Arteriosclerotic Vascular Disease Becoming Diabetic - It Will Never Happen to Me.
Diabetes is the disease that someone else always gets. Or so we would like to believe. The fact of the matter is that diabetes is now essentially an epidemic worldwide, and it is getting worse. It has a direct correlation with our standard of living: The more overweight the population, the more diabetes occurs. America's population is generally overweight, indeed; over 3 in 5 adults are overweight, and 1 in 5 is downright obese. Children and adolescents are not doing much better, and in fact, may be worse.
The main focus of the diagnosis and treatment of diabetics is directed toward Type II diabetes, the one that develops over time. Type I diabetes is seen first in the young people who have had their own antibodies destroy the beta cells in the pancreas. The beta cells produce insulin, so essentially, they have no insulin. Type I diabetics are very brittle and complicated in their insulin needs, and are generally best followed by endocrinology specialists.
It is important to get your blood sugar checked every time you can, especially if you have a family history. Times to do this would be at annual physical exams, at health fairs, or perhaps by your friend who has a glucose meter. We want to see a fasting glucose of 70-100---fasting means no food, only water after 10 p.m. until about 7 to 9 a.m. when you should have your labs drawn. If it is between 100 and 126 (fasting), you are considered pre-diabetic, and chances are pretty good that you will develop this problem over your lifetime. If your fasting glucose is over 126 (fasting), then you are diabetic. All tests should be repeated at least once for confirmation. There are other glucose values for 2 hours after eating or specific random blood sugars, which help diagnose the condition.
The basic model is that your pancreatic beta cells produce too little insulin, and body cells have developed a resistance to the insulin which has been produced. But here's what happens: The elevated glucose (sugar) starts causing damage changes in both the tiny blood vessels, and in the larger ones, as well. The process of atherosclerosis called hardening of the arteries is started by the inflammation produced. As the disease progresses, the dreaded consequences of heart attack, strokes, blindness, kidney failure, and leg amputations may occur.
We can slow down the vascular disease by keeping blood sugar in the normal range. If every patient would walk 30-45 minutes per day and lose 5% to 7% of body weight, the insulin resistance would be markedly reduced. Doctors used to initially follow for long periods of time just emphasizing exercise and diet. Of course, diet and exercise are very important. Usually, by the time he or she is diagnosed, the patient has lost 50% of their beta cell function. Medicines are started right away to lower insulin resistance and blood sugar. One other caveat is that you absolutely have to quit smoking, as smoking accelerates the vascular damage that is already taking place. Often times, a grain of aspirin a day is given to lessen the chance of blood clots forming at the sites of arteriosclerotic plaque formation.
There are several medicines to start or add initial treatment. The first one usually prescribed is metformin (Glucophage), which lowers insulin resistance. One caveat with metformin is that it and other oral medicines should not be given in pregnancy. There are several conditions of the liver, kidneys, and heart that must be considered when prescribing all of these medicines. The next class of oral medicines which can be prescribed are the sulfonylureas. These have been around the longest, and they are time-honored. One problem with them is that they can cause the blood sugar to go too low (hypoglycemia). They cannot be used in people allergic to sulfa. The third types are those, which will not lower the sugar too low, but which have to be used with caution with people who have heart disease.
The most reliable of the medications to lower blood sugar is, of course, insulin. It has to be given by an injection under the skin or in a vein. There is one other class of drugs that is interesting. They are based on the fact that the intestines release something called incretin which lowers blood sugar when it is taken by mouth. These medicines make incretin-like body chemicals stay around longer to lower the blood sugar. Finally, there are medicines which block the uptake of glucose from the intestine.
The worst kind of body fat for diabetics to have is the fat inside the belly which is attached to the outside of the intestines. It is called visceral fat, and is the main cause of "pot-bellied" obesity. Three pounds of visceral fat is as bad for you as twenty pounds on the hips when it comes to controlling your blood sugar. So try to keep your body weight (B.M.I) Body Mass Index in the normal to ideal ranges. Get plenty of exercise and don't smoke. Your doctor can tell you if you need to be on aspirin therapy to prevent atherosclerotic blood clots. Get your blood sugar checked whenever you can, or if you are already diabetic, get a glucose meter and self-test regularly. A formal consult with a dietician is an excellent way to work out a proper diabetic diet. Eat healthy, and avoid junk foods, high carbohydrates and trans-fats. Keep that fasting blood sugar below 100 and the Hemoglobin A1C below 7%. Walk 30-45 minutes a day and work to lose weight. Take your medicines faithfully the same way each day. Together, we can work to prevent and successfully treat diabetes for this generation and the ones to come.
Arteriosclerotic Vascular Disease.