Diabetes SAVED MY LIFE

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You've heard the bad news. Now meet four people with this devastating disease whose lives are healthier, happier, more serene

A chocolate-drenched dessert on a delicate porcelain plate was, for Carol Guber, the defining moment. After a long dinner at Per Se, a New York City mecca for gourmet-food lovers, she shocked her friends by ordering the ultradecadent confection.

"When I was diagnosed with diabetes 6 years ago, I thought I'd have to eat a very restricted diet and limit my outings to great New York restaurants," says Guber, an author and former director of food programs at New York University's department of nutrition and food studies.

True, she does eat simple and healthy foods most of the time (that means smaller portions, steamed veggies, grilled fish). But with her background and degree in nutrition, and the help of a personal trainer, Guber has developed a sense of healthy balance that now permits astonishing freedom. Once, that chocolate ganache would have been off-limits. Today, she has incorporated healthy eating into her lifestyle and enjoys the results so fully that the occasional dessert or glass of wine isn't a crisis. "I was so pleased that I could finally order my own dessert and know that I wouldn't binge the next day or wreck my blood sugar," she says.

Guber is now in control. Spurred by her diagnosis and the healthy lifestyle it prompted her to adopt, she lost 52 pounds, left a desperately unhappy marriage, and gained new reserves of spiritual and physical energy. She's healthier, calmer, and fitter than she was 30 years ago. At 57, she looks a decade younger, the result of regular yoga sessions and morning workouts. (She never thought she'd be a gym rat!)

"I have used my diagnosis to transform my life," she says. "I'm incredibly grateful. I still face horrible complications, as my relatives with diabetes have. My great uncle's leg was amputated; my mother had a silent heart attack. But I am doing everything I can to prevent that. And my life is better than ever."

REVERSAL OF FORTUNE
Nearly 18 million Americans now have diabetes. Like Guber, most have type 2, in which blood sugar rises due to a metabolic double whammy: not enough insulin (the hormone that makes cells absorb sugar) plus body-wide insulin resistance (in which cells ignore the insulin anyway). Diabetes is a leading cause of heart attack, stroke, blindness, kidney failure, and amputation. (Rarer but equally dangerous is type 1 diabetes, an autoimmune disease that destroys insulin-making cells in the pancreas.)

The number of people with type 2 is rising along with the nation's twin epidemics of obesity and couch potato-itis. An estimated 30.3 million Americans will be diagnosed by 2030, including 1 in 3 born after the year 2000.

But there's a startling silver lining. Some people newly diagnosed actually credit this life-threatening illness with saving their lives. Once the initial shock subsides, they are finding ways to thrive by harnessing the newest, most powerful tools for controlling this killer: better medications, faster and easier blood sugar tests, insurance coverage for sessions with diabetes educators, and more research-based info about the blood sugar-lowering benefits of nutrition, exercise, and stress reduction.

"It's inspiring," says San Francisco diabetes specialist Gary Arsham, MD, PhD, coauthor of the new book Diabetes: A Guide to Living Well. "Although diabetes is still a challenge, I see people with the disease becoming so much more alive, energetic, and vibrant than ever before. They feel better and are motivated to keep on taking good care of themselves."

As diabetes and two related conditions--prediabetes and insulin resistance--soar in the United States, Prevention asked women and men who've triumphed to share their stories.

Small Changes, Big Rewards
Biggest obstacle Overturning old assumptions that threatened her health and blood sugar, such as, "I'll always be big" and "I'll never go to a gym: I don't look so great in spandex!"

Rewards More serenity, stronger belief in herself, less weight (she lost 52 pounds)

Practical wisdom Make conscious choices: Skip the brownie, have nuts! Celebrate small changes; they're the ones you'll stick with for life. Deal with stress right away

Bonus A new career as a motivational writer and speaker

Gabriel Caro | 32 Boston, MA
Gabriel Caro, a Harvard Medical School Web master, is at home in a high-tech world. After learning at age 28 that he had type 2 diabetes, he bought a state-of-the-art blood sugar monitor and embarked on a personal science experiment with a study population of exactly one: himself.

"I would run on the treadmill, then see how it affected my blood sugar," he says. "I'd check before and after meals, first thing in the morning, and last thing at night just to find out how everything in my life--food, activity, times of day, emotions--changed my body chemistry."

At the same time, he was using the Internet and his team of doctors at Boston's Joslin Diabetes Center to learn all he could about the body systems affected by type 2 diabetes, including the muscles, liver, eyes, kidneys, heart, arteries, and nerves. "If you embrace diabetes as an opportunity to learn and as something positive, it can make you very aware of yourself," he says. "It's wonderful. You become this expert about your own body."

Because Caro's mother and grandmother have type 1, his type 2 surprised doctors. "The good thing is, diabetes in the family means lots of support." Caro also became a runner, sometimes logging 11 miles a day. He practices "energy balance": A big breakfast or a planned dinner out inspires him to burn extra calories by walking home from work or staying longer at the gym near his office.

A Smart Balance
Biggest obstacle Loves to eat and enjoy life. "I didn't want to feel guilty about having a cookie or a glass of wine"

Rewards More alertness and focus, better sleep, improved overall health. For example. Caro recovers faster from colds or the flu

Practical wisdom Recruit family and friends for support. Think about the longterm effects of your lifestyle choices: Eating out tonight? Balance the calories by getting more exercise today

Bonus Deeper appreciation of how his body works

breakthrough drugs
NEW Faster insulin The FDA recently approved a new rapid-acting insulin, Apidra, to help rein in blood sugar spikes that can happen after eating a meal. Why it's a good thing: Even short bouts of high blood sugar raise the odds of diabetic complications, including kidney failure, blindness, and amputation.

SOON Inhaled insulin For the needle-shy, researchers are developing powdered insulin taken through an inhaler. In studies, an experimental version called Exubera--which may be the first to win FDA approval--helped control blood sugar better than pills alone.

Jacqueline Daniels | 45 Cincinnati, OH
Something felt terribly wrong when Jacqueline Daniels returned to her job as a nursing-home aide last January after surgery. "After 2 days back at work," she recalls, "I felt so weak that I asked one of the nurses to check my blood sugar. [Daniels's aunt and uncle both have diabetes.] It was 380." (A normal, nonfasting level is 125 mg/dl or lower). "They rushed me to the hospital. I found out later I was close to death."

Daniels was determined not to end up like the diabetic patients she cares for. "I've seen them lose limbs, lose their eyesight, and pass away. I never thought it would happen to me, and I didn't know what to do. I cried." Everything she ate seemed to raise her blood sugar. The turning point: Once she returned to work, she looked for help. "One of the nurses said, 'Eat less. Check your sugar more often. Instead of a whole apple, eat one-fourth and see what happens.'"

She prayed with the nursing-home chaplain. "I remembered that little verse, 'God grant me the serenity…' That helped me a lot," she says. She also met with a diabetes educator--someone trained to help diabetics deal with nutrition and lifestyle issues--who worked with her to develop a practical eating and activity plan. Daniels left the appointment ready to overhaul not just her own life but also her family's. Later, she joined a University of Cincinnati research study that's looking at the effects of portion control on blood sugar.

"I used to eat a lot of meat--I love pig's feet--and bread. Instead, I started having more salad, chicken, fish, and veggie burgers because of everything I've learned. We always had sugary soda pop and chips in the house. That all changed. The kids didn't like it at first. They kicked and screamed. But now they beat me to the refrigerator. They like these healthy foods." In her kitchen: diet drinks, fruits and veggies, lean meats, baked chips, and low-fat popcorn.

"I try to walk for at least 30 minutes a day and make the kids come, too," she. adds. "On Saturdays, we walk to my brother's produce stand at Findlay Market, where I sometimes help out. It's a great place to get fruits and vegetables."

Daniels now eats seven small meals and snacks per day, up from two or three large meals. She tracks her carbohydrate intake and measures healthy portions with a clever trick: comparing serving sizes to her hand. "A 5-ounce serving of protein is equal to my palm; a cup of pasta is about the size of my fist. It's a system I can take with me anywhere."

The results? "Now I can laugh at diabetes. At work, they call me Miss Diabetical," says Daniels, who also stopped smoking. Gone, too, is her quick temper. "I used to whoop and holler and get mad about everything," she says. "But that really kicks my blood sugar up. It isn't easy, but now I try to pray for someone who's making me mad. I just walk away. We're only here on Earth for a short moment. I have a lot left to do."

Faith and Determination
Biggest obstacle Balancing personal health with raising the three youngest of her five kids, ages 11 to 28, and working full time

Rewards 42-pound weight loss, boosted energy levels, defused stress and anger

Practical wisdom Create an expert support team. Make use of faith and humor

Bonus Healthier food and more exercise cut her children's risk of diabetes, too

breakthrough devices
NEW Insulin pump that circulates you dose for you With the Medtronic Paradigm 512 pump system, you put a drop of blood on a test strip, then insert it into a blood sugar meter. Machines do the rest: Wireless technology sends the info to an insulin pump, which calculates the right dose and delivers it via a small plastic tube attached to the skin.

SOON Bionic pancreas Medtronic is testing an artificial pancreas system: A glucose sensor implanted under the skin transmits blood sugar data to an infusion pump for automatic insulin delivery, The system is designed to mimic a healthy pancreas.

Clark Virden | 37 Birmingham, AL

At a routine eye exam, an optometrist unexpectedly told Clark Virden that he might need a diabetes check. "Something must not have looked right to the doctor. I have no idea what it was," Virden says. Subsequent blood tests showed that his blood sugar levels were slightly elevated, but not severely enough to require treatment. However, after 5 years of annual monitoring revealed that his blood sugar was steadily climbing higher, his family physician confirmed that he was, in fact, nearly diabetic. "My doctor wanted to treat it as type 2 diabetes; he felt I was really heading in that direction," says Virden. "I was pretty freaked-out."

Why the diagnosis was so unnerving: "I'm not overweight. I wasn't in what you'd consider bad shape. But I wasn't doing much to stay active, either," notes Virden, who is a sales representative for a Birmingham printing company and was a newlywed at the time of his diagnosis. ("My wife, Alison, is my moral support," he says.)

His life changed swiftly. Virden began taking a diabetes drug that increases sensitivity to insulin. He added a second drug to protect his kidneys from damage, a common diabetes side effect. Because he had high cholesterol, he was already taking a statin, a drug often recommended for diabetics to lower their elevated heart-disease risk.

The drugs all helped, but Virden took his health care to the next level by meeting with a certified diabetes educator. "That was the biggest contributing factor to my change in diet," he says. "By learning how my body processes certain foods, I've found a comfort level without sacrificing too much. I also learned that it's not about giving up everything you like; it's about moderation. Looking forward to the mushroom risotto? No problem. Just pass on dessert."

He also began the long process of accepting that he'll have diabetes for the rest of his life and of finding a healthy lifestyle that works for him. Before his diagnosis, Virden had been an on-again, off-again exerciser. All that changed. "I quickly realized that this was not the time to start an exercise routine and then quit," he says. He headed for the gym and adjusted his diet.

"I was always the smallest guy in my class at school," he says. "Now I'm getting back to a very slight frame." Virden made yet another adjustment: working with a personal trainer to build muscle. "I wanted to bulk up a little. I wanted to be able to put on a pair of shorts and take my shirt off at the beach." More muscle mass is a plus for someone with diabetes, because active muscle tissue automatically absorbs and burns more blood sugar.

Virden credits diabetes with delivering a wake-up call he might never have heard otherwise. "When I was diagnosed, I was 34 years old, I weighed 175, and I had no history of health problems except high cholesterol. I felt good, my weight was average, and I was even on a low-fat diet. I had no intentions of changing my lifestyle any further," he says. "Diabetes wasn't an epiphany of, 'Oh, my God, I'm going to die.' It was more along the lines of, 'Okay, so these are the cards I've been dealt. Let's start taking advantage of those things in my control--diet and exercise.'"

The result: "I feel better than ever, both physically and mentally. When you can say to yourself, I'm handling my end of the deal, it's a good feeling. The rest of it is faith in God."

From Freaked-Out to Feeling in Control
Biggest obstacle Taking diabetes and its complications seriously. Early on, they can't be seen or felt

Rewards Less risk of heart disease, great physical condition

Practical wisdom No magic bullet: Eating healthfully and getting regular exercise are the important lifestyle changes you can make

Bonus Feels emotionally and physically in charge of his life

Carol Guber | 57 New York City
At first, Carol Guber hid her diabetes from colleagues in New York University's food and nutrition department. "I was so embarrassed," she says. "Nutrition and food is my profession. Somehow, I thought knowing all about nutrients and healthy food preparation would keep me from getting diabetes. I couldn't believe it happened to me."

Food was more than a job: It was her life. At various times, Guber owned a café in Philadelphia, was retail sales manager for a caviar company, and studied cooking with (and worked for) the renowned American chef James Beard. When she was diagnosed with diabetes, she was married to a restaurant consultant; together, they socialized with friends over lengthy and lavish meals. She was at least 50 pounds overweight. "I had been gaining weight, but I brushed it aside by telling myself that all the women in my family were big," she says. "After my diagnosis, I was determined to make my health and well-being my top priority."

Knowing that weight control and exercise would help control her blood sugar, Guber switched to a lower-fat diet with well-timed, balanced meals, watched her portion sizes, and began exercising at home. She promised herself a new body by the millennium, a few years away. After 4 months of home workouts, she felt slim enough to venture into a gym. There, she met a personal trainer who taught her how to box. "I'll never be a peppy aerobics girl," she says. "But boxing? Wow! I loved it!" Later, she added weight training to her exercise regimen. And by testing her blood sugar daily, she learned how to balance diet, exercise, and stress so that there was room for a carefully chosen restaurant meal. At first, she worried that eating out would mean a return to big portions of the wrong foods. "Once I knew that I needed to integrate diabetes into my life, I realized that the big thing for me was being out with my friends," she says. "That made it easier to enjoy smaller portions and to turn some foods down."

The lightning-bolt moment? "One day I said to myself, Wait a second, I'm not losing weight now to get into a particular dress for a big event. Diabetes is for the rest of my life. There weren't going to be any quick fixes. That's a huge shift." It brought with it a new freedom to appreciate small, sustainable lifestyle changes--and to see their power.

Tiny changes led to enormous ones. Goober left her stressful marriage and went to work for herself as a writer and speaker specializing in health and wellness. Her first book, Carol Goober's Type 2 Diabetes Life Plan, was published by Broadway Books in 2002. "Putting my health and well-being as a top priority has been a key for me," she says. "When I get stressed now, and all those hormones start chugalugging and sending messages to my brain, I stop whatever I'm doing. If I'm eating, I just put down my fork. I take a deep breath and figure out a way to prioritize what really needs to be done. Stress, for me, leads to negative behaviors. If I don't watch it, I'll overeat, stop exercising, and feel guilty about the whole mess. I'm not doing that anymore."

PHOTO (COLOR): Carol Guber dropped four dress sizes

PHOTO (COLOR): Gabriel Caro burns extra calories by walking to work

PHOTO (COLOR): Now, Jacqueline Daniels serves produce at every meal

PHOTO (COLOR): Clark Virden got active to preempt diabetes complications

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By Sarí Harrar

Prevention Senior Health News Editor Sarí Harrar covers diabetes and heart disease for the magazine.

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