The Big D
Jim Atkinson cures what ails us.
“MY FRIEND’S FATHER is not going to have his foot amputated,” my wife informed me one morning.
“Oh, good,” I said.
“They have to take the entire lower leg,” she quickly added, frowning. “Diabetes. I didn’t know it could be so horrible.”
If this story line is not yet familiar, just wait. Diabetes—the metabolic condition in which the body does not utilize glucose efficiently because of poor production of insulin, causing havoc with the vascular and nervous systems—is quietly making a bid to join the uppermost strata of insidious diseases presently occupied by the Big One and the Big C. Over the past thirty years, incidence of the disease has doubled in the U.S.; diabetes deaths have jumped 45 percent. And Texas is a veritable hot spot: We now have more than one million people with diabetes—not to mention the additional estimated 343,000 who are still undiagnosed. What do you really know about diabetes? Here are the top five myths about our newest epidemic, explained with the help of Dr. Eugenio Cersosimo, of the Texas Diabetes Institute and the University of Texas at San Antonio Health Science Center.
Myth 1: Diabetes is caused solely by being too fat. Nope. First off, Type 1, formerly called juvenile diabetes, is almost entirely genetic and strikes at a young age; it is responsible for 5 to 10 percent of cases. Type 2—the stripe of the disease responsible for almost 95 percent of cases and the present outbreak—also involves certain genetic defects, although these are subtler. That said, don’t throw your diet out the window: Cersosimo points out that obesity is generally what triggers Type 2 in those predisposed to the condition. A lot of people who carry the mutation don’t become diabetics because they keep their weight under control.
Myth 2: So you must have to lose a lot of weight to keep diabetes in check. Actually, says Cersosimo, a loss of as little as ten pounds can rein in the disease’s most deleterious effects—if you can keep the weight off.
Myth 3: Diabetes doesn’t make you any more prone to a heart attack or a stroke than other things, so big deal. Uh, the big deal is that it can make you two to four times as likely to suffer those conditions as a nondiabetic. It’s also the leading cause of nonhereditary blindness, non-accident-related amputations, and kidney failure. American diabetics now spend upward of $100 billion a year on medications and supplies—10 to 15 percent of total health care expenditures. (Put it this way: You know a disease has arrived when it gets its own section at Wal-Mart.) “Overloading the body with sugar causes problems with nerve conduction and cell regeneration,” Cersosimo told me, “as well as anoxia [lack of oxygen to tissues], bleeding of small vessels, and peripheral neuropathy, to where a patient can’t even feel if, say, he steps on a nail. So he could get an infection that progresses undetected to the point that he has to have a limb amputated.”
Myth 4: Hispanics, African Americans, and Native Americans are more prone to Type 2 diabetes because of poorer dietary habits. Well, it is epidemiologically true that minorities are almost two times as likely to develop the disease as Caucasians. But a majority of Americans of all colors have poor eating habits. What has made these ethnicities more vulnerable to the disease, says Cersosimo, is the head-on collision between those eating habits and evolution.
According to what is known as the thrifty gene theory, the original Homo sapiens couldn’t really count on three squares a day—famine was frequent—and so their metabolism developed to save as much glucose as possible and produce insulin only when absolutely necessary, a propensity that got passed down as a “thrifty gene.” You can then imagine what happened when this metabolism ran into the fat- and sugar-rich diet of later civilizations: The pancreas had to work overtime to produce enough insulin to handle the deluge of sugar, and then, in many cases, it simply exhausted itself, producing less insulin and leaving too much glucose in the bloodstream. Looking at history, people of Western European descent are better adapted to the American diet because their forebears had agricultural and industrial revolutions earlier than other peoples—thus overeating and underexercising sooner—whereas Hispanics and other minorities do not have this advantage.
“With Mexicans, there has been a lot of intermarriage with Indians, who have real diabetes problems,” says Cersosimo. “Diabetes becomes bred into people over centuries.”
Myth 5: Diabetics are doomed to daily insulin injections to survive. Insulin injections are the only treatment for Type 1 diabetes, but they are a last resort for those with Type 2. Many drugs can now control blood sugar or increase insulin production. Cersosimo is especially enthusiastic about thiazolidinediones, which sensitize the body’s cells to insulin and decrease the glucose processed by the liver. Just as promising are incretins, hormones that not only improve the function of the cells in the pancreas that produce insulin but also, as Cersosimo says, “make people slightly nauseous, so they eat less and lose weight.”
And there’s more on the horizon: The Texas Diabetes Institute is looking into the genetic defects that make one prone to Type 2, while Boston’s Joslin Diabetes Center is hot on the trail of an enzyme called PKC, which may be partly responsible for diabetes’ vascular damage. Meanwhile, the California company Novocell has developed a means of converting stem cells into pancreatic cells that enable insulin production—meaning that in the future, diabetics may be able to acquire a properly functioning pancreas via the needle. The best news recently is not so high-tech: Scientists in Canada have found that an age-old diabetes drug, Avandia, can cut the risk of developing the disease in half if administered to people who qualify as prediabetic.
The bad news, however, is that the Type 2 epidemic is claiming younger and younger victims. According to the Texas Diabetes Council, cases of diabetes among kids are expected to triple by 2025, which in turn means a predicted cost to the state of $15 billion. Public health officials are responding—after all, there wasn’t such a thing as a Texas Diabetes Council some twenty years ago—but they’re going to have to do more, and faster. As Martin Silink, of the International Diabetes Federation, observed recently, “The diabetes epidemic will overwhelm health care resources everywhere if governments do not wake up now and take action.”
Doping Out Diabetes: How do I know if I have it?
Much of the diabetes epidemic owes to the fact that people don’t know they have the disease until it’s too late. The symptoms are fairly obvious: You pee a lot, are dehydrated, feel thirsty and hungry all the time, and inexplicably lose weight. Even if you’ve had no such episodes, it’s a good idea to get your blood glucose checked, especially if you’re over 45 or have a diabetic in your family. This is easily done at a yearly physical. If you don’t have a doctor or health insurance—another factor in the surge of diabetes is the 46 million Americans who are uninsured and unable to obtain regular checkups—then get on the Internet, where you’ll find dozens of diagnostic outfits (such as privatemdlabs.com) that will direct you to a local lab to get blood drawn, sent to them, and tested for as little as $30. As a general rule of thumb, if the results of a blood test come back below 99, you have nothing to worry about; 100–125, you might be prediabetic; over 125, you have diabetes.