Diet, exercise can control diabetes BY DR. NELDA P. WRAY
Diabetes is one of the leading causes of death and disability in the United States. About 17 million Americans have the disease, including one in eight VA patients. At especially high risk are the elderly, the overweight, those with a family history of diabetes and certain ethnic groups.Unfortunately, as many as one-third of Americans with diabetes are unaware they have the disease. Also of concern is the rising prevalence of type-2 diabetes - formerly known as adult-onset diabetes - in teenagers. This may be due to heredity and increasing obesity and physical inactivity among young people. But the health community agrees that maintaining a healthy weight and exercising are two of the best ways to prevent and treat this potentially devastating disease.
Causes.
In type-1 diabetes, the body is unable to produce insulin, a hormone that helps convert food sugar into cellular energy. Without insulin, sugar builds up in the bloodstream to dangerous levels. Patients with this condition need daily doses of insulin to live.
In type-2 diabetes, which accounts for more than 90 percent of cases, the body makes insulin but can't use it properly. Type-2 patients usually can manage their conditions through lifestyle changes and medications that control blood sugar and help the body use insulin.
Early signs are more noticeable in type-1 diabetes. These include weight loss, fatigue, blurred vision, increased thirst and hunger, and frequent urination. Similar symptoms occur in type-2 diabetes, but they develop more gradually and often go unnoticed until the disease reaches a later stage.
When either form of diabetes goes unchecked, excess blood sugar harms nerves and blood vessels, leading to heart disease, kidney failure and other serious complications. The breakdown of blood vessels in the retina can affect vision and even cause blindness. Nerve damage in the feet can limit sensation and lead to skin ulcers that, because of poor blood flow, do not heal. In the most severe cases, amputation is required.
Self Care.
Patients with diabetes must regularly check their blood sugar with a special glucose meter. Too much sugar is dangerous, and too little sugar - such as when drug or insulin doses are too high - can cause shakiness, sweating, dizziness and other symptoms. Rather than rely on needles, syringes and self-injections, many patients today wear small, computerized pumps to deliver just the right dose of insulin at the right time. This helps avoid blood sugar fluctuations.
Patients also must watch their diets. Reducing sugar intake, salt and harmful fats is a key step. This helps not just blood sugar, but hypertension and cholesterol, which are risk factors for heart disease - the leading cause of death in diabetes. Quitting smoking is important, too. People with diabetes who smoke triple their risk of dying from cardiovascular disease.
Several VA studies focus on vascular complications in diabetes. For instance, VA health-services investigators are exploring strategies for lowering coronary risk factors in diabetes patients. Also, VA is conducting a major clinical trial with 1,700 veterans to test whether stronger doses of certain diabetes drugs will help prevent heart attack and stroke.
Scientists at the Gainesville VA Medical Center and the University of Florida are testing a genetically engineered! gel that may help wound healing in diabetics and prevent the need for amputation.
Exercise is vital for those with diabetes, mainly because it improves weight and cardiovascular health. VA research found that. Diabetic patients who regularly exercise are nearly three times more likely to have good control of their blood sugar.
Early detection is perhaps most important. Diabetes can be managed more easily when recognized early. Research at the Durham, N.C., VA Medical Center showed that routine finger-stick testing of outpatients with no known diabetes turned up a significant number of previously undiagnosed cases. This so-called opportunistic screening may be an effective way of identifying many millions of Americans who don't know they have the disease and starting them on the course toward longer, healthier lives.
Nelda P. Wray, M.D., M.P.H., is chief research and development officer for the Veterans Health Administration.
