Tuesday, June 19, 2012

Fighting Type 2 diabetes for better future


Related story: Study: Type 1 diabetes is also on rise among youth.

"I always post things about it," the 17-year-old said, referring to her Facebook profile. Her mother, Rhonda Chandler, also talks about Morgan's condition on Facebook.

It's about raising awareness, Chandler said. A lot of people don't know why they're tired all the time, why they're getting headaches, why their eyesight is blurry. With a blood test they could find out whether they have diabetes.

Morgan said she started to notice something was wrong when she was about 10.

Her skin color started to change, and her complexion was getting darker. Then three years later, while visiting her father, she was at Walmart "and I had got really dizzy and was shaking and all of that," Morgan said.

Her dad took her home, and she got something to eat and felt better.

But upon returning to Tulsa and going to the doctor, Morgan underwent a battery of tests. Her A1C level - an average of her blood sugar level over the past two to three months - was high, and ultimately it was determined that Morgan, at 13, had Type 2 diabetes.

"I was just like 'whoa,' " Morgan said.

None of Morgan's immediate family members have diabetes, but an uncle of hers, recently deceased, had Type 1 diabetes.

Doctors believe Morgan's case is hereditary.

But her Type 2 diabetes diagnoses at such a young age - Type 2 is usually diagnosed in middle-aged adults and older - was once something very uncommon among young people but seems to be part of a growing trend.

Among teens in 1999-2000, the rate of Type 2 diabetes and prediabetes - a time of high blood sugar levels not exceeding the threshold for Type 2 diabetes - was 9 percent.

Last month, a study published in the journal Pediatrics reported that this diagnosis rate more than doubled in 2007-2008 to 23 percent.

Preliminary data from the Centers for Disease Control show diabetes (Type 1 and 2) was the seventh-leading cause of death among Americans in 2010. In 2011, the agency reported that the disease affected about 26 million people, or 8.3 percent of the U.S. population.

The news isn't a surprise for family physician Michelle O'Meara. She's known about it for decades.

"It's pretty sad that we are seeing this explosion of it," O'Meara said.

Prediabetic and diabetic teens are the tip of the iceberg for the physician who has seen patients as young as 6 and 7 years old with prediabetes. In her Broken Arrow office, she diagnoses prediabetes daily and diabetes nearly weekly. Type 2 diabetes can be symptomless, and diagnosing it requires a blood test.

"A lot of people may come in and feel fatigued, but some people have no idea that they have diabetes, and they come in and have an average blood sugar of 300 (mg/dL)," O'Meara said. "Normal is less than 100 fasting."

Starts at home

Genetics are to blame for some of those numbers, but lifestyle choices are a big contributing factor, O'Meara said.

The average Oklahoman gets two servings of fruits and vegetables a day, far less than what is recommended by the U.S. Department of Agriculture, she said. Fast food is everywhere, and 40 percent of the average Oklahoma family's budget is spent on food that is eaten away from home, she said.

O'Meara looks to the home as a source of the problem, as well as the solution.

She remembers herself as a little girl, playing in the neighborhood with her friends until the streetlights came on.

It's something kids don't do anymore.

"Some kids, they go home after school, they don't get exercise, they're on computers, their watching TV," O'Meara said, "and what do they do? They have their big bag of chips and their soda pop."

But Morgan is active. When she was diagnosed with diabetes, she was a cheerleader.

During the school year, she is a twirler for the marching band.

Watching her uncle's health decline, Morgan told herself she wanted her future to be different. After her uncle died of complications of Type 1 diabetes last September, it motivated her to be more vigilant about caring for herself and taking her medication.

"Basically, teens aren't watching their diets, and Type 2 comes with obesity - you weigh a lot," Morgan said. "So you can get it from that - not exercising, not eating healthy - so that's how I feel like the rate is going up."

Grim future

Lead researcher Ashleigh May of the CDC told Reuters Health that the growing trend of teens with prediabetes and Type 2 diabetes requires more research but is concerning. People with prediabetes are more likely to develop Type 2 diabetes, which puts them at greater risk for heart disease, stroke and kidney disease as they age.

"And so, unfortunately, these people who get diabetes at 14, 15 and 16 instead of 40, 50 or 60, by the time they're 30 or 40, they're going to be on dialysis. They're going to be having vision issues, they're going to be losing limbs if their (disease) is not well controlled," O'Meara said.

She calls diabetes, hypertension and high cholesterol "the triple threat." Any one of the three increases a person's chances of developing the other, and all, separate or individually, have a negative effect on life expectancy.

Morgan sees the physician who diagnosed her diabetes every four to six months. She stays active and continues to watch what she eats, careful to read the labels on food. When Morgan was first diagnosed with diabetes, her A1C was 7.5.

As of her most recent checkup, it was 5.4, which is good. The American Diabetes Association considers an AIC of 5.7 prediabetic. Morgan said she is doing well though she has noticed her vision changing.

"Just take care of yourself," Morgan said she would tell peers who may have been diagnosed with the Type 2 form of the disease. Having Type 1 diabetes - the insulin-dependent form - could be worse, she said. But with Type 2, you can manage it with exercise, by eating correctly, making sure you make your doctor visits, taking your medicine and checking your blood sugar regularly.

"That's a big part," Morgan said. "Don't stop taking your medicine. Or else you'll gain all your weight back and you'll get sick or sicker than what you were."

O'Meara's recommendations, though more clinical, are nearly the same.

The CDC predicts that by 2050, 1 in 3 adults in the U.S. will have diabetes if current lifestyle trends don't change. And the forecast for children doesn't look any better, O'Meara said.

But if families and doctors can catch diabetes early, she said, there can be a turnaround.


What is diabetes?

According to the American Diabetes Association, diabetes is a group of diseases characterized by high blood glucose levels that result from defects in the body's ability to produce or use insulin.

What is the difference between Type 1 and Type 2 diabetes?

Type 2 - or adult onset diabetes - is the most common form of diabetes diagnosed among Americans. Type 2 diabetics do not naturally produce enough insulin, or their pancreas' beta cells do not use insulin properly.

About 5 percent of diabetics have Type 1 diabetes - once known as juvenile diabetes. This form of the disease is usually diagnosed in children and young adults. With Type 1 diabetes, the body does not produce insulin.

Diabetes symptoms

Type 1
  • Frequent urination
  • Unusual thirst
  • Extreme hunger
  • Unusual weight loss
  • Extreme fatigue and irritability
Type 2

This form can be symptomless, but indications of concern include:

  • Any of the Type 1 symptoms
  • Frequent infections
  • Blurred vision
  • Cuts/bruises that are slow to heal
  • Tingling/numbness in the hands/feet
  • Recurring skin, gum, or bladder infections
Source: American Diabetes Association

Eating healthy

Dr. Michelle O'Meara encourages some guidelines:

Eat smaller portions

Check labels: Find out what a serving size is for different foods and use that when making a meal.

Less fat: Make fewer high-fat food selections, and try to cut down on your use of fat for cooking. Pay special attention to foods high in trans fat or saturated fat and limit consumption. They include: fatty cuts of meat, fried foods, whole milk and whole-milk dairy products, salad dressings, cakes, candy, cookies, crackers and pies.

Less sugar and salt: Make fewer high-sugar food selections, which can include fruit-flavored drinks, sodas, and tea or coffee sweetened with sugar. High-salt content foods include canned and packaged soups, canned vegetables, pickles and processed meats

More whole grains: Digestion of whole grains - look for labels that read "100 percent whole grains" - limits a spike in blood sugar from the carbohydrates in those foods.

More fruits and vegetables: Fresh, frozen, canned or dried fruit are preferable, as is 100 percent fruit juices most of the time, says the CDC. Healthy vegetable choices include dark green veggies (broccoli, spinach, brussels sprouts), orange veggies (carrots, sweet potatoes, pumpkin, winter squash), beans and peas (black beans, garbanzo beans, kidney beans, pinto beans, split peas, lentils).

Source: Centers for Disease Control and Prevention

Original Print Headline: Taking On Type 2 Diabetes


Bravetta Hassell 918-581-8316
bravetta.hassell@tulsaworld.com

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