dLife Bookshelf

This material is from The 7 Step Diabetes Fitness Plan (© 2006 Sheri R. Colberg) by Sheri R. Colberg, PhD. For more information or to order this book, please visit www.shericolberg.com.

Introduction

Ignorance Is Not Bliss

Americans are undeniably getting heavier by the minute. Maybe you also find yourself lamenting about your ever-increasing body weight, but wonder if all that extra fat means that your health will invariably suffer. The answer is that it depends. Many people who put on too much fat also suffer from other health problems, including diabetes. In fact, a diabetes epidemic is currently sweeping the nation – and the world.

More than 90 percent of people developing diabetes are developing type 2 diabetes, characterized primarily by insulin resistance, or an inability of the hormone called insulin to work effectively to keep blood sugars (referred to throughout this book as blood glucose, or BG) in check. Although a minority, the people with type 1 diabetes which is caused by their bodies’ own destruction of insulin-producing beta cells in the pancreas (essentially autoimmunity triggered by an environmental cause), can also develop an insulin-resistant state that makes their diabetes harder to control. Of late, a new type of diabetes – unofficially known as type 1.5 diabetes, or “double diabetes” – has been emerging; it has characteristics of both type 1 (autoimmunity) and type 2 (insulin resistance) diabetes, making it difficult to make an accurate initial diagnosis is all cases.

If you are reading this book, that means either diabetes or a pre-diabetic condition (characterized primarily by insulin resistance, with a closer-to-normal BG level) has already happened to you or someone you know or care about. Perhaps your doctor recently told you that you have type 2 diabetes, which is frequently diagnosed by a fasting BG level of 126 milligrams per deciliter (mg/dl) or 7.00 mmol/l) or above first thing in the morning, or perhaps your sugars have been hovering in the prediabetic range (100 to 125 mg/dl, or 5.56 to 6.94 mmol/l, prebreakfast) as your body weight has been creeping up. You may want to blame the half-dozen glazed doughnuts or that triple-fudge sundae you just ate, instead of diabetes or prediabetes for a passing BG reading of 200 mg/dl (11.11 mmol/l), but you can’t. The reality is that regardless of what you eat, your BG level will never spike above 140 mg/dl (7.78 mmol/l) if you don’t already have one of these health conditions.

A doctor may have already advised you to lose some weight to better control your BG, but is losing weight the only solution? If it is, then most people are out of luck. The reality is that only a fraction of the millions of dieters – with or without diabetes – succeed in losing weight and keeping it off permanently. Obesity and diabetes are currently overtaking our nation. Two-thirds of American adults are considered overweight or obese, and that number is rising fast, particularly among younger adults and youth, based on their body mass index (BMI).

Even more alarming is the fact that children born nowadays have a one-in-three chance of developing diabetes in their lifetime, and for many minority groups, the risk is close to a whopping 50 percent. More than 20.8 million people in the United States already have diabetes, and the projected number of Americans with diabetes by 2030 is over 30 million. That’s an overwhelming number of Americans with diabetes, and that doesn’t even include the more than 40 million insulin-resistant, prediabetic people who have a strong potential for developing it. Moreover, among the nearly 370 million cases of diabetes projected worldwide by 2030 (up from 170 million in 2000), the United States lags behind only India and China, two countries with much larger populations.

Why should you worry about diabetes?
As many as a third of the people who have diabetes don’t even know it. So, is ignorance bliss? Absolutely not, because you can’t fight back against diabetes – or even prediabetes – unless your condition and ready to do something about it. Having diabetes is definitely something to worry about.

Diabetes has the potential not only to rob you of, on average, more than 12 years of your life, it can also dramatically reduce your quality of life for more than 20 years. Diabetes can result in compromised physical capacity, partial limb amputations, loss of mobility, chronic pain, blindness, chronic dialysis, and heart disease. For women, the reality may be even worse: 38.5 percent of average females born in the year 2000 or later are predicted to develop diabetes; diabetes will cut short the lives of these women by 14.3 years if they are diagnosed by the age of 40 and lower their quality of life for 22 of the years they do live.

Our current national health problems are irrefutably serious. In fact, the generation of Americans now being born is the first ever predicted to die before their parents. If you or your kids have diabetes, you have twice the risk of dying compared to anyone without the disease, and if you’re younger when diagnosed with diabetes (age twenty-five to forty-four), your risk is almost four times as high as your nondiabetic counterparts. Diabetes is the sixth leading cause of death in the United States, based on death certificates listing it as the cause. However, these statistics belie its significant negative impact on longevity, as many death certificates list diabetes only as a contributing cause of death; still more fail to mention it at all. For instance, is someone with diabetes dies from a heart attack, the death certificate may not even list diabetes as a cause or contributor, even though it is well documented that poor control of BG levels accelerates the blockage of coronary arteries, which leads to heart disease. A newly released study from the World Health Organization found that diabetes kills more people worldwide than was previously suspected: it is currently the cause of 3.2 millions deaths per year, or 6 deaths every minute.

Heart disease is the leading cause of death in people with diabetes. In fact, if you have diabetes, you now have the same risk of having a heart attack as someone without diabetes but with known heart disease who has already had at least one coronary event. Many undiagnosed people with type 2 diabetes actually first learn of their condition shortly after having their first heart attack. It is likely that they have already had undetected diabetes for a number of years, long enough f or it to cause significant damage. Plaque buildup in the coronary arteries begins in childhood. In adulthood, the heart disease process continues, and when commonly coexisting health issues such as high blood pressure and elevated blood fats are also present, plaque formation is further accelerated. Moreover, almost three-fourths of adults with diabetes have high blood pressure (an average reading of above 130 over 90), which may or may not be effectively controlled with medications. Insulin resistance itself may be even more important to control than BG levels to reduce your risk of a heart attack.

Diabetes is also well known for its damaging effects on the eyes, kidneys, and nerves, which can significantly lower quality of life. Poorly controlled diabetes is the leading cause of new cases of blindness among adults, and proliferative diabetic retinopathy (one form of diabetic eye disease) alone causes tens of thousands of new cases of blindness each year. In addition, diabetes causes six other eye diseases, including glaucoma, cataracts, and neuropathy of the optic or eye muscle nerves. Diabetes is the leading cause of new cases of end-stage kidney disease, treatable in the short term with dialysis and in the long term only with kidney transplants. As for damage to the nervous system, 60 to 70 percent of diabetic individuals have mild to severe nerve damage, including impaired sensation (numbness) in their feet or hands, gastroparesis (slowing of the digestion of food), carpal tunnel syndrome, hypoglycemic unawareness (loss of ability to sense low BG levels), and orthostatic hypotension (severe dizziness when standing up). The majority of toe, foot, and lower limb amputations, or more than 40,000 amputations annually, also occur among people with diabetes. As if all this weren’t enough, diabetes is also the cause of increased incidence of periodontal (gum) disease and the greater incidence of birth defects in infants born to mothers with poorly controlled BG levels.

The point of discussing the more negative aspects of diabetes is not to depress or scare you, but rather to convince you that your primary goal should be to prevent, reverse, or effectively control insulin resistance and BG levels so that you can prevent these complications from ever happening to you. The good news is that they are almost entirely preventable with good BG control. An added bonus is that the majority of the same strategies used to control diabetes and it complications will also reverse a prediabetic state and potentially prevent diabetes from ever happening to you in the first place.

The problem with current diabetes care, however, is that most people never achieve or maintain optimal control over their BG levels (“optimal” means average BG in a normal or near-normal range, or a glycated hemoglobin level of no more than 7 percent). In fact, according to a recent report, only 37 percent of people in the United States with diagnosed diabetes ever achieve this level of control, and as many as a third of the others are still unaware of their condition and the damage it is already causing to their bodies.