Managing Diabetes

It's getting easier, thanks to recent advances

FRIDAY, Nov. 14, 2003 (HealthDayNews) -- A diagnosis of diabetes is never easy.

First, there's the realization you're confronting a potentially deadly disease. Then comes the doctor's admonition to pay close attention to your diet, exercise routine, medication and insulin levels. If you do so faithfully, you can keep such complications as heart and kidney disease, nerve damage and blindness at bay.

Yet several advances in recent years -- ranging from better blood sugar monitoring devices to solid research showing that a healthful diet and regular exercise offer great benefits -- have eased the burden of managing the disease.

That's a message health professionals will share during November, which has been designated American Diabetes Month.

While the cause of diabetes remains a mystery, doctors know it's triggered by the body's inability to produce or properly use insulin -- a hormone needed to convert sugar, starches and other food into energy for cells.

About 18.2 million people in the United States have diabetes, according to just-released statistics from the U.S. Department of Health and Human Services, although one-third of them are unaware they have it. Of those 18.2 million, about 5 percent to 10 percent have type 1, previously called juvenile diabetes, while the remainder have type 2 diabetes.

Diabetes is the sixth leading cause of death in the United States and is the leading cause of blindness among Americans between the ages of 20 and 74.

In type 1 diabetes, the body doesn't produce insulin. This requires people to inject insulin daily to survive and to keep their levels of blood sugar -- called glucose -- under control. If glucose levels get too high, it increases the risk of complications such as blindness or kidney problems.

In type 2 diabetes, the body doesn't make enough insulin or the cells don't process the insulin. These people are advised to lose excess weight, eat a healthy diet and exercise regularly. Some are put on oral medication or insulin to manage blood sugar levels.

In years past, diabetics had just one choice for measuring their blood sugar -- pricking their finger or forearm with a special needle called a lancet to get a drop of blood, then placing the blood on a test strip to be read by a monitor.

But in the past few years, advances in blood glucose monitoring devices have made the task much less of a nuisance, says Dr. Gerald Bernstein, past president of the American Diabetes Association and an associate clinical professor of medicine at the Albert Einstein College of Medicine in New York City.

"The major advance is the fact that you need much less blood," he says. "And it's less painful."

And most monitors now give you a reading very quickly -- down from about a minute's wait to only five seconds. That time savings can add up in the course of a day, especially if someone needs to test their blood six or 10 times daily.

The time difference "makes a substantial difference to people," Bernstein says.

Another advance: The GlucoWatch. A wristwatch-like glucose monitoring device approved by the U.S. Food and Drug Administration for adult use in 2001 and for children and teens in 2002, it works by extracting fluid through the skin and measuring the glucose in the fluid.

It can produce up to six painless measurements an hour for 13 hours.

"I don't recommend it for everybody," says Dr. Lyle Mitzner, an endocrinologist and diabetes specialist at The Joslin Diabetes Center in Boston. Typically, he will recommend it for some patients with type 1 diabetes because they tend to have more fluctuations in blood sugar. But he sometimes will advise a type 2 patient to try it, too, if he or she is having trouble controlling blood sugar levels.

Bernstein and Mitzner agree there have been no major advances recently in diabetes medication, with insulin or oral medications -- also called oral agents -- prescribed as they have been for years. Oral agents work in a number of ways, such as stimulating the pancreas to produce more insulin, Bernstein says.

A newer option to insulin injections or oral medication is the insulin pump. The beeper-sized device continuously delivers insulin to the body through a flexible tube, and can be programmed to deliver an extra dose at meal time.

There is universal agreement among experts on the role that lifestyle can play in managing -- and helping to prevent -- the disease.

In 2001, a major U.S. clinical trial called the Diabetes Prevention Program was stopped early because it found the benefits of lifestyle changes -- such as losing weight and exercising -- were overwhelmingly positive. It looked at 3,234 people with a condition called impaired glucose tolerance, which often precedes diabetes. The researchers compared lifestyle changes to drug treatment with an oral diabetes medication and with placebo pills.

While 29 percent of the group taking placebo pills developed diabetes during the study's three-year follow-up, only 14 percent of the lifestyle group and 22 percent of the medication group did. This led the researchers to conclude that lifestyle changes can delay or even prevent diabetes.

The best advice, Bernstein says, is to keep your weight down. "Maintain as close to an ideal body weight as possible," he says. That means keeping your body mass index (BMI) -- a measure of height to weight -- below 25, considered the cutoff for a healthy weight. A man or woman who is 5-foot-5 and weighs 150 pounds has a BMI of 25.

Regular exercise is also crucial, and Bernstein tells people it can be as simple as walking every day or every other day for 30 minutes at a time.

In the future, Bernstein says, there may be alternate ways to deliver insulin. One system under review is inhaled insulin, in which a portable device contains a powdered mist of insulin.

Another possibility is a device that looks like an asthma medication inhaler that would let people breathe in insulin. They would probably use it before each meal to control blood sugar levels, says Bernstein, who is on the board of directors of the company developing the system.

More information

For information on high blood sugar, see the Joslin Diabetes Center. For more information on diabetes, visit the American Diabetes Association.

SOURCES: Lyle Mitzner, M.D., endocrinologist, Joslin Diabetes Center, affiliate of Harvard Medical School, Boston; Gerald Bernstein, M.D., past president, American Diabetes Association, and associate clinical professor, medicine, Albert Einstein College of Medicine, New York City
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