<< home  < Articles

Positive health requires a knowledge of man's primary constitution and of the powers of various foods, both those natural to them and those resulting from human skill. But eating is not enough for health. There must also be exercise ... If there is any deficiency in food or exercise the body will fall sick.
--Hippocrates, 480 BCE

Source:
http://www.intelihealth.com/IH/ihtIH/EMIHC000/333/333/353293.html

Doctors Treat Diabetes Personally
August 6, 2002
WASHINGTON (AP) -- "What's the hardest thing about living with your diabetes?" Richard R. Rubin asks each of his patients.

Seldom do they say cite fear of the amputations, kidney failure, blindness and heart attacks that years of uncontrolled diabetes will cause. But often they cite sleepiness from middle-of-the-night bathroom runs.

Let's fix that, Rubin says. And with a few treatment adjustments to stop excess urination from high blood sugar, a grateful patient may be more likely to heed Rubin's prescription for the long-term diabetes control that so many diabetics shun.

Some 17 million Americans have diabetes, and experts estimate a third don't even know it. But at least half of those who are diagnosed don't control their blood sugar well enough to slow diabetes' constant erosion of their
bodies. The most sophisticated measurement of diabetes control - the A1C test - shows the nation has made little progress in a decade.

Now a growing number of frustrated specialists say it's time to shake up diabetes care, telling patients in stark terms that early, aggressive treatment is all that stands in the way of a nasty death. They also want to persuade doctors to push stronger therapies sooner.

"People are still in denial about diabetes," says Dr. Alan J. Garber of Baylor College of Medicine, who is gathering specialists to develop such a campaign.

Indeed, research suggests that patients should wait only three months to see if a prescribed treatment - first diet and exercise, then varying types and amounts of medication - controls their diabetes before changing or adding therapies. One recently published study found patients need a combination of diabetes pills plus insulin far sooner than many doctors advise.

"Patients don't want a second pill. They don't even always want the first pill," Garber said, and they really balk at insulin shots. "You have to twist their arm."

Why? Complacency plays a role. Type 2 diabetes, the main type, is so sneaky that people often don't realize they're getting worse and thus avoid stronger treatment until their bodies are badly damaged. In fact, in survey
after survey, patients tell the American Diabetes Association they know diabetes can kill them - it claims 180,000 U.S. lives a year - but admit they don't do enough to control it.

"For whatever reason, they forget it," sighed association medical director Dr. Richard Kahn, who says Garber's campaign to scare people into treatment just might work.

But there's a fine line between making people anxious enough to follow treatment and overwhelming them, cautions Rubin, a psychologist and certified diabetes educator at Johns Hopkins University.

Rubin isn't part of Garber's campaign but of another growing movement in diabetes: researching just what motivates patients to change behavior. Diet and exercise, for example, are more effective than drugs at lowering blood sugar during early diabetes - and the government just started a 5,000-patient study to prove whether it prevents diabetes-caused heart disease, too - but keeping the pounds off is difficult.

Hence Rubin's theory that tackling day-to-day diabetes concerns, like late-night bathroom visits, works better than big lectures about blood sugar or weight. "Unless I find something the person is really concerned about and really wants to change, it's all just talk."

While scientists debate improving care, how can patients tell if they're properly treated today? Get those A1C tests. They measure glucose control over time, and patients are supposed to get the $15 to $30 tests every three months - yet hundreds of thousands skip them.

A normal A1C level is a score of 6; U.S. diabetics average a dangerous 9. Specialists recommend diabetics drop to 7 or below, because every point-drop lowers the risk of diabetes complications about 25 percent.

Typically A1C testing requires a laboratory blood sample; the doctor calls with results a few days later. Metrika Inc. recently began selling on-the-spot tests for use in doctors' offices or at home, contending that immediate results can spur diabetics to seek more aggressive treatment. Aventis Pharma, maker of a once-a-day insulin, is funding a 14,000-patient study that, among other things, seeks to prove if on-the-spot A1C testing helps.

Don't let your doctor shrug off a high A1C test, advises Norman Hente of Granite City, Ill. His was too high for years until Hente - scared he'd end up like a diabetic friend who lost both legs - left his regular doctor to enter a specialist's clinical trial of insulin, and dramatically improved. "People have to take care of themselves," Hente says.
 

On 8/10/02 at 9:20 PM Clyde Gittins wrote:

>Supposedly, on Sat 10 Aug 2002 at 10.50PM [I'm writing at 8.31PM]
>Melissa BEE wrote, distinguishing between Diabetes insipidus (DI) and
>Diabetes mellitus (DM) [this is the 'mel', meaning honey or something
>sweet, in mellifluous, mellow I think, and mead].

That's me .... the meaning of the name Melissa is honeybee (Greek)

>   I forget which is which. My recollection is the one we used to call
>'juvenile onset' is now called Type 1, and 'adult onset' Type 2.
>   My next recollection is that in Type 1 the body fails to produce
>insulin, but in Type 2 while the body still produces insulin, for some
>reason it fails to do its job. Perhaps someone can improve on my vague
>statements.

Which pretty well sums it up.
I checked with my textbook and it says:

"There are two types of Diabetes Mellitus. In type I, or insulin-dependent diabetes, the beta cells are destroyed and produce little or no insulin. This accounts for about 10% of the cases of diabetes in this  (note this is an American book) country. About 90% of people have type II, or non-insulin dependent diabetes.

Type I diabetes is also called juvenile-onset diabetes, because it is usually diagnosed in people under the age of thirty.  Type II or mature-onset diabetes, diagnosed in people over thirty.

Melissa BEE
 

>Supposedly, on Sat 10 Aug 2002 at 10.50PM [I'm writing at 8.31PM]
>Melissa BEE wrote, distinguishing between Diabetes insipidus (DI) and
>Diabetes mellitus (DM) [this is the 'mel', meaning honey or something
>sweet, in mellifluous, mellow I think, and mead].
>    I forget which is which. My recollection is the one we used to call
>'juvenile onset' is now called Type 1, and 'adult onset' Type 2.

You're half right. Type I diabetes is "juvenile onset" and is caused by lack of active insulin. Type II is "late onset" and is caused by insulin resistance.

Diabetes insipidus is a completely unrelated problem caused by inappropriate ADH metabolism (ADH controls the amount of urine the kidney makes). DI causes a hormonal increase in urine production and is extremely
dangerous. But it doesn't have anything to do with insulin or sugar.

Chris Lawson

On Sunday 11 August 2002 08:10, Melissa wrote:
> I checked with my textbook and it says:

>
Which only goes to show that medical textbooks date as quickly as
computer textbooks nowadays.

> "There are two types of Diabetes Mellitus. In type I, or
> insulin-dependent diabetes, the beta cells are destroyed and produce
> little or no insulin. This accounts for about 10% of the cases of
> diabetes in this  (note this is an American book) country. About 90%
> of people have type II, or non-insulin dependent diabetes.
>

Type II diabetes is not "non-insulin dependant diabetes".  Many (most) Type II diabetics will progress to become insulin dependant and not just because they can't use the insulin properly, eventually the manufacture (the beta cells) decreases and stops.  At that time there is no practical difference between a Type I and a Type II and the only way anyone would know would be by knowing the patient's history.

When diagnosed with diabetes my doctor informed that there was more than one chance in three that I would be insulin dependant within ten years.

"Controlling" diabetes is an attempt to delay the onset of insulin dependance to beyond the lifespan.

But becoming insulin dependant does not turn a Type I into a Type II.
 

> Type I diabetes is also called juvenile-onset diabetes, because it
> is usually diagnosed in people under the age of thirty.  Type II or
> mature-onset diabetes, diagnosed in people over thirty.

One of the reasons for moving away from the 'juvenile' and 'mature-onset' designations is the fact that juveniles are now coming down with 'mature-onset' due to deteriorating (or maybe some would call it improving) lifestyles.  Which (even apart from the human tragedy) is unfortunate as the 'juvenile' and 'mature-onset'
conveyed something meaningful while Type I and Type II doesn't convey much.  The situation is far more messy now.  We all need to improve our lifestyles.
- --
Zero Sum

Chris Forbes-Ewan adds
 

Your book is not only American, it is also out-of-date. There are actually
many types of diabetes mellitus. The most common are type 2 (also known as
non-insulin dependent diabetes mellitus, NIDDM), type 1 (IDDM) and
gestational diabetes (a usually transient form that can occur during
pregnancy, but which increases the risk of later development of type 2.

To state that type 2 occurs after age 30 is no longer correct. It is now
being diagnosed even in pre-teen children. The epidemic of type 2 diabetes
is inextricably linked to the obesity epidemic.

For information on appropriate diet and lifestyle to prevent (or, if too
late, to treat) type 2 diabetes, I recommend the Nut-Net FAQ available
through:

www.nutritionaustralia.org

Click on 'frequently asked question' and scroll down.

>An interesting (at least to me) point.  Is it possiblke to "cure"
>(note the quotes) type II diabetes or glucose intolerance?
>
>My blood sugar for the last three mornings (in fact the last three
>weeks) has not been indicative of diabetes. eg 3.2, 3.8, 4.2 and
>those were not alcohol free nights.
>
>Is it possible to reverse the damage?

I am not an expert on diabetes, but my experience in treating it is that you can't "cure" it and won't be able to unless genetic engineering or some other technology comes along. But you can change your diet and exercise,
take tablets if necessary, and get your diabetes under control so that you don't get high sugar levels. And since high sugar levels seem to be the culprit behind the complications of diabetes, this means you can avoid all the nasty effects. In principle.

Can you reverse damage already done? Probably to a small extent.  Unfortunately most of the damage done by diabetes is permanent. By controlling your sugar levels, you can reverse the active pathology, which means you can get an improvement in kidney function, etc., but this is only on the surface. Mostly, you can't get it back just be controlling your sugar. You can stop it getting worse though!

regards,
Chris Lawson

On 1/9/2002, Zero added a link

http://news.bbc.co.uk/2/low/health/2225404.stm

Tattoo to monitor diabetes

Scientists are developing a smart tattoo that could tell diabetics when their glucose levels are dangerously low.

Once perfected, the tattoo will allow glucose levels to be monitored round the clock, and could allow an alarm
system that would warn the diabetic if their glucose levels were to fall dangerously.