Living With Diabetes

Diabetes “The Silent Killer”

WHEN he was 21 years old, Ken developed a puzzling, unquenchable thirst. He also had to urinate frequently—eventually about every 20 minutes. Soon Ken’s limbs began to feel heavy. He was chronically tired, and his vision became blurry.

The turning point came when Ken caught a virus. A visit to the doctor confirmed that Ken had more than the flu—he also had Type 1 diabetes mellitus—diabetes, for short. This chemical disorder disrupts the body’s ability to utilize certain nutrients, primarily a blood sugar called glucose. Ken spent six weeks in the hospital before his blood-sugar level stabilized.

That was more than 50 years ago, and treatment has improved considerably during the past half century. Nevertheless, Ken still suffers from diabetes, and he is not alone. It is estimated that worldwide, more than 140 million people have the disorder, and according to the World Health Organization, that number could double by the year 2025. Understandably, experts are concerned about the prevalence of diabetes. “With the numbers we’re starting to see,” says Dr. Robin S. Goland, codirector of a treatment center in the United States, “this could be the beginning of an epidemic.”

Consider these brief reports from around the world.

AUSTRALIA: According to Australia’s International Diabetes Institute, “diabetes presents one of the most challenging health problems for the 21st century.”

INDIA: At least 30 million people have diabetes. “We hardly had any patients under 40 about 15 years ago,” says one doctor. “Today every other person is from this age group.”

SINGAPORE: Nearly a third of the population between 30 and 69 years of age have diabetes. Many children—some as young as ten—have been diagnosed.

UNITED STATES: Approximately 16 million people are afflicted, and each year some 800,000 new cases are diagnosed. Millions have the disease but do not yet know it.

Treatment for diabetes is made more difficult because a person can have the disease a long time before it is diagnosed. “Because the early symptoms are relatively mild,” notes Asiaweek magazine, “diabetes often goes unrecognized.” Hence, diabetes has been dubbed the silent killer.

In view of the prevalence and the severity of this disorder, the questions is:

What causes diabetes?
How can those who have the disorder cope with it?

The Challenge of Treatment

“There’s no diabetes that’s not bad. It’s all serious.”—Anne Daly, American Diabetes Association.
“YOUR blood tests came back with significant abnormalities. You need immediate medical attention.” The doctor’s words hit Deborah like a sledgehammer. “That night, I kept thinking there must have been a lab error,” she says. “I told myself I just couldn’t be sick.”

Like many people, Deborah thought that she was reasonably healthy, so she ignored the nagging symptoms. She blamed her persistent thirst on the antihistamines she was taking. She attributed the frequent urination to an excess intake of water. And the tiredness—well, what working mother does not get exhausted?

But then a blood test confirmed that diabetes was the culprit. It was difficult for Deborah to accept the diagnosis. “I told no one about my illness,” she says. “At night, when the family was asleep, I would stare out at the darkness and cry.” Upon learning that they have diabetes, some, like Deborah, experience a flood of emotions, including depression and even anger. “I went through a tearful period of denial,” says Karen.

These are natural responses to what seems an unfair blow. With support, however, those with diabetes can adapt. “My nurse helped me to accept my condition,” says Karen. “She assured me that it was OK to cry. This emotional outlet helped me to adjust.”

Why Serious

Diabetes has been called “a disorder of the very engine of life,” and for good reason. When the body cannot metabolize glucose, a number of vital mechanisms can break down, sometimes with life-threatening consequences. “People don’t die directly from diabetes,” says Dr. Harvey Katzeff, “they die from complications. We do a good job of preventing complications, but a poor job of treating [them] once they occur.”*

Is there hope for those who are afflicted with diabetes? Yes—if they recognize the seriousness of the disorder and submit to a program of treatment.

Diet and Exercise

Although Type 1 diabetes cannot be prevented, scientists are studying the genetic risk factors and are trying to find ways to suppress an immune attack. (See the box “The Role of Glucose.”) “With type 2, the picture is much brighter,” says the book Diabetes—Caring for Your Emotions as Well as Your Health. “Many of those who might be genetically susceptible avoid showing any sign of this disease simply by eating a balanced diet and exercising regularly, thereby staying physically fit and keeping their weight within normal limits.

Proper diet is essential for diabetes sufferers

Underscoring the value of exercise, the Journal of the American Medical Association reported on a large study involving women. The study found that “a single bout of physical activity increases insulin-mediated glucose uptake [by the body's cells] for more than 24 hours.” Hence, the report concludes that “both walking and vigorous activity are associated with substantial reductions in risk of type 2 diabetes in women.” The researchers recommend at least 30 minutes of moderate physical activity on most if not all days of the week. This can include something as simple as walking, which, says the American Diabetes Association Complete Guide to Diabetes, “is probably the best, safest, and least expensive form of exercise.”

However, exercise by people with diabetes should be professionally supervised. One reason is that diabetes can damage the vascular system and nerves, thus affecting blood circulation and feeling. Hence, a simple scratch on the foot may go unnoticed, get infected, and turn into an ulcer—a serious condition that may lead to amputation if not treated immediately.^

Still, an exercise regimen can help one to manage diabetes. “The more researchers study the benefits of regular exercise,” says the ADA Complete Guide, “the better the news gets.”

Insulin Therapy

Many with diabetes must supplement their diet and exercise program with daily testing of glucose levels along with multiple insulin injections. As a result of improved health through diet and a good routine of exercise, some with Type 2 diabetes have been able, at least for a time, to discontinue insulin therapy.** Karen, who has Type 1 diabetes, found that exercise increases the efficiency of the insulin she injects. As a result, she has been able to cut her daily insulin requirements by 20 percent.

If insulin is needed, however, there is no reason for the sufferer to feel discouraged. “Going on insulin does not imply failure on your part,” says Mary Ann, a registered nurse who cares for a number of diabetes patients. “Whatever form of diabetes you have, if you carefully control your blood sugar, you will minimize other health problems later.” In fact, a recent study revealed that people with Type 1 who kept strict control of their blood-sugar levels “had drastic reductions in the occurrence of diabetic eye, kidney, and nerve diseases.” The risk of eye disease (retinopathy), for instance, was cut by 76 percent! Those with Type 2 who keep tight control of their blood-sugar levels enjoy similar benefits.

To make insulin therapy easier and less traumatic, syringes and insulin pens—the most common tools used—have microfine needles that give minimal discomfort. “The first shot is usually the worst,” says Mary Ann. “After that, most patients say they hardly feel a thing.” Other methods of injection include automatic injectors that shoot a needle into the skin painlessly, jet injectors that literally fire insulin through the skin by means of a fine jet blast, and infusers that employ a catheter that stays in place for two or three days. About the size of a pocket pager, the insulin pump has gained popularity in recent years. This programmable device dispenses insulin through a catheter at a steady rate according to the body’s daily needs, making insulin administration more precise and convenient.

Keep Learning

All told, there is no blanket therapy for diabetes. When considering treatment, each individual must take into account a number of factors in order to make a personal decision. “Even though you may be under the care of a medical team,” says Mary Ann, “you are in the driver’s seat.” In fact, the journal Diabetes Care states: “Medical treatment of diabetes without systematic self-management education can be regarded as substandard and unethical care.”

The more those with diabetes learn about their disease, the better equipped they will be to manage their health and increase their prospects of living a longer, healthier life. Effective education, however, calls for patience. The book Diabetes—Caring for Your Emotions as Well as Your Health explains: “If you try to learn everything at once, you are likely to get confused and not use the information effectively. Besides, much of the most useful information you will need to learn isn’t found in books or pamphlets. It has to do with . . . how your blood sugar varies with changes in routine. This can be learned only over time, through trial and error.”

For example, by careful monitoring you learn how your body reacts to stress, which can cause your blood-sugar level to shoot up. “I’ve lived with this diabetic body for 50 years,” says Ken, “and I know what it is telling me!” “Listening” to his body has paid off, for Ken is still able to work full-time—even though he is over 70 years of age!

The Importance of Family Support

Not to be overlooked in treatment of diabetes is support from the family. In fact, one reference notes that “the quality of a family’s life together is perhaps the largest single factor” in managing diabetes in children and young adults.

It is beneficial when family members learn about diabetes, even taking turns attending medical appointments with the sufferer. Knowledge will help them to be of support, recognize important symptoms, and know how to respond. Ted, whose wife has had Type 1 diabetes since the age of four, says: “I can tell when Barbara’s sugar level goes down too low. She will get quiet in the middle of a conversation. She perspires profusely and gets angry for no reason. And her reactions slow down.”

Similarly, when Catherine, Ken’s wife, observes Ken becoming pale and clammy and when she sees a change in his disposition, she presents him with a simple math problem. Ken’s confused response tells Catherine that it is time to take any decision-making out of his hands and act quickly to remedy the situation. Both Ken and Barbara deeply appreciate having informed marriage mates whom they love and fully trust.

Loving family members should strive to be supportive, kind, and patient—qualities that can help an ill person face life’s challenges and can even influence for the better the course of their disease. Karen’s husband reassured her of his love, which made a big difference. Karen relates: “Nigel said to me, ‘People need to take in food and water to survive, just the same as you need food and water—and a little dose of insulin.’ These warm yet practical words were just what I needed.”

Family and friends also need to understand that as blood-sugar levels fluctuate, diabetes can affect one’s moods. “When I experience sugar-related lows,” says one woman, “I get very quiet, moody, easily upset, and frustrated. Then I feel awful about being so childish. But it helps when I know that others understand the reason for these feelings which I try to control.”

Diabetes can be managed successfully, especially if the sufferer has cooperation from friends and family members.