to me, ‘People need to take in food and water to survive, just the same as you need food and water —and a little dose of insulin.’ These warm yet practical words were just what I needed.”
Family and friends also need to understand that as blood-sugar levels fluctuate, diabetes can affect one’s moods. “When I experience sugar-related lows,” says one woman, “I get very quiet, moody, easily upset, and frustrated. Then I feel awful about being so childish. But it helps when I know that others understand the reason for these feelings
—which I try to control.”
Diabetes can be managed successfully, especially if the sufferer has cooperation from friends and family members
The Role of Glucose
Glucose fuels the body’s trillions of cells. To enter the cells, however, it needs a “key”
—insulin, a chemical released by the pancreas. With Type 1 diabetes, insulin is simply not available. With Type 2, the body makes insulin but usually not enough.* Moreover, the cells are reluctant to let insulin in —a condition called insulin resistance. With both forms of diabetes, the result is the same: hungry cells and dangerous levels of sugar in the blood.
In Type 1 diabetes, a person’s immune system attacks the insulin-producing beta cells in the pancreas. Hence, Type 1 diabetes is an autoimmune disease and is sometimes called immune-mediated diabetes. Factors that can trigger an immune reaction include viruses, toxic chemicals, and certain drugs. Genetic makeup may also be implicated, for Type 1 diabetes often runs in families, and it is most common among Caucasians.
With Type 2 diabetes, the genetic factor is even stronger but with a greater occurrence among non-Caucasians. Australian Aborigines and Native Americans are among the most affected, the latter having the highest rate of Type 2 diabetes in the world. Researchers are studying the relationship between genetics and obesity, as well as the way excess fat seems to promote insulin resistance in genetically susceptible people.*Unlike Type 1, Type 2 diabetes occurs mainly in those who are over 40 years of age.