The American Diabetes Association reports that over fifteen million Americans have diabetes. In Canada, prevalence rates for the disease were 13.2% for men ages 65 to 74 and 12% for women between 1986 and 1992.

Dealing with Diabetes

Dealing with Diabetes

Approximately ten percent of diabetics have Type 1 diabetes, where the body fails to produce insulin. Also known as insulin-dependent diabetes mellitus, it used to be called juvenile diabetes even though adults get it as well.

The vast majority of diabetics have Type 2 diabetes where insulin is made but the body uses it improperly or levels are inadequate. The muscles fail to pick up the glucose they need to function.

Diabetic Chris Basile checks his blood sugar levels almost a dozen times a day. Basile is trying to undo the damage done from years of ignoring common symptoms of the disorder. “I was extremely thirsty, that was one of the first,” he says. “I couldn’t get enough water: water, bathroom, water, bathroom.”

Endocrinologist Dr. Athena Philis-Tsimikas, MD of Scripps Whittier Institute for Diabetes in La Jolla, CA says symptoms are sometimes subtle. “The symptoms of diabetes aren’t always obvious,” she says. “The elevated blood sugars can cause fatigue, but fatigue can be caused by someone that’s working very hard, and they don’t realize that it’s from high blood sugars.”

Symptoms of diabetes come from high blood sugar levels. Over a long period of time, high glucos levels can lead to serious complications like heart disease, blindness, kidney failure, and nerve damage.

Higher blood sugar levels can also cause short-term problems in diabetics, like increased yeast infections in women.

On average, six years passes before the average diabetic discovers his or her disorder. For Basile, treatment delays have cost him partial nerve damage in his legs. “I get hot burning pains like a ice pick or a cigarette or something burning my foot.”

Diagnosed two years ago, the 48 year old Basile is currently enrolled in a special program that aggressively manages his condition. Each day is a balancing act with careful timing of insulin shots and oral medication. “I can’t just take a magic pill and make it go away,” says Basile. “I can’t reverse the damage that has been done, but you can do some maintenance to prevent it.” Basile is trying to stave off the threats of amputation and blindness.

Staying in control of the time he eats, what he eats, and resisting temptation when others go for second or third helpings at the dinner table, is also crucial as nutrition plays a big factor in preventing blood sugar highs and lows.

Basile was persuaded from all sides to undergo a crash course in diabetes because understanding the mechanisms of the disease increases the chance of treatment adherence.

He’s particularly aware of any wounds that won’t heal. Periphery neuropathy among some diabetics can reduce the awareness of infection, leading to amputation of limbs. Foot disorders are particularly troublesome for diabetics.

In the late 1990’s four new classes of drugs have been approved which help the body burn fuel properly, helping keep tight control of glucose levels. Dr. Philis-Tsimikas, citing findings from the 1983 to 1993 DCCT clinical study, the largest, most comprehensive diabetes study ever conducted in the US and Canada, says that keeping blood sugar levels as close to normal as possible slows the onset and progression of eye, kidney, and nerve diseases by 50% to 75%. Studies in Japan and Britain show similar results for Type 2 diabetes, she says.

Blood sampling mini-computers, like the wearable Cygnus GlucoWatch Monitor, assist patients with their glucose balancing act.

Basile says he knows the stakes are high: “I want to be able to walk. I want to be able to see, you know, the beautiful sunrise and sunset. I want to live a normal life.”

Diabetes is the seventh leading cause of death in the United States and the leading cause of blindness and kidney disease. Diabetics are two to four times more likely to have a heart attack and face two to five times higher medical costs compared to the non-diabetic population.

In the modern era, a diabetes diagnosis is no longer a death sentence or a guarantee of traumatic sickness. But aggressive management of either type of the disease, Type 1 or the more common Type 2, is crucial for reducing the risk of serious complications of the disease like blindness and the need for limb amputations. The hormone allows blood sugar, or glucose, to enter the cells the body and be used for energy.

The Canadian Diabetes Association (CDA) reports that thirty percent of people with Type 1 diabetes, where the body produces no insulin, and seventy percent of people with Type 2 diabetes, improper use or levels of insulin, receive inadequate diabetes education resulting in insufficient care. Forty percent of people with diabetes will experience complications from the disease at some point in their lives.

Health officials find that although the initial costs of intensive therapy are two to three times greater than more passive, conventional therapy, the long-term costs are significantly less.

Carolyn Baker is taking a bolder approach to her diabetes. Now 41, she’s done little about her Type 2 diabetes since she was diagnosed. The average time before a diabetic is actually diagnosed is six years because the symptoms, particularly of Type 2, aren’t always obvious. Baker isn’t sure how long she had it before diagnosis at age 29.

For years Baker hasn’t felt well because her blood sugars were fluctuating dramatically up and down. “I was in a state of denial because I felt OK after I took the medicine. I just go on and live my life,” Baker says. “But then, I knew that I really wasn’t really feeling well. I was always thirsty, I was always wanting something.”

As the years go on, out of control blood sugar levels damage the body. However, studies show that keeping blood sugars within an ideal range can reduce complications by fifty to seventy-five percent.

In some cases diet is enough to achieve balanced blood sugar levels.

Baker, who is severely overweight, is now involved in a disciplined program overseen by her doctor. She’s been taught to get readings on her home blood glucose monitor throughout the day, and tries to keep the readings within an ideal range.

To accomplish this she has had to make some major life changes, losing weight for starters. For as long as Baker can remember she has been large. She’s now using walking as part of her exercise regimen.

The CDA says after six years of effort diet and exercise end up helping eighteen percent of diabetics. Dr. Athena Philis-Tsimikas, MD, who is an endocrinologist at Scripps Whittier Institute for Diabetes in La Jolla, CA says diet plays the other key role. “If you’re limiting the carbohydrates that you are eating, and yet your blood sugars are still rising, then it means that one of these mechanisms that causes diabetes is really not working, and you need medication to help you,” says Dr. Philis-Tsimikas.

In the past five years, four new classes of drugs have been approved which help the body burn its fuel properly. “In the past we were having a difficult time bringing diabetes under control,” Philis-Tsimikas says.

One of this latest series of medications prevents the liver’s normal outpouring of sugar during sleep. Many diabetics find their blood sugar levels elevated when they awake. Another drug slows down the absorption of carbohydrates, starches, from food, the normal catalyst for a rise in blood sugar.

In what some might regard as a cure and others as a desperate measure for survival, patients are having pancreas transplants–so-called islet transplantation because insulin-producing cells are found in the Islets of Langerhans there–in order to have a functioning regulator of insulin. Immunosuppressive drugs must be taken daily to reduce the risk of rejection. These drugs bring the risk of certain infections like Cytomegalovirus (CMV). Some have simultaneous kidney transplants because that organ, too, is failing.

African Americans, American Indians, Alaska Natives, Asian and Pacific Island Americans, and Hispanic Americans have higher incidence rates than Caucasians in the US. African Americans, for example, are 1.7 times more likely to have diabetes than non-Hispanic whites. One in four African American women over age 55 has the disease.

Genetic factors, combined with unhealthy cultural traditions like high fat diets, make for troublesome combinations that result in the higher rates.

Similar patterns are found among Canadians. Toronto’s large Portuguese community is just one high-risk group receiving special outreach.

In addition to reducing the risk of complications, aggressive management also offers an added bonus. “There is an immediate benefit,” says Dr. Philis-Tsimikas. “The fatigue that people feel from running high blood sugars for long periods of time improves when you bring blood sugars down.”

This energy boost has been Caroloyn Baker’s reward for her efforts to prevent more severe illness. Though she regrets not starting sooner, in the past thirteen months Baker has lost 65 pounds and has a goal of someday not needing medication at all. “It’s hard. It’ll never get easy. There are days when I slip back. But I shake it off and start over again. What motivates me the most is I feel so much better,” she says.

Baker says she’s excited about the prospects of the future. “I’m in control. I feel confident I know what it is I’m fighting and that it can take control of my body. God has a purpose for me being here.”