The Rising Rate Of Diabetes
Health Source Magazine November 2012
WHAT’S BEHIND THE GROWING EPIDEMIC?
Due to the large senior population in Florida, Edward Shahady, M.D., President for Medicine NF/SG Chapter, American Diabetes Association, estimates the number of those living with diabetes throughout the state may be as high as 30 percent.
Insulin is a hormone produced by the pancreas that helps the body utilize glucose. Those with diabetes either don’t make enough insulin or are unable to correctly use the insulin they do make.
Without insulin, glucose builds up in the blood causing blood sugar levels to rise.
Type 1 diabetes can happen at any age, but usually develops in children or young adults. Those with type 1 diabetes cannot make their own insulin, so must receive it through injections or an insulin pump. Approximately 5 percent of those with diabetes have type 1.
Ninety percent of those with diabetes have type 2, when the body is unable to properly use insulin, and eventually, the pancreas may stop producing
It’s more common in older individuals, those who are obese, certain ethnic groups, those with a family history of diabetes or women who have been diagnosed with gestational diabetes. It is being diagnosed more frequently in children and adolescents.
Ideally, patients diagnosed with type 2 diabetes should see an endocrinologist.“We are the diabetic experts because of our level of knowledge about the disease and its management.Diabetes is complicated, which is why in an ideal world, it needs to be managed by a specialist,” says David Sutton, M. D., Northeast Florida Endocrine and Diabetes Specialists. “However there are 24 million people with diabetes and there are not enough endocrinologists to handle that large population so a lot of care is done by primary care physicians.” Still, if blood sugar control is difficult to attain, an endocrinologist or diabetes educator may be the answer to helping a patient get on track.
Diabetes is the leading cause of kidney failure in this country. As medical director for DaVita Dialysis, Esha Kancha, M.D., estimates approximately 80 percent of the dialysis patients she treats have diabetes and 10 percent to 40 percent of all individuals with diabetes will eventually require dialysis.
High blood sugar levels can damage the intricate filtering system in the kidneys even before diabetes is diagnosed.Controlling blood sugar levels can’t reverse the damage, but it can help prevent additional damage. According to the American Diabetes Association, good blood glucose control cuts a patient’s risk of progressing to severe kidney disease by half.
And kidney disease isn’t the only serious health complication linked to diabetes. The 2011 National Diabetes Fact Sheet released by the Centers for Disease Control and Prevention includes blindness, high blood pressure, stroke, nervous system disease, amputation and gum disease as the major complications of diabetes.
“Diabetes is the most difficult of chronic diseases to manage,” says Dr. Shahady. “It really does take a village.” Blood sugar levels should be maintained as close to the normal range as possible, since both high and low levels can have serious consequences.
“People with diabetes make many choices on a daily basis,” says St. Vincent’s inpatient diabetes education coordinator, Gloria Dobies, RN, CDE.
Her goal is to “empower patients with knowledge” so the decisions they make are wise ones.
“Only 50 percent of those with diabetes receive formal diabetes education,” says Dobies. Some patients are simply never referred to a certified diabetes educator.Others may lack access to education sessions, especially those that don’t drive or can’t afford transportation costs.”
Financial barriers can also keep patients from receiving the diabetes education they need. “The economy has really affected patients seeking diabetes education,” says Memorial Hospital diabetes educator, Linda Strecker, RN, CDE. “Patients may choose to do something else with their money like pay an electric bill or buy groceries.”
Even those who learn how to manage the disease struggle with compliance.“Stress, chronic health conditions or even colds make diabetes harder to treat,” says Strecker. “It’s very hard to control blood sugar in people with chronic disease.”
Diabetes in Children
Not surprisingly, Nelly Mauras,M. D., chief of Pediatric Endocrinology, Diabetes & Metabolism at Nemours Children’s Clinic points out, children with supportive families typically fair better than others dealing with diabetes; financial stability and faith help, too. But, unfortunately, diabetes treatment is often complicated by lack of health insurance, unemployment and homelessness. “The brokenness of America is augmented by chronic disease,” she says.
“Type 1 diabetes is the second most common chronic disease of childhood,” says Dr. Mauras. Managing diabetes in a child can be a daunting task and one that affects the entire family.
Three years ago, Dr. Richard Picerno’s son, Ricky, was diagnosed with type 1 diabetes. Now age 11, his dad says Ricky handles the condition incredibly well. “He has a great understanding of his diabetes, and we’re blessed because he is a rule follower who wants to do what he knows is right.”
Still, Dr. Picerno, admits, it’s not easy. “We have the typical challenges. Ricky’s blood sugar has to be checked multiple times each day, and we check him at 2 am every morning.” Additionally, he says, the family counts carbs and adjusts insulin doses around meals to correct Ricky’s blood sugar levels. “My wife has always been strict on what we eat, in a good way, so we didn’t have to make many dietary changes.”
Electronic blood sugar monitors and insulin pumps are common tools, and clinicians are also turning to other technologies to assist in diabetes management.
Internet tools provide support and education 24 hours a day and online self-assessment programs help patients track blood sugars and insulin doses. Text messages and emails are also being used.
“Programs are starting to become more creative,” says Dr. Shahady, who is the medical director of the Diabetes Registry of the Florida Academy of Family Physicians..
The new technologies may be especially beneficial for children with diabetes. “Technology is not foreign to children,” says Dr. Mauras. “They often do better than parents.” Dr. Mauras says progress is being made toward making the pumps fully automated where insulin delivery and continuous glucose monitoring are integrated, creating an artificial pancreas.
The Picerno family has embraced available technology and Ricky uses both an insulin pump and an electronic monitor to check his blood sugar. When dining out, they use a phone app that lists the carb count for menu items in hundreds of restaurants.
Type 1 diabetes can’t be prevented, but most people who develop type 2 diabetes first start with blood sugars higher than normal, but not high enough to be called diabetes. This condition is known as prediabetes.
Diet, exercise and healthy living can be effective against prediabetes. “Lab work, including elevated blood sugars and triglycerides, can reverse and return to a normal range. But once an individual is in that place, he will always be at risk,” says registered dietician, Jenna Braddock, a nutrition expert at http://www.freshfoodperspectives.com.
Regular exercise can help control weight, lower blood sugar levels, reduce the risk of heart disease and regulate blood pressure. Reducing diastolic blood pressure from 90 mmHg to 80 mmHg cuts the risk of a major cardiac event by half.
Parents who embrace a healthy lifestyle can impact not only their own health, but also that of their children. “The best lessons about life, nutrition and health happen in the context of family,” says Braddock.
Diabetes isn’t just a national epidemic. It’s hitting home right here in Northeast Florida.Statistics from the Florida Department of Health indicate that in 2010, an estimated 11. 4 percent of Duval County adults had diagnosed diabetes.
High blood sugar levels can damage the intricate filtering system in the kidneys even before diabetes is diagnosed. Controlling blood sugar levels can’t reverse the damage, but it can help prevent additional damage.
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