Diabetes

Disarming a Potential Killer

Sugar and spice are fine for nursery rhymes.

But when the amount of sugar in your blood is too high, you probably have diabetes, a disease that afflicts nearly eight million American women. It's the nation's fourth leading cause of death, claiming about 160,000 lives each year--about half that number women. Over time, unmanaged diabetes can cause stroke, heart attack and kidney failure even in young people, who normally don't face these problems. Diabetes can also lead to blindness, nerve damage and sexual disinterest.

No Easy Outs

But even trying to manage this disease can age you before your time. Women with diabetes must adhere to strict diets in both what and when they eat. "Maybe they can have an infrequent piece of cake, on a child's birthday or an anniversary, but that's it," says Audrey Lally, R.D., a certified diabetes educator and nutrition specialist at the Mayo Clinic in Scottsdale, Arizona. "But for the most part, I discourage my patients with diabetes from ever using anything that contains large amounts of pure sugar."

This regimen goes beyond the kitchen. No longer can women with diabetes casually stroll barefoot on a summer's day. Because of nerve damage that could result in a loss of sensation in their legs and feet, they may be unaware of foot injuries. According to the American Diabetes Association, more than 54,000 diabetes sufferers lose their feet or legs to amputation each year because of the disease.

"Any time you change the chemistry of the blood, you're going to change virtually every system affected by the blood," says Steve Manley, Ph.D., a psychologist in private practice in Denton, Texas. "And that would be all of them."

Including your sexual organs. Since diabetes can debilitate both the neurological system and the vascular system, and you need good nerves and blood flow to function sexually, many women lose the pleasure they once found in sex. "Men often become impotent from diabetes, and in a way, it affects women the same way," says Dr. Manley. "The lubrication phase for women is similar to the erection phase for men."

The Brain Drain

Diabetes can have an effect on your mind in more ways than one. "When your blood sugar is out of control, it has an effect on your cognitive function," says Patricia Stenger, R.N., a diabetes counselor and senior vice president for the American Diabetes Association. "You may have slower response time, and you feel sluggish and fatigued."

Adds Dr. Manley, "In effect, diabetes kicks you into a grief reaction, because you have lost something. Some people feel helpless and hopeless that their bodies somehow revolted against them. Some feel that they are no longer in control of their own destinies. They may lose belief, at least temporarily, that they are going to be okay at some point in the future. The disease begins to interact with their basic personalities."

A Bitter Sweet

Diabetes occurs when the body doesn't produce enough or properly use insulin, a hormone secreted in the pancreas that's needed to convert food into energy. Much of what we eat for energy is broken down into a sugar called glucose, the fuel that's fed into every single cell to keep us alive. The disease isn't caused by eating sweets, although people with diabetes must limit their sugar intakes because sweets can make blood sugar rise drastically.

In healthy people, glucose is automatically absorbed by cells. The body uses exactly what it needs and stores the rest. But without insulin to unlock a cell's receptors so that glucose can enter, excess amounts of this sugar accumulate in the bloodstream, where it can cause a host of problems. People with diabetes face five times the risk of stroke and two to four times the risk of heart disease compared with people who don't have the disease. One in ten sufferers develops kidney disease, and between 15,000 and 39,000 a year lose their sight because of the disease.

Subtle Trouble

There are two types of diabetes. With Type I (or juvenile) diabetes, which accounts for only 10 percent of cases, the body completely fails to produce insulin, so daily injections of this hormone are needed. Type I is often diagnosed during puberty, and the symptoms, which can mimic the flu, are sudden and very noticeable: extreme hunger and thirst, sudden weight loss and extreme fatigue and irritability.

In the more common Type II (or adult-onset) diabetes, which usually strikes women after age 45, the pancreas produces insulin, but not enough. There may be some symptoms--slow-healing cuts or bruises, recurring skin, gum or bladder infections or slight tingling or numbness in the hands or feet--but many women don't notice these subtle changes or simply shrug them off. And that's exactly why over half the women with diabetes are unaware of their condition. Diabetes is a subtle disease that just creeps up on people--and with devastating results, says Xavier Pi-Sunyer, M.D., professor of medicine at Columbia University in New York City and past president of the American Diabetes Association.

That's why it's important for you to get a blood screening for elevated glucose levels, especially if you have a family history of the disease, are overweight, are over age 40 or had a baby with a birth weight of over nine pounds. "People may be unaware that they have the disease because they feel fine," says Stenger.

Beating the Odds

"The best way to avoid diabetes is to watch your weight," says Lally. "That means eating a healthy diet that focuses on fruits and vegetables. Being overweight is the major risk factor for adult-onset diabetes. This is important for everyone but is essential if you have a family history of diabetes or had diabetes during pregnancy."

Even if you're among the 650,000 people diagnosed this year--that's one every 60 seconds--a healthy lifestyle may be all that's needed to get the upper hand on diabetes. Although some people with Type II diabetes require oral drugs or injections to stabilize their blood sugar, most can control the disease simply by adopting healthier lifestyles. By committing yourself to certain lifestyle changes, you may be able to reduce your need for medication--and possibly get off and stay off diabetes drugs for the rest of your life, says James Barnard, Ph.D., professor of physiological science at the University of California, Los Angeles. Here's how.

Share your feelings. Learning that you have diabetes can be quite a blow, and many women find comfort in sharing their experiences with others going through the same thing.

Meeting regularly with a support group can help you cope with the disease, mentally and physically; it's also a good way to beat depression. Call your local chapter of the American Diabetes Association for a list of support groups in your area.

Neutralize stress. Even if you're not worried about depression, studies by researchers at Duke University in Durham, North Carolina, show that when you're under stress, certain hormones are activated that pump stored glucose into your bloodstream. Conversely, stress management and taking time to relax improve glucose control, a significant factor for those with diabetes. While group therapy is one way to relax, others include meditation and yoga.

Eat right. That means low-fat and high-fiber, with at least five servings of fruits and vegetables a day, says Lally. For each extra 40 grams of fat eaten per day--the amount found in one fast-food burger and a large order of fries--your risk of developing diabetes rises threefold, and if you already have diabetes, you face a greater chance of complications, finds a study in the American Journal of Epidemiology. The problem: Dietary fat readily converts to body fat, and body fat induces cells to resist insulin, says Frank Q. Nuttall, M.D., Ph.D., chief of the Endocrine, Metabolic and Nutrition Section of the Minneapolis Veterans Administration Medical Center.

Meanwhile, try to consume at least 25 grams of fiber daily from complex-carbohydrate foods, which help put the brakes on glucose entering your bloodstream and also keep cholesterol low--important for people with diabetes, who face higher risk of heart disease. That's between two and three times what most Americans eat. The best sources of complex carbohydrates are potatoes, whole-grain breads, rice, pasta, legumes, oats and barley.

Time it right. "If you have diabetes, you need to eat every four or five hours," says Lally. Grazing is best, since large meals make it tougher for your body to meet the increased demand for insulin. The key is to evenly distribute your food throughout the day, so no single meal overwhelms the pancreas.

Avoid sugar and salt. It's a given that you should avoid sugar; even in tiny amounts, it can send your blood sugar sky-high. Of course, low sugar and low salt are good dietary rules for everyone to follow, but those with diabetes must be especially careful. Instead, satisfy your sweet tooth with artificial sweeteners such as aspartame (NutraSweet). But also be on the lookout for low-sodium or reduced-sodium products. Salty foods can raise blood pressure, a danger for people with diabetes.

Get your heart pumping. Regular aerobic exercise not only helps you control your weight but also makes cells more receptive to insulin. "You need to get your heart going and keep it going for at least 20 minutes," says Stenger. "You don't need to do anything fancy: a brisk walk is fine."

Meanwhile, researchers at Harvard University in Cambridge, Massachusetts, found that exercise is an excellent way to help prevent Type II diabetes. In their Physicians Health Study of 22,000 doctors, researchers noted that those who exercise at least five times a week lowered their risk of developing diabetes by more than 40 percent.

But people with diabetes need to exercise with care. "The main concern for exercise and diabetes is the risk of hypoglycemia, or low blood sugar," says Greg Dwyer, Ph.D., professor of physical education at Ball State University in Muncie, Indiana. To avoid this, he suggests sticking to a routine that requires the same amount of exercise at the same time daily.

Pump some iron, too. Weight lifting also plays a role in improving glucose tolerance, the body's ability to metabolize sugar properly, according to a study by researchers at the University of Maryland College Park and Johns Hopkins University in Baltimore. Check with your doctor before starting a weight-lifting program. Resistance training may cause surges in blood pressure.

Take vitamins E and C. These two antioxidants tend to be in short supply among people with diabetes--and Italian researchers have found that vitamin E helps improve the action of insulin. Good food sources include wheat germ, corn oil and nuts, but you should take a supplement containing 400 IU each day.

Meanwhile, because those with diabetes are prone to vascular disease, they may need to increase their intakes of vitamin C, suggests Ishwarial Jialal, M.D., assistant professor of internal medicine and clinical nutrition at the University of Texas Southwestern Medical Center at Dallas. The Recommended Dietary Allowance is 60 milligrams a day, but Dr. Jialal suggests a minimum of 120 milligrams of vitamin C daily, the amount you'd find in a guava or a glass of orange juice.

Pretend you have a headache. Aspirin can reduce the risk of heart attack and stroke among diabetes sufferers by as much as 20 percent, according to research conducted by the National Institutes of Health on 3,711 people with both types of the disease. "People with diabetes are much more likely to have cardiovascular disease, so the aspirin recommendation is even more relevant for them," says Frederick Ferris, M.D., chief of the Clinical Trials Branch at the National Institutes of Health in Bethesda, Maryland.

Most researchers recommend a daily dosage of one-half of an adult aspirin or one children's aspirin, but check with your doctor first: Aspirin therapy isn't suggested for people taking blood thinners or suffering from ulcers.