A not-so-invisible killer

Diabetes may be the most visible of invisible killers. It takes a gradual toll, exacerbating conditions such as heart disease and kidney failure, yet the warning signs are as plain as the nose on your face.

Or, more precisely, the rolls on your midsection.

Not every person with a weight problem has diabetes, but there is a proven connection between obesity and the blood-sugar disorder. It’s not much of a stretch to guess you’re looking at a diabetic—or someone on the road to diabetes—when you see a man, woman or child of extraordinary girth.

“There’s a genetic component, but lifestyle also makes a big difference,” said Dr. Leena Singh, an endocrinologist who treats diabetes and other hormonal conditions at her practice in Chico.

Roughly 1 in 10 Americans suffers from diabetes. That’s also the incidence rate in Butte County, according to the latest California survey, compiled in 2009. The statewide rate is 1 in 7 adults with diabetes, plus 1 in 6 adolescents considered pre-diabetic (in the early stages of the disease).

Those rates are expected to double in the next 15 years. That’s right: double.

Considering how often diabetes is preventable, that’s a staggering figure.

“It is definitely frustrating,” Singh said, “because even the diabetics I see, you try to counsel them about diet and exercise, and they don’t always comply. If they would be better about diet and exercise, maybe this wouldn’t be such a bad disease to treat.”

Raising awareness is particularly important, which is why the American Diabetes Association promotes March as Diabetes Awareness Month and the fourth Tuesday of March as American Diabetes Alert Day.

“You could say everybody in our society is at risk,” said Mary Aram, a clinical dietician who’s also a certified diabetes educator (CDE) for Enloe Medical Center. “But really you can point to certain people where you can identify high risk and target interventions.”

Those at particular risk have a family history of diabetes, a body-mass index (BMI) over 30 and certain levels of hemoglobin and blood sugars.

As for treatments, research has found some basic lifestyle changes can reduce the chance of developing diabetes or lessen the severity. The changes are weight control and exercise, combined with lower fat and higher fiber in the patient’s diet.

“That’s the biggest bang for the buck,” Aram said. “Better than diabetes medications, behavioral modalities targeting these risks in people are very effective.”

Diabetes is a disease with several variations. The two that linger are Type 1 diabetes and Type 2 diabetes; a third, gestational diabetes, can surface during a woman’s pregnancy and usually disappears soon after she’s given birth. Type 1 and Type 2 diabetes cannot be cured—they can only be controlled.

Diabetics have issues with insulin, a hormone produced in the pancreas that regulates blood sugar. Singh characterizes Type 1 as “insulin deficiency” and Type 2 as “insulin resistance,” but those are just simple labels. In fact, she stressed, Type 2 diabetics may develop a deficiency as well.

Type 1 diabetes is an autoimmune condition in which the body attacks itself—in this case, cells in the pancreas that produce insulin. As a result, without supplements, Type 1 diabetics lack enough insulin to process all their sugars.

Type 2 diabetes stems from resistance, where the insulin is not as effective at helping process sugars. “The body makes more [insulin] to try to metabolize glucose,” Singh explained, but the higher levels can lead to lower levels of good cholesterol and higher levels of triglycerides, which also are factors in heart disease.

What are the symptoms? That’s a complicated question. “Symptoms can develop so slowly and subtly,” Aram said, “that you can write them off to other things.”

That stated, symptoms of diabetes include:

• increased thirst and urination;

• changes in vision;

• scrapes or cuts that don’t heal;

• tingling or burning in the hands or feet;

• red, bleeding gums;

• unexplained weight loss.

Women also may get chronic yeast or bladder infections. “A person whose body is in balance should get these infections [only] irregularly,” Aram said, “and they should resolve.” Frequent infections raise a red flag.

Long-term complications of untreated diabetes include increased risk of cardiovascular disease and chronic kidney disease, retinopathy leading to blindness, and foot problems that can require amputation. It’s a nasty disease.

Developing diabetes shouldn’t be seen as a personal indictment. Yes, in many cases it’s preventable, but there’s more to diabetes than carbohydrate consumption.

“You didn’t get diabetes because you ate ‘junky,'” Aram said. “You can’t eat your way into diabetes. You have to have a genetic marker for Type 2 diabetes [to get it].”

Still, there’s such a thing as tempting fate. “You have to balance how capable you are of burning calories with the ease of getting calories,” Aram said.

Both Singh and Aram stress the quality of the calories ingested. Are you eating fast food or whole food? Lean protein or fatty protein? Good carbs or bad carbs?

“It’s hard to be good about diet because healthful foods are more expensive,” Singh said. “That’s a challenge with the economy.”

Singh offers a simple visual for a more healthful dinner: Divide your plate into fourths and have one quarter salad, one quarter protein, one quarter vegetables and one quarter starch.

Aram has two suggestions to mitigate diabetes. First, “do not gain weight. Weight creep is a biggie,” she said, and adding pounds will add to the problem. Second, “more than weight, and rather than focusing so much on eating habits, be active.” Aram recommends 30 minutes a day, five days a week.

“A lot of clinicians underestimate how exhausting and challenging the day-to-day demands of diabetes can be,” Aram added. “It’s not just ‘take a little pill and go down the road.’ Elements of life need to be revamped, and it’s an everyday thing.”