Richard Bergenstal, executive director of the International Diabetes Center at Park Nicollet
If you think you’re seeing diabetes in the news more often these days, you're not wrong.
Over the past 25 years, Type 2, or adult-onset diabetes, has become one of the nation's major health crises. In 1980, 5.8 million Americans suffered from diabetes; that figure stands at 18.2 million today, according to the U.S. Centers for Disease Control.
That 18.2 million means 7 percent of the entire population has diabetes. Ten percent of the population over age 20 has the disease, and for the 60-plus population, it's 20 percent.
Children account for most new cases of diabetes, prompting the medical profession to change the term "adult onset" to "Type 2," explains Bergenstal, M.D., at Park Nicollet, www.internationaldiabetescenter.com, in St. Louis Park, Minn.
But obese, inactive children are not the only group pushing the statistics. An aging population and an increasingly diverse population are also making diabetes a growing public health concern. Here, Dr. Bergenstal answers common questions about diabetes, its causes and its effect on lifestyle.
Body & More: Why is the United States seeing a massive increase in diabetes?
Dr. Bergenstal: There is a link to obesity, inactivity and fast food, but there’s a little more to it than that. The population is aging, and as you get older, the risk goes up, no matter how healthy you are. Then, what’s not appreciated is diversity. As the United States looks a little more diverse, that increases the incidence of diabetes. Every non-Caucasian is more prone to diabetes: African-Americans have two times the risk and Hispanic-Americans have one and a half times the risk. That’s why a city like New York will have a higher incidence than Minneapolis, and Chicago will have more cases than Appleton, Wis. Native Americans have three times the risk of diabetes. The Pima Indians in Arizona, 30 percent have diabetes.
Body & More: How does the onset of diabetes change a person’s life and lifestyle?
Dr. Bergenstal: The biggest change is monitoring blood sugar. You have to poke your finger and know where your blood sugar is. You can’t rely on “oh, I feel OK.” So that’s a change. Luckily we have really good technology today. The blood-sugar test is a 5-second test. It’s not painless, but it’s gotten a lot better.
No. 2, the goal for most people with Type 2 diabetes is to control or lose weight. The main lifestyle changes are eating more consistently, eating a better balance of foods and getting some exercise. Our general guidelines are lose 5 percent of your body weight and exercise 30 minutes a day most days, which means five days a week. For people at risk for diabetes, those two factors reduced their chance of getting it by 58 percent. People think “I have to lose 100 pounds,” but it turns out that the first 5 percent has the most effect on your body’s ability to control or prevent the disease: It appears to get your insulin working again. After that first 5 percent, people have more energy, and they can continue to lose weight.
Body & More: Is adult-onset diabetes always weight-related? If not, what are other causes?
Dr. Bergenstal: Eighty percent of adult cases are overweight, 20 percent aren’t. That’s where you say, is Type 2 caused just from being overweight? No, there’s a genetic predisposition, and something triggers it. And genetics win, even if you aren’t overweight. The 20 percent of folks that have this adult type, they make insulin but their bodies don’t utilize it properly. So the term we use is “insulin resistant.”
There is a strong genetic tendency toward diabetes. Something has to tip it over: weight gain, getting really inactive, even taking some medications such as prednisone (a steroid). Pregnancy can also tip you over in the form of gestational diabetes. Pregnancy is a stress test on the pancreas, and if you have a tendency toward diabetes, pregnancy might make you flunk the test. Twenty percent of women who get gestational diabetes keep it after they deliver, but all women who’ve had it during pregnancy should get checked once a year. More than 50 percent will get diabetes (again) over the next 10 years if they don’t do the preventive things we’ve been talking about.
Body & More: How and when does diabetes become dangerous?
Dr. Bergenstal: Diabetes is the No. 1 cause of blindness in adults. It causes kidney failure and amputations, and people with diabetes have two to four times the risk of a heart attack. But people with uncontrolled diabetes have all these risks. If you’re able to get your blood sugars into normal ranges, you can lead a healthy, active life.
The therapies we have today can work if the patient is educated. There’s also an inhaled insulin coming, which might help for people who don’t want to take a shot. And there’s a new blood test called the A1C that tells what your blood sugar average has been for the last three months. The glucose stick tells you at the moment; we recommend both. Day to day testing lets you see how diet and exercise drops blood sugar: You can walk around the block and see your blood sugar drop 40 points.
Body & More: Can exercise, diet and weight loss reverse diabetes?
Dr. Bergenstal: Be careful of the word “reverse.” You can control it and get off medicine. Does that mean you don’t have diabetes anymore? No. It means you got your blood sugars under control. If you start eating wrong again, you will get it again.
 |
