| Diabetes An American Epidemic: Diabetes The silent killer: Scientific research shows a ‘persistent explosion’ of cases—especially among those in their prime The rise in type-2 disease among teenagers is “extraordinarily worrying,” says Dr.Rubenstein, because diabetes can take decades to reveal its most appalling effects—including ulcerating sores, blindness, kidney failure, strokes and heart disease. “If people become diabetic at age 10 or 15 or 20,” he says, “you can predict that when they are 30 or 40, they could have terrible complications.” Diabetes is a disorder of the very engine of life, a subtle calamity at the molecular level. Its hallmark is a failure to metabolize glucose, the ubiquitous sugar molecule carried by the bloodstream to fuel every part of the body. Deprived of their prime energy supply, muscle and nerve cells slow their function, which is why early diabetes may manifest itself as lethargy and irritability. At the same time, glucose accumulates in the patient’s blood, and can reach concentrations two to three times normal and even higher. The excess is eventually excreted by the kidneys, which require copious quantities of water as a dilutant. That’s how Keith Wein, 42, a mechanical engineer from Irvine, Calif., caught his diabetes—or, rather, his wife, Michelle, did. “I thought something was wrong when all of a sudden he started drinking water nonstop,” says Michelle, a nutritionist. “He would come home from the grocery store with six or eight bottles of Crystal Geyser”—and spend a corresponding amount of time going back and forth to the bathroom. High Blood Sugar Levels Increase Pancreatic Cancer Risk CHICAGO, IL -- May 16, 2000 --- Diabetes and related health factors such as abnormal blood sugar levels, obesity and elevated serum uric acid concentrations have long been associated with higher cardiovascular disease risk. A new study by Northwestern University Medical School researchers has also linked these health conditions to increased risk for pancreatic cancer. Results of the study, which appear in the May 17 issue of the Journal of the American Medical Association, showed that risk for pancreatic cancer rose incrementally with an individual's blood glucose level The Biochemistry of Diabetes Two important consideration. The first has to do with glycosylation, the binding of glucose to proteins that leads to changes in the structure an function of the body’s proteins. In the diabetic, excessive glycosylation occurs with the proteins of the red blood cells, the lens of the eye, and the myelin sheath that surrounds the nerve cells of the nervous system. Glycosylation is not a good thing. Secondly, the diabetic produces a by-product of glucose metabolism called sorbitol. It is formed with the cell through the action of the enzyme aldose reductase. In the non-diabetic, sorbitol is formed but broken down readily into fructose, another simple sugar. This allow the sorbitol to be excreted from the cell. In the diabetic however, with frequent elevations of blood sugar levels, sorbitol accumulates in the cell and plays a major role in the complications of the diabetic. The following diseases are linked to diabetes mellitus: atherosclerosis, diabetic neuropathy, diabetic retinopathy, diabetic nephropathy and diabetic food ulcers. The diabetic has a three-times higher risk of dying prematurely of hardening of the arteries than the non-diabetic. THE TWO TYPES DIABETES Diabetes comes in two forms. Both involve problems with insulin, a hormone that helps the body stash various nutrients in cells. You can look at insulin as the finger that pushes the button on the gas pump. It doesn’t actually pump the gas, it just turns on the machine that sucks the gas out of the tank and into your car. If there’s no insulin telling the cells to pick up sugars, fats and a host of other nutrients, you’ll just waste away. If there’s too little insulin, or if your body doesn’t use insulin effectively, a condition called insulin resistance, sugar just accumulates in the blood. And while high blood sugar levels don’t make you feel bad, they are toxic to many of the body’s systems Type 1 diabetes is an autoimmune disease that destroys the body’s ability to produce insulin. Although it is usually diagnosed in young people, it can crop up in older adults. Thus the term juvenile diabetes is a misnomer, experts say. People with Type 1 diabetes must take insulin shots to live. The more common form of the disease, Type 2, usually develops in adulthood. It is a disorder caused by either the body’s inability to make enough, or to effectively use, insulin. Ultimately it is diagnosed when there is too much glucose in your blood. This form of the disease accounts for 90 to 95 percent of diabetes cases. While people inherit a tendency to develop Type 2 diabetes, experts believe that it is often inactivity and obesity that trigger the disease. DIABETES IS ON THE RISE That’s why diabetes is on the rise in this country, says Linda Siminerio, director of the Diabetes Institute at the University of Pittsburgh Medical Center. In fact, Siminerio says, Type 2 diabetes among adolescent girls is growing at an incredible rate because these teens are spending less and less time exercising. When we accumulate too much fat, our bodies become insulin resistant and we end up with skyrocketing glucose levels, Goland says. If you have a genetic predisposition, being as little as 20 percent over your ideal weight can sometimes cause blood sugar to shoot up. This means, for example, that if your ideal weight is 120 pounds and you gain 24, you may end up with dangerously high blood sugar. But even if you are overweight, exercise can help, according to a study published this month in the Journal of the American Medical Association. That study, which followed more than 70,000 female nurses for 12 years, found that exercise — even if it was just walking — could protect a woman against diabetes. The women who worked out the most were half as likely to develop diabetes as those who eschewed exercise. Even when the researchers factored out the weight-lowering effects of exercise, it still reduced the risk of diabetes. That’s because muscles at work are able to take up sugar directly from the bloodstream without any signals from insulin, explains Dr. David A. Simmons, an associate professor of endocrinology, diabetes and metabolism at the University of Pennsylvania Medical School. When muscles cells are inactive, they need insulin to turn on the pump. So, if you exercise, your insulin goes a lot further, Simmons says. All of this has me worried. Even though I run 18 miles a week, don’t have any close relatives who were diagnosed with diabetes and I’m not in any of the ethnic groups known to be at a higher risk — African Americans, Hispanics, Native Americans, Asian Americans and Pacific Islanders — |
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