“I was in denial,” he says. “I didn’t want to believe I had diabetes. I thought there was a mistake and the tests were aberrations of the true picture.” With no family history of the condition, Sloane thought his chances of developing diabetes were slim to none, but at 238 pounds (he’s five feet, eleven inches), he was at his heaviest weight ever, thanks to a sedentary lifestyle and frequent trips to the steakhouse.
Sloane’s reaction to his diagnosis is a common one, says Dr. Robert Smith, director of the Hallett Center for Diabetes and Endocrinology at Rhode Island Hospital. “People tend to focus on medical problems when they can feel them,” he says. “But diabetes doesn’t automatically make people feel bad, although eventually it can make them very ill.” Indeed, its complications can include blindness, kidney failure, poor circulation (sometimes requiring amputation of the foot or leg), and heart and blood vessel problems, including stroke and heart attack.
The stats leave no doubt that diabetes has become an epidemic in this country. “The numbers are phenomenal,” says Smith. It now affects nearly 24 million (or one in every fourteen) Americans, most of whom have type 2, according to the U.S. Centers for Disease Control and Prevention. And up to 25 percent of them don’t even know they have it. One in every seven people age sixty and older lives with the condition. Locally, the numbers reflect the national rate. Roughly 94,000 Rhode Islanders, as well as one in every four people admitted to Rhode Island Hospital, have the disease, according to Smith.
Type 2 diabetes (formerly called adult-onset diabetes) affects the great majority of people with diabetes. It occurs when the body either does not produce enough insulin or the cells ignore the insulin, which is necessary for the body to be able to use glucose for energy. Insulin normally delivers sugar from the blood into the cells, but when glucose builds up in the blood, it can starve cells for energy. Over time, high blood glucose levels can harm the body and lead to eye, heart, kidney and nerve damage. Conversely, type 1 is an auto immune disease that usually develops in childhood to early adulthood and occurs when the immune system attacks the cells in the body that make insulin.
While the development of type 2 diabetes is affected by several genetic and environmental factors, it is powerfully influenced by high caloric intake, lack of exercise and obesity. Commonly, as was the case with Sloane, people will not notice signs of the disease until it reaches an advanced stage. Symptoms include frequent urination, dry mouth, blurred vision and lack of energy. It was fatigue that drove Nancy Young, now seventy-one, of Cranston to her doctor eighteen years ago. “I had always been full of energy and even worked while I was on chemo, so I knew something wasn’t right,” she says. Her doctor eventually diagnosed her with type 2 diabetes using a simple blood test.
Once diagnosed, treatment depends on the severity of the disease. One of the most important aspects of treatment is managing diet, increasing exercise and losing weight, if necessary. In most cases, patients use insulin injections or oral medications (or some combination of the two).They act by a variety of mechanisms, including increasing the body’s insulin production, bolstering the cell’s ability to respond to circulating insulin and blocking the absorption of glucose in the gastrointestinal tract. People with the condition also have to monitor their own blood sugar levels on a regular basis, usually using a blood glucose meter or glucometer.
When Sloane eventually came to terms with his diagnosis, it hit him hard. So hard, in fact, that he started a strict diet and exercise plan that included daily exercise, adding healthy foods like veggies and lean protein to his diet, cutting carbs and eliminating sweets and fried foods. As a result, he not only lost forty pounds (which he’s kept off for two years), but was eventually able to go off of his medication and control his diabetes with lifestyle changes alone. “It [diabetes] is an ever present consideration, and that’s not a bad thing,” Sloane says. “I’ve experienced a whole lot of benefits, like dropping suit sizes. And there’s an exhilaration that comes with exercise.” As a result of getting his blood sugar back in line, Sloane has not experienced any complications from the condition.
For many others, however, complications can be debilitating. Young suffers from nerve damage, or neuropathy, in her legs. “My legs are like lead and they hurt,” she says. “I try to keep going but I’m not moving like I used to, and that hurts because I love being out and about.” Others experience blindness, the amputation of a limb due to nerve damage or loss of blood flow, kidney failure (about half of people on dialysis are on it because of diabetes) and depression.
April Silvestro, RN, coordinator of South County Hospital’s Diabetes Center and a certified diabetes educator, has worked with diabetes patients for twenty years and says depression can be a major problem for diabetics, in part due to the stress of coping with daily management of the disease. “I see people going through stages of grief,” she says. “They have to come to terms with something we don’t have a cure for that is progressive and affects everything in their life.” Depression further complicates the situation by causing patients to lose the all-important motivation required to monitor their condition and take care of themselves.
There is also a strong link between the disease and heart and vascular problems. A person diagnosed with diabetes is just as likely to have a heart attack as someone who has already had a heart attack, according to Smith. High insulin levels are thought to contribute to high blood pressure and artery damage.
“Taking care of a type 2 diabetes patient is taking care of a complicated patient,” says Smith. “We’re not just monitoring their blood sugar. We evaluate blood pressure, aggressively work to lower cholesterol levels, improve diet, provide foot care and make sure patients get regular eye exams.” Despite the seriousness of potential complications, a recent focus group study showed that participants consistently ranked the severity of diabetes as a four or five on a scale of one to ten, while heart disease and cancer regularly scored nines and tens, according to a report by the New York Times. Smith and Silvestro attribute this to the condition’s lack of immediate, serious physical signs and the fact that problems develop over time, as opposed to a heart attack, which is immediate and usually frightening. “It’s very hard to wrap your head around it,” says Silverstro. “But if every single time your blood sugar went up, you had a searing pain in your body, you’d want to keep it down.”
In addition to one-on-one sessions with physicians and certified diabetes educators, many diabetes patients attend group meetings, such as the Hallett Center’s eight-hour course on diabetes management and South County Hospital’s support group for diabetes sufferers and their families.
Along with those who already have the disease, an additional 57 million Americans and 40 percent of Rhode Islanders age forty to seventy-four have pre-diabetes. This means they have blood glucose levels higher than normal but not high enough to be classified as diabetes. Pre-diabetes puts people at increased risk for developing full blown diabetes, as well as heart disease and stoke.
Like regular diabetes, pre-diabetes can be helped or eliminated due to lifestyle changes. A study done by the Harvard School of Public Health found that being obese or overweight was the single most important risk factor that predicted who would develop type 2 diabetes. The sixteen-year study showed that regular exercise and a low-fat, high-fiber diet significantly helped prevent the disease.
“The most important thing is the number of calories consumed,” says Smith, noting that the progression from pre- to full blown diabetes is cut in half if someone adopts healthy eating habits and regular exercise.
Although type 2 diabetes used to be called adult-onset diabetes, the name has since changed, as children are developing the disease at an increasing clip. “When I was in medical school [in the seventies], children with type 2 diabetes were almost unheard of,” says Smith, adding that a child who develops the condition at age ten will have an average of nineteen years cut off of his or her life.
The disease can have some serious effects, but the good news is that diabetes is largely manageable. “I always tell people that the complications are very preventable with good blood glucose control,” says Silvestro. Since he started practicing medicine, Smith says the advancement in treating diabetes has been “unbelievable” and expects even more progress in the near future. “I think it’s an exciting time,” he says. “I think someone who gets diabetes today has a lot of grounds for optimism.”
*name has been changed