Eileen Arbiture knows the toll diabetes can take on a person’s health. “I saw the ravages of that disease throughout my entire family,” says the 71-year-old Mequon resident, who lost her mother, grandmother and several other family members to the condition. Last year, when she was diagnosed with type 2 diabetes, she decided to take control.
Arbiture began tracking her blood sugar and keeping a detailed diet journal, noting the way her body responded to certain foods. She ramped up her walking routine and focused on eating vegetables, fruits and whole grains. She read as much as she could about diabetes and its management. Soon, people began noticing a difference.
“My color was better. Friends would ask if I had new makeup,” Arbiture says. She found her was body changing as well. “My husband said, ‘Oh my gosh, you’ve got a figure like you did when I first met you!’ ”
Arbiture’s lifestyle changes have allowed her to manage the disease without the use of insulin or other medications, which was important to her. “Some diabetics, if they want to eat a piece of pie, they just take more insulin. But that doesn’t always work. You have to take responsibility.
“People say, ‘Oh, you’re neurotic with the diet,’ ” she says. “But I don’t want to lose limbs, have eyesight problems, cardiovascular problems. That’s always in my mind.”
Diabetes is epidemic in the United States, affecting almost 24 million people. The majority of those cases – between 90 and 95 percent – are type 2 diabetes. Formerly referred to as “adult onset,” type 2 diabetes was once thought of as a grown-up’s disease, but the condition is increasingly common among obese children and adolescents. Meanwhile, 57 million people have pre-diabetes, an abnormal blood sugar condition that frequently leads to diabetes. Some experts believe the number of Americans with diabetes will double in the next 25 years, while spending on the disease will triple.
Diabetes is a chronic condition; once you have the disease, it tends to progress. That said, studies suggest there are steps patients can take to slow the advance of diabetes and minimize complications. Whether patients are diabetic, pre-diabetic or simply at risk, lifestyle changes such as diet, exercise and weight loss are some of the most powerful tools they have to maintain their health.
A Sneaky Disease
Diabetes occurs when a person’s body can no longer process sugar (glucose) effectively. In a healthy body, food is broken down into glucose, which enters the bloodstream and passes into the body’s cells to provide energy. Insulin, a hormone produced by the pancreas, is crucial to this process. When you eat, your pancreas releases insulin, which permits the glucose to enter your cells, lowering the amount of sugar in your bloodstream. When your blood sugar level drops, the pancreas slows the production of insulin.
A person with type 2 diabetes has either become resistant to insulin or her body doesn’t produce enough insulin (or both). As a result, sugar builds up in the bloodstream instead of fueling the cells.
Unfortunately, the disease often has an insidious onset, explains Dr. Irene O’Shaughnessy, endocrinologist and medical director at Froedtert & The Medical College of Wisconsin’s Metabolic Syndrome Clinic. “Type 2 diabetes is really a very sneaky disease. It’s difficult to pinpoint the day when insulin resistance starts occurring in the body.”
For example, in the initial stages of diabetes, when the cells are not responding properly to insulin, the pancreas may overcompensate by producing very high levels, dropping blood sugar and masking the disease. This overproduction of insulin is what causes some patients to experience hypoglycemia, or low blood sugar, in the beginning phases of diabetes.
Studies show diabetes can start causing long-term harm to the body, especially the heart and circulatory system, early on. This is of particular concern for patients with pre-diabetes, a state of abnormally elevated blood sugar that almost always precedes diabetes. Although such patients may not know they are at risk, they can already be developing diabetes-related complications, including kidney, eye, nerve and cardiovascular problems, says O’Shaughnessy.
“That’s the scary part about pre-diabetes,” says Colleen Kristbaum, director of Clinical Nutrition and Diabetes Management for Wheaton Franciscan Healthcare. “All of this underlying damage can be occurring and you don’t even know it’s happening.”
Lifestyle Changes
The good news is that pre-diabetics can delay or possibly prevent diabetes by making changes in their diet and activity. An oft-cited, multicenter study called the Diabetes Prevention Program (DPP) found that participants who underwent intensive lifestyle changes reduced their risk of developing diabetes by 58 percent. Certain diabetes medications were also found to be effective, reducing the risk by 31 percent, although they were not as helpful as weight loss.
Lifestyle changes are also extremely important for helping diabetics keep the disease under control. “Once patients have been diagnosed with diabetes, they really have to take good care of themselves,” says O’Shaughnessy. “They are in the driver’s seat, and they need to make good choices.”
Unfortunately, not all patients are proactive. “We see a lot of patients come in with high blood sugars and they start medications, but they don’t really do the lifestyle changes required to improve their condition,” says Dr. Ervin Szoke, an endocrinologist with Madison Medical Affiliates and Columbia St. Mary’s Diabetes Treatment Center.
This is not to say that medication and insulin aren’t important parts of managing diabetes; for many people, they are. Yet, a treatment plan shouldn’t stop there. “I usually tell my patients, especially if [they’re in the early stages of the disease], that at least 50 percent of treatment should be lifestyle changes,” says Szoke. “You should not ignore the benefits of diet, exercise and weight loss.”
In fact, shedding even a modest amount of weight can make a difference. Upper-body or abdominal obesity, which affects many diabetics, appears to be linked to insulin resistance. However, when people lose weight, that’s typically where they lose it first, Szoke says. Accordingly, “Even five to 10 pounds of weight loss can dramatically improve the blood sugar.” In the DPP study, participants lost an average of 5 to 7 percent of their body weight, or about 15 pounds.
Likewise, exercise needn’t be extreme to have an immediate impact. “We’re not talking about running a marathon, we’re talking about good, brisk walking,” says Dr. Melissa Walbrandt, a family practitioner with Wheaton Franciscan YMCA Healthy Lifestyle Village in Brown Deer. The DPP group exercised for 150 minutes a week, which equates to five 30-minute sessions.
Diabetes patients looking to make lifestyle changes may want to consider local education programs and support groups, which can be a great resource for information as well as motivation and community. At Wheaton Franciscan, which recently teamed with the International Diabetes Center to implement an extensive diabetes education program, plans are also under way for a pre-diabetes program.
Know Your Risks
For patients who have not yet developed pre-diabetes or diabetes, knowing the risk factors can also help you stay on top of the disease. Being overweight or sedentary can put you at risk. Genetics also plays a strong role. Certain ethnicities, including African-Americans, Hispanics, American Indians, Asian-Americans and Pacific Islanders, are more likely to get type 2 diabetes, as are women who developed gestational diabetes during pregnancy or gave birth to a baby weighing more than 9 pounds. Finally, age itself is a risk factor for the disease.
At the age of 45, it’s recommended that all patients have their blood sugar tested. If the test comes back normal, they should repeat it every three years. But younger patients who have one or more risk factors may not want to wait. “A lot of studies have been saying ‘45 is too late,’ ” says Kristbaum. “You really need to go in sooner, especially if there’s a history in the family or you are overweight.”
A patient’s blood sugar may be tested by one of several methods. A fasting blood sugar test is given after a patient has refrained from food for a minimum of eight hours. Some patients may undergo a glycated hemoglobin (A1C) test, which reveals their average blood sugar over the past two to three months.
A third test, called the oral glucose tolerance test, is sometimes not used for logistical reasons; it requires two samples to be taken, two hours apart. However, Dr. Szoke says it is “the gold standard” for diabetes testing. “We should use it more. We might be missing a significant number of diabetics.”
As for Eileen Arbiture, she’s made sure her two daughters are aware of their family history of diabetes. They, in turn, are working hard to pass healthy habits on to their own children. When Eileen hears of others who are diagnosed with diabetes, she makes it a point to share her success story. Often, when she describes her approach, “People say, ‘Boy, you take it serious.’ I say, ‘So should you.’ ”
Health Tips by Julie Sensat Waldren
Eat Pomegranates for Better Breasts More good news about pomegranates, the antioxidant-rich fruit touted for its health benefits. A Cancer Prevention Researchstudy found that chemicals in pomegranates called ellagitannins may help slow the growth of breast cancer. In lab tests, compounds from the fruit helped inhibit a key enzyme that fosters the production of estrogen and the growth of breast cancer. Researchers recommend eating pomegranates or drinking pomegranate juice for its protective effect.
Less Salt Lengthens Lives Reducing salt intake could decrease your risk of stroke or cardiovascular disease, notes a report in British Medical Journal. The World Health Organization recommends a maximum of 5 grams of salt per day (about one teaspoon); the average American consumes twice that. People who consumed just 5 fewer grams per day were 23 percent less likely to suffer from stroke and 17 percent less likely to have cardiovascular disease.
Folic Acid: Good for Baby, Then Bad?
It’s tricky. Pregnant women are advised to take at least 400 micrograms of folic acid daily prior to conception and during the first trimester to protect against birth defects such as spina bifida and anencephaly. Yet a study in the American Journal of Epidemiologyfound that taking folic acid late in the pregnancy could cause asthma in the child. Mothers who took a multivitamin containing folic acid after the 30th week of pregnancy were 25 percent more likely to have a child who developed asthma by age 3. Researchers advise women to stop taking folic acid supplements after week 12.
Cell Phones Combat Dementia Cell phones may actually protect against Alzheimer’s disease, found a study in the Journal of Alzheimer’s Disease. Mice exposed to cell phone electromagnetic waves exhibited no effects of dementia, even if they were predisposed to develop Alzheimer’s. Even better, the cell phone waves reversed memory impairment in mice if it had already begun. Researchers say the waves prevent the buildup of beta-amyloid, a harmful protein that causes Alzheimer’s disease. Whether this applies to humans remains to be studied.
St. John’s Wort Won’t Help Bowels The herbal supplement St. John’s wort is no help for irritable bowel syndrome (IBS), reports the American Journal of Gastroenterology. IBS is a chronic condition that includes abdominal pain, gas, diarrhea and constipation. Experts think depression and anxiety may play a role in IBS, and antidepressants are often prescribed. Subjects in this test took 450 milligrams of the herb twice daily, yet the placebo group had better results.
