The New Diabetes Epidemic: What's Fueling It, How To Combat It

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Chances are, you know someone with type 2 diabetes. Of the 16 million Americans with diabetes, 90% to 95% have type 2, which until recently was the bane only of older adults. Now, experts are realizing everyone is potentially vulnerable--even children. In fact, the rise in the incidence of type 2 diabetes is of epidemic proportions. According to a new report from the Centers for Disease Control and Prevention, the disease shot up 6% in 1999 alone, confirming it is a major public health threat.

The recent jump in obesity--up 57% in the last 10 years--is undoubtedly to blame for the sudden escalation in diabetes, including among children. About 80% of people with the disease are overweight. Though being overweight does not cause the disease, it can be a trigger in those who are susceptible.

In fact, Shape Up America!, a nonprofit organization that promotes a healthy body weight, is using the term Diabesity(TM) (obesity-induced diabetes) to emphasize the importance of obesity in triggering type 2 diabetes. The group has just launched the first phase of a public health initiative addressing the issue.

Diabetes is one of the leading causes of blindness, kidney disease, nerve damage and leg amputations. It is also a major cause of heart disease and stroke. The increasing diagnosis of type 2 diabetes in children is particularly disconcerting, because the earlier diabetes strikes, the more time there is for complications to do damage.

Defining Diabetes. Type 2 diabetes is the result of an inherited tendency to become resistant to insulin, the hormone that escorts glucose from the bloodstream into cells, where it's needed for energy. (In type 1 diabetes, the body destroys its own insulin-producing cells in the pancreas, so there is no insulin at all.)

This tendency to resist the action of insulin, even when it is available, prompts the pancreas to pump out more insulin to overcome the resistance and force glucose into the cells. But over time, even souped-up insulin production falls behind, leaving glucose levels elevated in the blood.

Realizing the Risks. It's the combination of inheriting a tendency for the disease and living an unhealthy lifestyle that increases the risk of developing type 2 diabetes. (Age and race also affect risk--see "Who's at Risk for Type 27"). But the recent jump in the disease in the U.S. seems to be fueled mostly by eating more and moving less.

Of course, not everyone who gets type 2 diabetes is overweight, nor does everyone who is overweight get diabetes. "But the incidence is much less in those who are closer to their ideal body weight, who exercise and who eat the right foods," explains James Rosenzweig, M.D., of the Joslin Diabetes Center in Boston.

Getting Tested. You may not be able to tell if you are developing type 2 diabetes, because, unlike type I diabetes, symptoms develop gradually. (They include frequent urination, fatigue, blurred vision and recurring infections.) Some people in the early stages of the disease may not have symptoms for years. That's why you should see a doctor for routine blood glucose testing beginning at age 45--earlier if you're at high risk. A fasting blood glucose of more than 125 on two different days confirms a diagnosis of diabetes. Even a slightly elevated blood glucose, if chronic, can lead to complications of diabetes, with no symptoms.

Managing the Disease. Type 2 diabetes is best managed with healthy life-style choices and blood glucose monitoring. Many people also need to take oral medication or insulin to control blood sugar. Here, EN offers advice on how to lower your risk of developing type 2 diabetes and how to minimize potential complications if you live with it.

How to Gain Control
Maintain a healthy weight. Being overweight makes your cells more resistant to insulin, which can cause blood sugar levels to rise. The good news is that losing as few as 10 to 20 pounds can decrease that resistance and bring blood sugar levels down. Losing weight can even avert the need for medication in some people.

Eat healthfully. Gone are the days of a restrictive "diabetic diet." Eating plans are now individualized, based on medical history, lifestyle and changes people are willing to make to better control blood sugar levels. "There is no one-size-fits-all approach anymore," says Hope Warshaw, M.M.Sc., R.D., a certified diabetes educator and co-author of How to Carb Count (American Diabetes Association, 2001). Moderate weight loss is one strategy, but making better food choices and controlling portion sizes are just as important.

It still surprises many people that, within the context of a healthful diet, people with diabetes can eat the same foods as everyone else--even sugary foods--in moderation. Research shows that the total amount of carbohydrate is more important than the type. Focus on whole grains, legumes, vegetables and fruits; the fiber in these foods may help control blood sugar and the antioxidant phytochemicals they contain may help prevent oxidative damage.

Also key is cutting back on fat, especially saturated fat, since people with diabetes are at higher risk for heart disease. Make the majority of your fats monounsaturated (e.g., olive oil, nuts), while including fish, poultry, lean meat and low-fat dairy products.

Keep active. Physical activity is as important as healthful eating when it comes to controlling type 2 diabetes. It helps keep blood sugar levels down by decreasing insulin resistance. If you're at risk for the disease, regular exercise may help prevent its development. If you've already been diagnosed, exercise can reduce or eliminate the need for insulin. Exercise also helps control weight, blood pressure and blood cholesterol. Aim for 30 minutes of physical activity on most, if not all, days of the week.

Monitor your blood sugar. Self-testing of blood glucose allows you to track the effect of meals and activity on blood sugar levels in an effort to gain better control. That's important, because experts believe keeping blood glucose levels close to normal lowers the risk of developing complications.

Speak with your physician about the diabetes management strategies best suited for you. A registered dietitian who specializes in diabetes can help tailor an eating plan to fit your needs. To find one, contact the American Diabetes Association for a listing of recognized diabetes education programs in your area. Call (800) DIABETES or visit www.diabetes.org/education/ eduprogram.asp.

Who's at Risk for Type 2?
People who are most susceptible are:

Over age 45
Overweight
Sedentary
African-American, Latino, Native American, Asian-American
And those who have or have had:

A family history of diabetes
Low HDL (high-density lipoprotein or "good") cholesterol
High triglycerides
Gestational diabetes (during pregnancy)

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