Type 2 Diabetes: The Choice is Yours

The statistics for type 2 diabetes are staggering. There are about 20 million Americans with type 2 diabetes, a high sugar condition caused by poor nutrition, being obese, and a lack of exercise—factors that can all mostly be prevented.

About two-thirds of the people with type 2 diabetes have been diagnosed, which leaves about 6 million people walking around with undiagnosed diabetes. That’s a huge number of people who have a very serious disease and don’t know it. And that makes type 2 diabetes, like hypertension, another silent killer.

Unlike type 1 diabetes, type 2 diabetes is not a failure of the pancreas, but an inability to produce adequate amounts of insulin for a body that is out of control. On top of that, the insulin that is being produced is not acting the way it should, a situation called insulin resistance that occurs when the insulin can no longer stimulate the cells to process the sugar in the blood. This causes the sugar to build up in the blood, ultimately doing damage to the heart, eyes, and kidneys, and creating small-vessel disease.

Type 2 diabetes is now an epidemic, and if not corrected in this generation, it will probably be responsible for most of the strokes, hypertension, and cardiovascular disease that we will encounter in our sixties and seventies. Type 2 diabetes is especially common among African Americans, Latinos, Native Americans, and certain Asian populations.

Most people develop type 2 diabetes because they are overweight. Basically the human body does two things: it takes in calories, and it burns calories. When you consistently bring in more calories than you burn off, all those extra calories turn into fat. That fat first gets stored in the abdomen and the intestines, and then it begins to infiltrate the muscle mass of our body. And what you end up with looks very much like a marbleized piece of sirloin that you see at the butcher shop. That marbleization is one of the hallmarks of people with type 2 diabetes.

If you keep piling on the extra calories, the pancreas, whose function begins to slow down anyway with age, is no longer able to meet the demand for large quantities of insulin needed to metabolize all that sugar in the blood.

If you were to lose weight, a significant amount of weight, I mean, your type 2 diabetes could disappear almost overnight. Yes, it’s that simple. I, myself, was a diabetic. I had very elevated sugars. I was overweight, excessively stressed, and exercise-phobic. I had a very clear, black-and-white case of type 2 diabetes. So I lost 50 pounds; I now exercise three times a week, and I’ve maintained that weight loss.

Today, I am no longer diabetic. If, like me, you have not had type 2 diabetes for very long, and if you can overcome it by simple weight loss, you will end up with no permanent damage to your organs.

If you have any choice in the matter, diabetes is a road you don’t want to go down. Just to give you an idea, here are a few numbers:

–Heart disease from diabetes accounts for 65 percent of deaths in diabetics.

–The risk of stroke is two to four times higher in diabetic patients than in nondiabetics.

–Seventy-three percent of adults with diabetes have hypertension.

–Diabetic retinopathy, which is damage to the vessels of the retina, creates about 24,000 cases of blindness in America every year.

–Diabetes is the leading cause of kidney failure.

–One-third of people with diabetes have gum disease.

–About 10 percent of pregnant women who are diabetic may experience a spontaneous abortion or have children with major birth defects, including spina bifida.

–About 82,000 people lost a foot or a leg last year because of diabetes.

The list of damage diabetes does to the body is virtually endless. If you are a diabetic, you must learn to prevent complications and stay ahead of the game. Being a diabetic is a full-time job, and there are several measures you will have to take to ensure you keep your health on track.

You will constantly have to monitor your cardiovascular risks by monitoring your blood pressure and keeping it under control.

You will have to watch your cholesterol levels.

You will have to visit your ophthalmologist regularly to ensure you don’t development retinopathy.

You will need very comprehensive dental and foot care.

But, most important, you will have to monitor and control your sugar levels. Several times a day you must take a glucose reading either by using Accu-Chek or doing a finger prick. You will look at your morning sugar and at your sugar two hours after you eat. For the most part you want your morning sugar to be less than 100 milligrams per deciliter, and you want your postdinner values, usually two hours after you eat, to be 120 and 130 milligrams per deciliter.

If your sugar is high, you will need either to inject yourself with insulin or to take an oral hypoglycemic. This kind of supply-and-demand treatment model may soon give way to more convenient methods, made possible by new research into diabetes. Devices are now being developed in which a sensor that continuously monitors your sugar levels triggers a tiny pump when your blood sugar is elevated to release small doses of insulin.

Other new research is focusing on the possibility of transplanting the pancreatic cells, called isolet cells, into those who need them, in the hope of restimulating insulin production inside their body and minimizing the amount of insulin that needs to be injected. The hope is that this research will one day lead to a cure, whereby insulin will once again be naturally produced in the body. But as of right now, diabetes is not cured; it is treated.

Diabetes can be managed. Ultimately, if you’re talking about juvenile diabetes and you start very early in the game by getting diagnosed and getting effective treatment, you can probably expect a normal life expectancy, but it’s a very dedicated type of life.

If you are now in your forties and you develop type 2 diabetes, and you continue for a decade or more without any checks and balances, it’s very unlikely that you’ll make it into your late seventies or eighties. There’s just not enough time in the pot. In other words, if you are 40 years old, 50 or more pounds overweight, with high blood sugar levels and high cholesterol, and you don’t exercise and you don’t watch what you eat, you will without doubt see the effects 10 to 15 years from now.

By the time you’re in your sixties, you will most likely have hypertension, stroke, and cardiovascular disease. Don’t go there.

Sweet Questions

“I’m a fifty-five-year-old woman with two married daughters. We all have a sweet tooth in our family, and I’m worried that we might all become diabetic. Can people who eat a lot of sweets become diabetic?”

No. If you exercise and for the most part follow a balanced diet, you can like sweets and not become diabetic.

“Can people with diabetes eat sweets?”

If it’s part of a healthy lifestyle involving a good diet and exercise, a diabetic can eat sweets.

“Can you catch diabetes from someone else?”

No, though some people think they can. Diabetes is probably largely a matter of genetics for Type 1 and lifestyle factors for Type 2.

“Are people with diabetes more likely to get colds or other illnesses?”

No. Your immune system is not compromised when you have diabetes. However, people with diabetes should get regular flu shots because any infection can interfere with blood-sugar management.

Stroke: Know the Signs, Save Lives

Your heart is not the only potential victim of cardiovascular disease. Your brain can be, too. Stroke is a type of cardiovascular disease that affects the arteries leading to and within the brain. A stroke occurs when the blood vessels that carry the oxygenated blood and nutrients to the brain are either blocked by a clot or break.

This prevents the brain from getting the oxygen and nutrients it needs, and within minutes to a few hours brain cells begin to die. Every 45 seconds someone in the United States has a stroke, and every three minutes someone dies of stroke. That’s about seven hundred thousand strokes a year, of which about 160,000 result in fatalities.

I can’t stress enough how important it is to learn how to recognize the symptoms of stroke because it can save your life or the life of someone you know. The most characteristic symptom is a sudden numbness, weakness, or paralysis of the face, arm, or leg, usually on one side of the body. Other symptoms include loss of speech or trouble talking, blurry vision, double vision, decreased vision, dizziness, loss of balance and coordination, an out-of-the-blue bolt of pain, headache, vomiting, or altered consciousness and disorientation or memory loss. Usually these symptoms strike suddenly and without warning.

It is important to recognize the signs and symptoms of stroke because every minute counts when it comes to treating one. The longer a stroke goes untreated, the greater the damage and potential disability. So if you have any of the signs and symptoms of stroke, it is important to get help immediately.

Eighty percent of strokes are ischemic, which means they are caused by an obstruction from a blood clot or particle of cholesterol plaque that reduces the blood flow to the brain. The brain cells die within minutes of this happening. There are two types of ischemic stroke. Thrombotic strokes are caused by clots that originate in the arteries that supply the brain, like the neck arteries, or the arteries within the head itself. Embolic strokes originate from blood clots that form away from the heart but are swept up through the bloodstream and into the narrow arteries of the brain.

The other 20 percent of strokes are hemorrhagic; they occur when a blood vessel in the brain leaks or breaks. The most common risk factor for hemorrhagic stroke is uncontrolled hypertension, though it can also be caused by an anatomical weakness of the blood vessel itself, that is, an aneurysm, or by an abnormal connection of the arteries and veins in the brain.

There are several risk factors for stroke.

People who have transitory ischemic attacks—a temporary halt to the flow of blood to the brain—have a ninefold increase of developing a full-blown stroke. At higher risk are those who have a family history of stroke, are older (the older we get, the greater the chance of stroke), and are African American, partly due to the high prevalence of high blood pressure and diabetes among the black community.

Other factors include hypertension, high cholesterol, cigarette smoking, diabetes, obesity, cardiovascular disease, and high homocysteine levels. Homocysteine is an amino acid in the blood, and people with elevated homocysteine levels have a higher risk of stroke. Women taking birth control pills or hormone replacement therapy may also be at higher risk for stroke.

The good news is that there actually are some things you can do to avoid being a victim of stroke. Even though you cannot do anything about your race, your sex, your family history, or your age, since cardiovascular disease and stroke go hand in hand, you certainly can look at your risk factors for heart disease and hypertension and focus on early screening.

Get your blood pressure checked; learn what your body mass index is; and check your cholesterol and glucose levels every two to five years.

Exercise, manage your stress, limit your alcohol consumption, don’t smoke, and stay away from foods with saturated fats.

Take a vitamin B complex, like B6, B12, and folic acid, which are essential in helping to reduce the levels of homocysteines in the body.

Don’t take illicit drugs, like cocaine, which may trigger a stroke.

People with risk factors for stroke should consider a brain-healthy diet that includes several servings daily of fruit and vegetables with nutrients rich in potassium, folate, and antioxidants. Eat foods high in soluble fiber, like oatmeal, to help reduce cholesterol, as well as foods rich in calcium and soy that help reduce your bad cholesterol and raise your good cholesterol. Foods rich in omega-3 fatty acids, which include, of course, plant oils, salmon and other cold-water fish like tuna, are also good weapons in the battle against stroke.

When it comes to the treatment of strokes, some hospitals have actually established special stroke emergency rooms that are manned by a multidisciplinary team well versed in their diagnosis and treatment. Whoever the doctor is, however, he or she must first determine the type of stroke and its location before treating it.

A wide variety of diagnostic tests are available to the doctor, and they all fall into one of three categories: imaging tests, which provide a better-than–X-ray picture of the brain; electrical tests, which record the impulses in the brain; and blood flow tests, which show any problem that may be causing changes in blood flow to the brain.

Essentially, all emergency room doctors will attempt to improve and restore blood flow to the brain of a stroke victim. One way to do that is by injecting a clot-bursting drug, or thrombolytic, that helps dissolve the clot. Other techniques include performing a surgical procedure such as a carotid endarterectomy, in which the surgeon opens the carotid arteries and removes the plaque from them, or angioplasty, in which a balloon-tipped catheter dilates the arteries to improve the blood flow.

Once a stroke has been diagnosed and treated, most individuals end up taking preventive medicines to minimize the chances of recurrence. Some may receive antiplatelet drugs to make platelet cells in the blood less sticky and less likely to form a clot, or anticoagulants, which again prevent the blood from clotting. In cases of hemorrhagic stroke, where a blood vessel has ruptured, surgical intervention is needed to minimize further bleeding by clipping, cauterizing, or removing the clot and any vessel that is actively bleeding.

Stroke survivors must cope with a life-changing experience. They are often significantly disabled and, as a result, need a strong support system. Usually the support system is a team of rehabilitation doctors, which might include a psychiatrist, a dietitian, an occupational therapist, a physical therapist, a speech therapist, and social workers.

A stroke victim has to deal with impaired movement, which has implications for walking, balancing, speaking, swallowing, and breathing; bladder and bowel dysfunction; and diminished sex drive—as well as all the emotional issues that result from those problems. A stroke victim’s family is also profoundly affected because they now have to take part in caring for the individual.

Stroke can change your life completely, so learn to recognize it and treat it urgently to minimize the terrible disabilities it can inflict on its victims.

The Other Victims of Stroke

The obvious result from a major stroke is devastating disability—such as speech impairment, weak hand and leg movement, and depression. But a stroke can also have an indirect effect on the health of the victim’s family and friends.

Imagine a very strong and vibrant man who has never been sick, who has been a good husband and provider, who has been a great father. His family, and especially his wife of 45 years, marveled at his strength. He was healthy and looking forward to a peaceful and blessed retirement. Then one day he suffered a major stroke, which left him unable to speak and walk. For the family, the confusion and shock were intense. How could this have happened?

This is not a fictional story. It happened in my family. When I first met my future father-in-law, I never imagined that one day his life would end up in such a way. However, this same scenario is played out over and over again in many families across the United States and around the world.

All of a sudden, responsibilities that were the stroke victim’s are now delegated to other members of the family, and in some cases the majority of the responsibilities falls on the spouse. From everyday things like shopping or paying bills to new responsibilities like making daily trips to the rehabilitation center; feeding, bathing, and keeping up with all the medications; and becoming a motivational guru.

All of this can have a tremendous impact on the caregiver’s health. Suddenly, what was once an ordinary life becomes an extraordinary one burdened by the pressure and eased by the love for the ailing family member. We doctors sometimes forget about the families, and that’s a big mistake. When dealing with stroke survivors, focusing on the family as a whole is always important. We must listen, support the changes that are needed, and monitor stress and the effect that it has on the people taking care of stroke survivors.

Family members take care of one another; they become the pillars of health care in the home and improve the outcome that any therapy in the hospital could bring. I remember the look of my mother-in-law as she dealt with her husband’s disabilities, a look of love, duty, and compassion. But we must always make sure that, as we take care of others, we take care of ourselves.

If you don’t take care of your own health, you may very well end up being unable to take care of the person you love. So stay healthy. They don’t say “in sickness and in health” for nothing.