DIABETES: Dealing With A Deadly Disease

Ebony, March, 2001

DIABETES nurse Cherrel Christian has heard it all--and then some. From her post at the Washington (D.C.) Hospital Center, she has listened to her patients downplay the symptoms of their disease--and even deny they have diabetes--insisting to themselves and others that they only have "a touch of sugar" or that they're only "a borderline diabetic."

"Diabetes is a silent disease. You can have it for years and not know it," says Christian, who is also a national board member of the American Diabetes Association (ADA). "It's important that African-Americans believe that diabetes can happen to them."

When diagnosed early and taken seriously, diabetes can be controlled, and those affected with the disease can live normal, healthy lives. But when left undiagnosed and untreated, it can be deadly. While doctors say that it is fairly common to hear diabetics refer to their affliction in terms of degrees, they warn that there is no such thing. A person either has diabetes, or he or she doesn't.

The statistics alone give a picture of how serious the disease should be taken. More than 3 million African-Americans have diabetes, and one-third don't even know it, medical officials say. One in four African-American women over 55, and one in four Black men between 65 and 74 years of age are afflicted. For Blacks, diabetes is the No. 1 disease causing death, blindness, kidney ailment and non-traumatic amputations. It kills more than 182,000 Americans each year and is the country's second most costly disease, behind mental health.

Diabetes occurs when the body is unable to produce or respond to insulin, a hormone that allows blood glucose (blood sugar) to enter the cells of the body and generate the body's energy. There are two major types of diabetes--insulin-dependent, also known as type I diabetes, and non-insulin-dependent, or type II diabetes. Type II is more prevalent in African-Americans and adults over 45, accounting for up to 95 percent of the 16 million Americans suffering from the disease. Type I diabetes usually, but not always, affects children and young people.

High-risk groups include African-Americans who are over 45, and other people who are overweight, rarely exercise or have a family history of the disease. Warning signs of diabetes include excessive thirst, frequent urination, extreme hunger, irritability, unexplained weight loss, tingling in fingers or toes, nausea, fatigue and vomiting. But the only way to know if you are a victim of diabetes is to see a doctor and get tested. The disease can be detected through a routine blood test. New recommendations suggest that all adults, 45 years of age and older, be tested for diabetes every three years. For higher-risk African-Americans, it is suggested that testing begin at a younger age and be given more frequently.

Those who are at risk can reduce their chances of getting diabetes by eating a low-fat diet, exercising regularly and controlling their weight. The same applies to those who have been diagnosed with the disease and want to control it. In fact, regular exercise is crucial to the management of diabetes, and can help to keep the disease at bay forever, doctors say. Increased physical activity can help reduce the amount of insulin or oral medication needed; it can decrease the risk of cardiovascular disease; and it can help to control weight gain. In addition, exercise can improve self-esteem and counteract the emotional strain associated with having a chronic disease.

A study conducted several years ago by University of California researchers concluded that regular exercise can actually help some diabetics discontinue taking insulin permanently. In the study, 652 non-insulin-dependent diabetics were placed on a three-week daily walking program, plus they adhered to an ultra-low-fat diet (10 percent of calories from fat, 75 percent from carbohydrates). Researchers found that the diet-exercise program greatly increased participants' insulin sensitivity. Among those taking insulin, 39 percent were able to stop injecting insulin and 71 percent were able to discontinue taking oral diabetes medication.

There are many other examples that indicate the exercise-diet program approach does work, but medical experts recommend consulting with a doctor before beginning any exercise routine.

People who cope best with diabetes are the ones who are able to change their lifestyle. It begins with regular doctor visits and taking the prescribed medication aimed at either increasing the body's ability to produce insulin, decreasing the amount of glucose the liver produces, slowing down how quickly glucose gets into the bloodstream or working on the cells' ability to use insulin.

Medication can come in the form of pills, injections, or pump therapy, which consists of a pager-sized mechanism that produces a constant flow of insulin. And soon, inhaled insulin is expected to be widely available to treat those who are reluctant to inject their medication.

Doctors stress that while a good relationship between a patient and his or her diabetes team--consisting of a primary-care physician, eye doctor, nurse and dietitian--is critical, the most important thing for diabetics to understand is that a good part of remaining healthy is in their hands. It is most important that diabetics take control of their bodies through routine self-inspections, religiously taking their medication, and having the will power to exercise and eat right.