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The New Silent Epidemic

Author: Janis Graham
Excerpt From: Ladies Home Journal,  November 2007

One-third of America's diabetics aren't aware they have the disease. The consequences can be nothing short of deadly. Diabetes is now an epidemic in this country. The number of American adults diagnosed annually has spiked 54 percent in the last decade and now stands at an estimated 21 million. At this very moment one-third of the estimated 19 million who have type 2 diabetes-the much more common type doctors call adult onset- don't even know they're sick.

Cathy D. Mann didn't. At 48, when she noticed she was making more frequent trips to the bathroom and her vision was getting more blurry, she chalked up the changes to age. "I figured my symptoms were just a normal part of getting older, since I was nearing menopause. It never occurred to me that I might have diabetes," says the mother of two from Providence, Rhode Island.

Mann easily could have gone months, even years, before her diabetes was detected. While the rarer type 1 form is usually rapidly diagnosed in childhood because its symptoms are so severe, people live with type 2 diabetes for an average of four to seven years before they learn the truth.

Mann was lucky: Her diabetes was uncovered by a routine urine test she took when applying for additional life insurance. Although she didn't get the extra insurance, her life may have been saved. Undiagnosed or poorly controlled diabetes can have dire consequences. Over a period of years, it can damage the blood vessels and arteries of virtually every organ in the body, leading to heart disease, stroke, blindness, kidney disease, foot and leg problems that can require amputation, nervous-system damage, even gum disease. By the time they're diagnosed, a third of diabetes patients already have evidence of cardiovascular disease. And if a diabetic woman gets pregnant and her disease isn't being controlled, she has an up to 20 percent risk of miscarriage and a 10 percent risk of giving birth to a child with a major birth defect.

Diabetics and their babies aren't the only ones in danger. Half of American adults over age 40 have blood sugar levels high enough, to put them in the gray zone now called prediabetes, which gives them a 30 percent risk of developing full-blown type 2 diabetes within three years. It almost goes without saying that most prediabetes don't know they're at risk, either.

Women with type 2 diabetes need to be especially concerned. They have twice the risk of heart disease, are likelier to have high blood pressure and have a higher chance of death from heart attack and stroke than do men with type 2. Treating the heart and blood-pressure aspects of diabetes is now thought to be as urgent and potentially lifesaving as controlling blood sugar. Yet women are less likely than men to recieve aggressive management of their diabetes-related coronary artery disease or some of the recommended treatments, including lipid-lowering medications and aspirin, according to a 2005 Harvard Medical School study of 4,000 patients with diabetics. "Many doctors aren't aware that women experience diabetes differently and need somewhat different care then man," says Marianne J. Legato, M.D., founder and director of the Partenership for Gender-Specific Medicine at Columbia Universitry and lead author of a groundbreaking 2006 review that gave doctors specific recommendations for caring for men and women with diabetes.

Are You At Risk?

Researchers don't completely understand why some women dodge the bullet of type 2 diabetes while others don't although it's clear that certain factors besides having had diabetes when you were pregnant increase risk. Among them:
Being Overweight
Even a modest weight gain of 11-17 pounds in the decades after your 18th birthday doubles your odds, according to a large Harvard study. Being obese (a body mass index [BMI] greater than 30) can increase them sixteenfold. Excess fat tissue produces a variety of hormones, fatty acids and other chemicals that make your cells more resistant to insulin. Where you carry you excess weight counts, too, according to a recent Harvard/University of Pittsburgh study that found the risk of type 2 diabetes increases progressively with the size of your belly, "If you're generally lean but carry extra pounds in your abdominal area, you're at a greater risk," says Florence Brown, M.D., codirector of Boston's Joslin-Beth Israel Deaconess Diabetes and Pregnancy Program. (To calculate your BMI, go to www.lhj.com/health.)

Sedentary Lifestyle
You can be thin, but if you're inactive you're still twice as likely to get type 2 diabetes as someone who exercises regularly. When you're sluggish, so is glucose delivery to cells, so you have higher blood sugar levels.

As you get older, your pancreas may start to slow its production of insulin. But you don't have to be all that old. Type 2 diabetes increased 76 percent within a single decade among people in their 30s; half of all people diagnosed with diabetes are under 55.

Family History
Having one first-degree relative with diabetes doubles your risk; having two quadruples it.

More than 6 percent of all Americans have diabetes,
but that rate at least doubles for African-Americans, Latinos and Native Americans.

People with the highest scores on a depression questionnaire were roughly 50 percent likelier to develop diabetes than those with the lowest scores, concludes a recent 10-year study at Northwestern University of nearly 4,700 adults. This mental illness may increase levels of the stress hormone cortisol, which can decrease the ability to use insulin efficiently. One bright spot: People treated with antidepressants didn't have elevated risk.

Polycystic Ovary Syndrome
Women with PCOS-a metabolic disorder that can trigger irregular menstrual cycles, thinning hair, acne, facial hair, and infertility-are at high risk for getting type 2 diabetes at a young age even if they are of normal weight, notes a study from Pennsylvania State University College of Medicine.

An estimated one in four Americans have pre-diabetes, or blood glucose levels that are higher than normal but not high enough to be called diabetes.  If your fasting blood glucose level is between 100 and 125 mg/dl (126 means you are diabetic), you should take action now.  There is plenty you can do to rewrite your health future.


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