Recent Advances Help In The Management Of Diabetes

November Is Diabetes Awareness Month

A diagnosis of diabetes is never easy. First, there is the realization you are confronting a potentially life-threatening disease.

Then comes instruction that you should pay close attention to your diet, exercise routine, medication, and insulin levels. If you do so faithfully, you can keep such complications as heart and kidney disease, nerve damage, and blindness at bay.

Yet several advances in recent years - ranging from better blood sugar monitoring devices to solid research showing that a healthful diet and regular exercise offer great benefits - have eased the burden of managing the disease.

That is a message health experts will share during November, which has been designated Diabetes Awareness Month.

While the cause of diabetes remains under study, physicians know it is triggered by the body's inability to produce or properly use insulin - a hormone needed to convert sugar, starches, and other food into energy for cells.

About 17 million people in the US have diabetes, according to the American Diabetes Association (ADA), although one-third of them are unaware they have it.

Of those 17 million, about 5 percent to 10 percent have type 1, previously called juvenile diabetes, while the remainder have type 2 diabetes.

In type 1 diabetes, the body does not produce insulin. This requires people to inject insulin daily to survive and to keep their levels of blood sugar - called glucose - under control.

If glucose levels get too high, it increases the risk of complications such as blindness or kidney problems.

In type 2 diabetes, the body does not make enough insulin or the cells do not process the insulin. These individuals are advised to lose excess weight, eat a healthy diet, and exercise regularly. Some are put on oral medication or insulin to manage blood sugar levels.

Monitoring Improves with New Technology

In years past, diabetics had just one choice for measuring their blood sugar - pricking their finger or forearm with a special needle called a lancet to get a drop of blood, then placing the blood on a test strip to be read by a monitor.

But in the past few years, advances in blood glucose monitoring devices have made the task much less of a nuisance, says Dr. Gerald Bernstein, past president of the ADA and an associate clinical professor of medicine at the Albert Einstein College of Medicine in New York City.

"The major advance is the fact that you need much less blood," Dr. Bernstein says. "And it's less painful."

And most monitors now give you a reading very quickly, down from about a minute's wait to only five seconds. That time savings can add up in the course of a day, especially if someone needs to test their blood six to 10 times daily.

The time difference "makes a substantial difference to people," Dr. Bernstein says.

Another advance: The GlucoWatch. This wristwatch-like glucose monitoring device was approved by the US Food and Drug Administration for adult use in 2001 and for children and teens in 2002. It works by extracting fluid through the skin and measuring the glucose in the fluid. It can produce up to six painless measurements each hour for 13 hours.

"I don't recommend it for everybody," says Dr. Lyle Mitzner, an endocrinologist and diabetes specialist at The Joslin Diabetes Center in Boston.

Typically, he will recommend it for some patients with type 1 diabetes because they tend to have more fluctuations in blood sugar. But he sometimes will advise a type 2 patient to try it, too, if he or she is having trouble controlling blood sugar levels.

Standard Medications Are Tried and True

Drs. Bernstein and Mitzner agree there have been no major advances recently in diabetes medication, with insulin or oral medications prescribed as they have been for years.

Oral medications work in a number of ways, such as stimulating the pancreas to produce more insulin, Dr. Bernstein says.

A newer option to insulin injections or oral medication is the insulin pump. The beeper-sized device continuously delivers insulin to the body through a flexible tube, and can be programmed to deliver an extra dose at meal time.

There is universal agreement among experts on the role that lifestyle can play in managing - and helping to prevent - the disease.

In 2001, a major study called the Diabetes Prevention Program was stopped early because it found the benefits of lifestyle changes, such as losing weight and exercising, were overwhelmingly positive. It looked at 3,234 people with a condition called impaired glucose tolerance, which often precedes diabetes.

The researchers compared lifestyle changes to drug treatment with an oral diabetes medication and with placebo (inactive substance) pills.

While 29 percent of the group taking placebo pills developed diabetes during the study's three-year follow-up, only 14 percent of the lifestyle group and 22 percent of the medication group did.

This led the researchers to conclude that lifestyle changes can delay or even prevent diabetes.

The best advice, Dr. Bernstein says, is to keep your weight down.

"Maintain as close to an ideal body weight as possible," he says. That means keeping your body mass index (BMI) - a measure of height to weight - below 25, considered the cutoff for a healthy weight.

A man or woman who is 5-foot-5 and weighs 150 pounds has a BMI of 25.

Regular exercise is also crucial, and Dr. Bernstein tells people it can be as simple as walking every day or every other day for 30 minutes at a time.

In the future, Dr. Bernstein says, there may be alternate ways to deliver insulin. One system under review is inhaled insulin, in which a portable device contains a powdered mist of insulin.

Another possibility is a device that looks like an asthma medication inhaler that would let people breathe in insulin. They would probably use it before each meal to control blood sugar levels, says Dr. Bernstein.

Always consult your physician for more information.

Online Resources

American Diabetes Association

Centers for Disease Control and Prevention (CDC)

Diabetes Care

National Diabetes Education Program

National Institute of Diabetes & Digestive & Kidney Diseases (NIDDKD)

National Insitutes of Health (NIH)

National Library of Medicine, at NIH 

In This Issue:

Recent Advances Help In The Management Of Diabetes

Monitoring Improves with New Technology

Standard Medications Are Tried and True

US Statistics on Diabetes

Who Should Be Tested?

Online Resources

Other Resources:

Find a St. John's Mercy Physician

Diabetes Services at St. John's Mercy

Diabetes Health Information

St. John's Mercy Classes and Programs

In Other Diabetes Health News:

US Statistics on Diabetes

The National Diabetes Information Clearinghouse of the National Institutes of Health (NIH) reports the following:

Non-Hispanic Caucasians: 11.4 million. 7.8 percent of all non-Hispanic Caucasians have diabetes.

Non-Hispanic African Americans: 2.8 million. 13 percent of all non-Hispanic African Americans have diabetes. On average, non-Hispanic African Americans are two times more likely to have diabetes than non-Hispanic Caucasians of similar age.

Hispanic/Latino Americans: 2 million. 10.2 percent of all Hispanic/Latino Americans have diabetes. On average, Hispanic/Latino Americans are 1.9 times more likely to have diabetes than non-Hispanic Caucasians of similar age. Mexican Americans, the largest Hispanic/Latino subgroup, are two times more likely to have diabetes than non-Hispanic Caucasians of similar age. Similarly, residents of Puerto Rico are two times more likely to have diagnosed diabetes than US non-Hispanic Caucasians. Sufficient data are not available to derive more specific current estimates for other groups.

American Indians and Alaska Natives who receive care from the Indian Health Service (IHS): 105,000. 15.1 percent of American Indians and Alaska Natives receiving care from IHS have diabetes. At the regional level, diabetes is least common among Alaska Natives (5.3 percent) and most common among American Indians in the southeastern US (25.7 percent) and in certain tribes from the Southwest. On average, American Indians and Alaska Natives are 2.6 times more likely to have diabetes than non-Hispanic Caucasians of similar age.

Asian Americans and Native Hawaiian or other Pacific Islanders: Prevalence data for diabetes among Asian Americans and Native Hawaiians or other Pacific Islanders are limited. Some groups within these populations are at increased risk for diabetes. For example, data collected from 1996 to 2000 suggest that Native Hawaiians are 2.5 times more likely to have diagnosed diabetes than Caucasian residents of Hawaii of similar age.

Who Should Be Tested?

Experts suggest that adults age 45 years and older be tested for diabetes. If their blood glucose is normal at the first test, they should be tested at three-year intervals.

According to the National Institute for Diabetes & Digestive & Kidney Diseases (NIDDK), people under age 45 should be tested if they are at high risk for diabetes. These high-risk factors include:

• being more than 20 percent above ideal body weight or having a body mass index (BMI) of greater than or equal to 27. BMI is the ratio of weight in kilograms to height in meters squared (kg/m2 ).

• having a mother, father, brother, or sister with diabetes

• being African American, Alaska Native, American Indian, Asian American, Hispanic/Latino American, or Pacific Islander American

• giving birth to a baby weighing more than 9 pounds or having diabetes during pregnancy

• having blood pressure at or above 140/90 millimeters of mercury (mmHg)

• having abnormal blood lipid levels, such as high density lipoprotein (HDL) cholesterol less than 35 mg/dL or triglycerides greater than 250 mg/dL

• having abnormal glucose tolerance when previously tested for diabetes

The NIDDK states that diabetes can be detected by any of three positive tests. To confirm the diagnosis, there must be a second positive test on a different day:

• a casual plasma glucose level (taken at any time of day) of 200 mg/dL or greater when the symptoms of diabetes are present

• a fasting plasma glucose value of 126 mg/dL or greater

• an OGTT value in the blood of 200 mg/dL or greater measured at the 2-hour interval

Always consult your physician for more information.