Another Eight Million Diabetics?  What's Going On?

If you are middle aged and even a little overweight or out of shape, you should read this article. If you are not, but care about someone who is, you should give this to them. There is bad news about how many people have diabetes in our country. It is news that reinforces the incredible cost of obesity and lack of exercise to individuals, to their loved ones, and to our economy. An ominous report from the Expert Committee of the American Diabetes Association was issued as part of the ADA’s 57^th Annual Scientific Sessions, held in Boston this June. The report lays out the numbers and the newer much stricter guidelines that will be used by health professionals to make the diagnosis of diabetes in an attempt to treat it sooner, rather than later or not at all.

There are now 8 million Americans with diabetes. Seven hundred thousand are young people with diabetes type 1, a form of the disease that usually comes from the destruction of the portion of the pancreas that makes insulin. Type 1 diabetes, therefore, is a disease brought about by not enough insulin. The report, and this column, are not about these individuals.

On the other hand, the report does focus on the other 7.3 million diabetics, called type 2 diabetics. These diabetics, who frequently have a genetic tendency to get the disease and then develop it primarily because they become overweight and out of shape, are now going to be joined by an additional 8 million Americans with the disease. Why? How did we instantly develop twice as many people with this silent killer?

To quote Dr. James Gavin III, chairman of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus, "We now have conclusive data from population-based research that shows serious complications of diabetes begin earlier than previously thought…" These complications include " an ever-upward spiral of blindness, kidney failure, amputations, heart disease and stroke caused by this insidious disease." What this means is that medical studies have now proven that doctors should be making the diagnosis of diabetes sooner, based on lower blood sugar levels than previously thought necessary.

Blood sugar is measured as a number expressed in milligrams per deciliter (mg/dl). In most laboratories a normal fasting blood sugar(FBS), also known as a fasting plasma glucose, falls in the range of 60 to 100 mg/dl, or perhaps 60 to 110 mg/dl. Research has also proven that many, many, people who are not yet diabetic, even by the new tougher diagnostic standards, are in a dangerous "nearly diabetic" state. Studies now suggest that these people, too, are at great risk of premature heart attack and stroke. Let’s take a look at some of the new guidelines.

• fasting blood sugar readings of 126 mg/dl, on two different days, lowered from a previous reading of 140 mg/dl or higher.

• A random glucose (blood sugar) level, taken at any time during the day, that is 200mg/dl or higher, combined with any of the classic symptoms of diabetes including increased urination, increased thirst, or unexplained weight loss.

• An oral glucose tolerance test (OGTT) value of 200mg/dl or greater at the two hour sample. The OGTT has long been held as the "gold standard" for the diagnosis of diabetes. After an eight to ten hour fast, a weight adjusted high sugar drink is consumed and a series of blood sugar tests are performed. Doctors will now be encouraged to only perform the OGTT in cases of doubt, since the fasting blood sugar test is so much cheaper and is just as reliable.

• Although informative, the fingerstick method of determining blood sugar, the one frequently done at health fairs and in the doctors office, is not to be considered diagnostic for diabetes. There is too much variability in measuring accuracy to use the fingerstick technique as a definitive diagnostic tool. A direct sample of blood from a vein is what works.

• Patients in the zone of "not normal but not quite overtly diabetic" that includes fasting blood sugar levels from 110 mg/dl to 125mg/dl, must now be looked on as patients who have "impaired glucose metabolism", a definite problem, and are at great risk for developing future diabetes and cardiovascular disease.

The report from the ADA conference then goes on to list who should be tested. This includes people who:

• are obese (more than 20% above their ideal body weight);

• have a first degree relative (immediate family member) with diabetes;

• are members of an ethnic group considered at high risk for diabetes(African American, Native American, Hispanic, Asian);

• delivered a baby weighing more than nine pounds or had gestational diabetes, a condition that can arise during pregnancy that usually disappears after delivery, but can lead to type 2 diabetes in later years;

• are hypertensive (high blood pressure) with readings at or above 140/90;

• have an HDL cholesterol level(the "good" cholesterol) of 35mg/dl or lower and/or a fasting triglyceride level (another type of blood fat) of 250 mg/dl or higher.

• on previous testing are known to have had fasting sugars between 110 and 126 mg/dl.

The reason I have listed all of this information for you, other than the fact that I think it is really important, is this: After seventeen years of practicing as an internal medicine specialist there isn’t much that scares me, but these numbers really do. What is so frightening to me, and also to people who study large populations for disease trends, is what all of this overweight and out of shape business is going to cost in human suffering as well as in real dollars. Our national bill for diabetes care is currently about three to five cents on the dollar. As millions more people are diagnosed with diabetes, it is projected that ten cents our of every health care dollar will soon be spent to treat diabetes. Wow. What a terribly high cost to all of us, individually and collectively, for not being able to sustain a program of healthy eating and physical activity.

The fact that one-third of all adult Americans are obese, and that one-third of all American children between the ages of six and seventeen are now overweight and out of shape, is not dependent on a lack of information in the marketplace about what constitutes good nutrition and proper exercise. Thirty-five to 40 million adults in this country overweight and out of shape is just too many people to say that what we have here is a lack of intelligence.

As a society we continue to look outside of ourselves for the answer. How about pills? How about surgery? How about fats that we can put into foods to make them taste good but that our bodies can’t absorb? The first two are loaded with cautions, risks, and poor long term results. The last simply gives you stomach upset, diarrhea, binds up the vitamins in your foods so you can’t absorb them, but does help those chips taste better. Yummy.

The answer to the healing/curing of a chronic disease like diabetes, or its precursors obesity and lack of exercise, must come from inside of us. There is a part that exists within all of us that knows how to be well, if just given the proper combination of information, insight, inspiration and motivation. We could all use more information about healthy nutrition and fitness, but the overweight person usually can’t use such information successfully. There is simply too much of an internal "conversation" in the moment to moment thoughts of these folks, a negative conversation that constantly reminds them of their inability to keep their promises to themselves, to trust themselves, and to forgive themselves. They hardly ever live up to their own expectations

It is always fascinating to me to observe how loving and compassionate my patients are with the people they love, and how brutal they are with themselves when they don’t live up to their own way-too-high standards about eating healthy or exercising. It is only when people are able to see, through coaching and commitment, that there is a new possibility for being well which must be created from within, that miraculous results can occur.

On Thursday, August 21, the To Life! Lifestyle Change Workshop begins again at Columbia Medical Center, Lancaster. This will be the fifteenth time in the last three years that my staff and I will lead this six week workshop. The very first To Life! patient was an obese out of shape diabetic woman. With a lot of hard work and life’s normally to be expected ups and downs, she persevered until she rediscovered within herself her natural ability to be well. She lost 200 pounds, kept the weight off, exercises regularly, and no longer has diabetes.

The new diagnostic criteria from the ADA are a warning to all of us. What we have suspected all along, that mind, body, and spirit are indeed all inter-connected, is true. How you fuel your body and how you move your body makes all the difference in how you view yourself and your world. If you cross the threshold and exceed your body’s limits to stay balanced, life will begin to devolve instead of evolve. When people come to see that who they fundamentally are as powerful human beings is not necessarily who they think they are, and when they couple such insights with a new level of understanding about how their body works, they can begin their journey of healing from the inside-out.

If you or someone you care about is suffering from type 2 diabetes, or is overweight and out of shape enough to be a potential candidate for this disease, I invite you to call my office to find out more about the upcoming six-week To Life! program, a place where this journey can begin. To Life!
 

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