Diabetes
Diabetes
The Threat You Can Prevent
You sit all day at a desk. You ride home in a car or bus. Then you sit some more. In fact, the only time you get any exercise is on the way to bed--if your bedroom is upstairs.
Guess who's a possible candidate for diabetes?
If you're a woman whose lifestyle is so inactive that cleaning the house is an indoor sport and running for the bus an Olympic event, you could be putting yourself at risk for diabetes, and it could show up between age 30 and 45.
More than seven million American women have diabetes, about the same number as men. Five to 10 percent have Type I, or insulin-dependent, diabetes, an inherited disease in which the immune system attacks the pancreas and destroys its ability to make insulin, the hormone that transports sugar from food to your body's cells. This type of diabetes usually appears sometime in childhood or adolescence, but it also occurs in adults.
The remaining 90 percent have Type II, or non-insulin-dependent, diabetes, a disease in which the body cannot use all the insulin it produces. Type II has genetic roots, but it's often triggered in women by too much testosterone, the male sex hormone, or a sedentary lifestyle.
Testosterone is not a factor in the development of Type II diabetes in men, studies indicate, but high levels of it seem to double or even triple the risk among women. What's more, a study of 165 women at the University of Texas Health Sciences Center in San Antonio revealed that the more testosterone a woman's body produces, the more likely she is to develop diabetes.
At least half of the women with Type II diabetes don't know they have it, experts say. This is because its development can be insidious. Women can have vague Type I symptoms, such as unusual thirst, extreme hunger or frequent urination, before showing Type II symptoms, which can include blurry vision, frequent infections, cuts and bruises that are slow to heal or tingling or numbness in the hands or feet. The warnings are often so subtle that even doctors can overlook them. Also, some blood tests used to identify the disease frequently fail to detect it.
This failure can be dangerous, since a woman with diabetes has 6 times the risk of heart attack as a woman who does not have it. She also has nearly 20 times the risk of kidney failure, nearly 5 times the risk of stroke and 3 times the risk of death.
Metabolic Mayhem
Diabetes is a disease that forces your body to starve when it's full of food.
Normally your body takes last night's dinner or this morning's breakfast and turns it into a sugar called glucose. Then it dumps the glucose into your blood, where it teams up with insulin secreted by your pancreas. The insulin carries glucose into your muscles and organs, where it provides the energy for everything you do.
A drop in available insulin or the body's resistance to using that insulin can cause metabolic mayhem. With diabetes, glucose builds up in the bloodstream because it's unable to gain admission to muscles and organs. It wears on the heart, kidneys and eyes and then it flows into the bladder and passes out of the body--leaving behind damaged organs starved for fuel.
Left too long in this situation, the body powers down: Symptoms you may have attributed to stress or growing older can, if unheeded, escalate into the complications of diabetes--heart disease, stroke, blindness or kidney failure.
How to Cut Your Risk
Both forms of diabetes can be treated with a smorgasbord of custom-tailored diets, exercise, insulin injections and other medications. But these treatment strategies sometimes fail to prevent the degenerative problems that go with diabetes.
That's why prevention is so important, says Maureen Harris, M.D., Ph.D., director of the National Diabetes Data Group at the National Institutes of Health in Washington, D.C. Here's what you can do.
Get an early warning. Type II diabetes doesn't emerge as a full-blown problem overnight, says Wendy Kohrt, Ph.D., research assistant professor of medicine at Washington University in St. Louis. It generally evolves over a period of years and can be detected in its earliest stages by a blood test that reveals whether your body is beginning to have trouble using insulin.
Lose weight. "The higher your weight, the higher your risk of diabetes," says Richard Hamman, M.D., Ph.D., professor of preventive medicine at the University of Colorado School of Medicine in Boulder. "If you're 150 percent of your ideal body weight, your risk is probably three to four times higher than normal. If you're 200 percent of your ideal body weight, your risk is probably six to eight times higher than normal."
But you especially need to lose weight if your body is shaped like an apple--thick in the middle--he adds. Why? Because "the fat in that region is different from other fat in two respects. First, it's metabolically more active, which means it's stored and mobilized more readily," says Dr. Kohrt. Second, that fat is in an area drained by a major vein that picks up the fat's metabolic by-products and takes them to the liver. There they give the liver a false message--that fat is being mobilized because the body is starving. But the liver doesn't know the message is false, so it responds by churning out an emergency ration of glucose into the bloodstream.
"That begins a vicious cycle that just keeps going," says Dr. Kohrt. More glucose in the blood makes the pancreas dump in more insulin. More insulin causes the liver to generate more glucose. More glucose makes the pancreas dump more insulin. Eventually the whole system breaks down, says Dr. Kohrt. Your body will either shut down insulin production or the muscles and organs will refuse to accept it. Either way, you've got diabetes.
When Pregnancy's the Problem Pregnancy is a time of great adjustment for a woman and her body. Raging hormones cause nausea, fatigue, physical change and an abundance of emotions--all part of a healthy, normal pregnancy. But these same hormones can bring on diabetes in a woman who has never before been diabetic. This condition is known as gestational diabetes. When a woman has gestational diabetes, one of the hormones affected by pregnancy is insulin, according to Helen Kay, M.D., a specialist in maternal/fetal medicine and associate professor of obstetrics and gynecology at Duke University in Durham, North Carolina. Insulin is produced by the pancreas and influences the way your body absorbs blood sugar, or glucose. Normally, your digestive system converts food into glucose and sends it into the bloodstream, while insulin helps it get into cells to power the body. When a pregnant woman has gestational diabetes, however, the fetus takes the glucose from its mother's bloodstream, leaving high levels of insulin behind. High levels of insulin trigger a reaction: The mother's body "reads" that high insulin concentration as a sign of too much glucose and then responds by producing even more insulin. With lots of insulin and little glucose, the result is a diabetic state. The mother's diabetes also affects the newborn, notes Yvonne S. Thornton, M.D., professor of clinical obstetrics and gynecology at Columbia University College of Physicians and Surgeons in New York City and director of perinatal diagnostic testing at Morristown Memorial Hospital in New Jersey. All babies have a drop in blood sugar after birth, but in babies born to diabetic mothers, the drop is far more severe. "When you cut that umbilical cord at birth, then--boom!--you're significantly decreasing the glucose flow to the baby," says Dr. Thornton. "That's when you have babies with dangerously low blood sugar." Women who develop gestational diabetes have different risks than women with diabetes who become pregnant. Those who develop diabetes during pregnancy tend to have chubbier babies and a higher incidence of unexplained stillbirths. They are also at greater risk for developing pregnancy-related high blood pressure, a condition known as preeclampsia. Women with diabetes who become pregnant, on the other hand, tend to have smaller babies. They have greater risk of birth defects and maternal and fetal death. Here are some ways to minimize the chances of developing gestational diabetes, or reduce its effects. Eat for one. "The woman who starts to gain a lot of weight is more inclined to develop gestational diabetes," says Dr. Thornton. "The American College of Obstetrics and Gynecology says you should gain around 35 pounds. But I'll tell you, if you aim for 25, you'll gain 35." Despite the old story about eating for two, you really need only 300 extra calories a day through the second trimester and 500 in the third. Eat beans. Studies indicate that folic acid, a nutrient that all women need, may prevent the neural tube defects that can occur when diabetes is uncontrolled, says Dr. Kay. (Researchers have found that folic acid helps prevent the overall incidence of spinal defects in the fetus, whether or not the woman has diabetes.) Good sources are beans; ½ cup will give you more than half of the Recommended Dietary Allowance for pregnant women, which is 400 micrograms a day. Get tested. Ask your obstetrician to test you for diabetes between the 24th and 28th weeks of pregnancy, says Dr. Kay. Usually you'll be asked to drink a glucose solution that tastes like "a flat cola," then you'll be given a blood test to measure glucose levels an hour later. If that test shows high levels of glucose, you'll be asked to come back for a second test that measures glucose levels over a three-hour period. Exercise tight control. If your glucose level is high, your doctor or nutritionist will probably prescribe the American Diabetes Association diet in an attempt to control it, says Dr. Thornton. "If the diet fails and your blood sugar remains high, you'll have to get insulin injections three or four times a day and follow the diet."
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Cut dietary fat. As you start to lose weight, pay particular attention to the amount of fat in your diet, says Dr. Hamman. That's because, independent of its effect on weight, dietary fat seems to increase the risk of diabetes.
Doctors and other experts recommend that you limit your daily diet to less than 30 percent of calories from fat. You can aim for this by limiting your intake of meat, always removing skin from poultry, avoiding processed foods and drinking low-fat milk. (For more tips on following a low-fat lifestyle, see page 393.)
A Disease That Lasts a Lifetime Kate Sullivan is a mother and part-time public affairs officer for the National Kidney Foundation in Philadelphia. She has lived with Type I (insulin-dependent) diabetes since she was born. This is her story. You know, there is absolutely no aspect of my life, no memory, that isn't completely permeated by this disease. Diabetes was in my consciousness from before I was really able to think. And I suspect it's influenced me in a number of ways because so much of the disease is a minute-to-minute type of management. If you're out of control there's always the chance that you could lapse into a coma--you know, the ten-seconds-from-now-you-could-be-dead kind of thing. My mother started giving me the responsibility for handling the disease when I was about eight years old. I remember the first time that I tried to give myself an insulin shot. I really had to sit there and kind of psych myself into it. And this was just injecting into the top of my leg, which isn't really a big deal. But it was very difficult. I know I found the routine of having to test my urine and record it on a little colored chart extremely tedious and I cheated as often as I possibly could get away with it. I think every kid in the world does. Long before blood-testing and even before they came up with those handy little dipsticks for urine testing, we used a little chemistry set with little glass test tubes and these little tablets that would dissolve in water. They came in little foil packets. You had to put so many drops of urine and so many drops of water into the test tube, then put the little pill in and watch the whole thing fizz up and watch for what color it turned. I also had a metal needle that attached to a glass syringe which came apart. Every morning we boiled all three parts inside a strainer which was inside a saucepan on the stove. What kept me doing it? We had a neighbor who lived around the corner who had diabetes. He was minus a foot. And through the years gangrene started to claim parts of his leg. So every time I would see him, you know, he would have less of one leg. And my mother kept saying, "Well, that's a diabetic just like you." You want to talk about keeping a little kid in line? I mean, I want to live. I don't want to forever be the kid with her nose pressed up against the candy store window looking at the kids inside. It's only as I've become an adult and looked back on this that I realize that my generation is really the first generation to survive--to get not only to adulthood but to start to get into some of the problems that the middle-aged and aging population normally face. Before, doctors never had to worry about diabetes and heart disease because diabetics never got old. So it's our observations and our experiences that are going to form the body of information for the generation that comes behind us. It's scary because there's no blueprint. On the other hand, thank God I'm in this generation and not the one before it.
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Get physical. "Women who are sedentary probably have a 25 to 40 percent increased risk of diabetes compared to women who are more active at the same weight," Dr. Hamman says.
"Active is walking to the corner grocery rather than driving," Dr. Kohrt says. "It's taking the dog for a one- or two-mile walk instead of putting him outside in a fenced-in yard. It's going up three or four flights of steps rather than taking elevators." It's doing these things every day.
The result? "If you have a 180-pound woman who loses weight--I mean down to her ideal weight, which is very hard to do--maintains it, decreases her dietary fat and increases her physical activity, I suspect she would cut her diabetes risk fivefold," says Dr. Hamman.
