Friday, January 25, 2008
Battling type-2 diabetes
Michelle Dowtin is battling type-2 diabetes
by Val Willingham

Medical Producer

21 million. I usually try not to start a blog with a number. But in this case, I'll make an exception, because the figure is jaw dropping.

21 million Americans have some form of diabetes. That's more than the entire population of the state of New York! And of those 21 million, around 90 percent have type 2 diabetes, which is usually brought on by obesity and genetics. So if you're overweight and have diabetes in your family, you're a prime candidate. But you don't have to be.

Diabetes 2 can be prevented; it just takes a few lifestyle changes. Studies have shown that even people who have Type 2 diabetes can turn the disease around, if they change their diets, lose weight and get exercise. Sounds so simple, but why is it that millions of Americans don't do it? Because changing the way you live, isn't always easy. Just ask Michelle Dowtin of Philadelphia.

Since she was a teen, Michelle has struggled with her weight. A mother of four, she developed gestational diabetes with each pregnancy. After giving birth it went away. But once her youngest twins were born, she was told she had type 2 diabetes. "The doctor tried to control it with changing my diet," she said. "That didn't work, so I had to go on medication." Michelle admits it's tough to keep to a weight-loss program. And being in her late 30s makes it even tougher.

As we age, and get into our 40s, the chance of contracting type 2 diabetes almost doubles, especially if you have a family history. Doctors say you should be thinking about diabetes when you're younger, in your 20s and 30s. Check if anyone in your family has diabetes -- parents, grandparents, siblings. Watch your weight. In some women, like Michelle, pregnancy can bring on gestational diabetes, a condition that if not taken care of, has a 20 to 50 percent chance of leading to diabetes later in life. As you get older, maintain a healthy weight. According to Dr. Guenther Boden, director of endocrinology at Temple University School of Medicine, staying slim and physically active "cuts your chances of becoming a type 2 diabetic by 60 percent."

Also, keep an eye on your numbers. Know your blood pressure and cholesterol. When you have a yearly exam, ask your doctor to take a glucose or blood sugar level. High sugar numbers can indicate you are pre-diabetic. And get off the couch!!! Even walking 30 minutes a day and limiting your calories can keep you from becoming a diabetic.

Since the new year, Michelle Dowtin has made it her goal to lose some weight. She's now on a supervised portion-control program she seems comfortable with. She hopes that by living a healthier life, she can pass on this lifestyle to her kids, so they won't have to deal with diabetes in their futures.

Do you suffer from type 2 Diabetes? Does someone in your family have it?

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My mother and my aunts all have Type 2 Diabetes, and I am on the cusp myself. I've recently turned my diet and exercise routine around, and hope to stay healthy as long as possible. I know it's a struggle, and many people have problems with it. My mother is slowly losing weight, but works two jobs and doesn't have the money to subscribe to a gym.

It's easy to say "fix it", but there are lots of issuesat the route of the bigger problem.
I was diagnosed with Type 2 diabetes 7 years ago. At the time, I was 43 years old and overweight (6'3" and 260+ lbs). My HbA1C was only 6.2 (slightly above the normal range) but I was experiencing numbness in my toes which turned out to be diabetic neuropathy. At the advice of my doctor, I began testing my fasting blood sugar daily, started exercising regularly and changed my diet (following ADA guidelines). This helped bring my fasting blood sugar level down to <100 and slowed the progression of the neuropathy, but over the next 5 years, I slowly slide off the wagon until last year I was up 300 lbs, my fasting blood sugar was up over 160 on average, my HbA1C was over 7% and the neuropathy was noticeably worse. I began taking oral medication (Glipizide), which immediately brought my sugar level down but I was told that this would not work indefinitely. I needed to do something more fundamental.

I came across the program described in Dr. Neil Barnard's book on reversing diabetes. I knew that I could lose weight again, but I didn't know how to avoid putting it back on. Dr. Barnard's program addresses this by making a permanent lifestyle change not only possible but practical. It is based on a clinical study he performed showing that a diet sufficiently low in saturated fat improves insulin sensitivity dramatically. It work for me. Combined with an exercise program, I lost 100 lbs in less than a year. My HbA1C dropped to 5.3% within 4 months and is still at this level today (one year later). I stopped taking Glipizide within 3 weeks because my fasting blood sugar was already dipping too low and the neuropathy is much less pronounced.

The interesting thing is that the diet is simple. It is a low-fat vegan diet. I would never have believed that I could be happy as a vegetarian but there are many resources that exist today (available foods, cookbooks, web resources) that didn't exist only a few years ago. And success does not rely on portion control. You can eat as much as you like. I don't go hungry.

I urge anyone who is following the sound advice of this article (i.e. lose weight) to consider Dr. Barnard's program as a means for doing so and keeping it off.

By the way, the same diet has had the added side effect of reducing my LDL levels and triglycerides. I was able to drop my statin medication (with my doctor's approval). I now take only a multivitamin and an Omega 3 supplement. I feel great! Good luck to any and all of you that are looking for a way out of this progressively debilitating disease.
Dear Val Willingham,

Many studies have shown that African Americans are better off in their health by getting their protein from plant sources (although except for weaning children with breast feeding).
In 2007, five friends and I started Tour for Health (www.tourforhealth.com)--a non-profit organization dedicated to raising awareness for diabetes control and prevention. Each of us have close friends and family afflicted by diabetes and we believe that early prevention is key in the fight against it. The goal was not only to raise money and awareness for Diabetes prevention and treatment, but to create an innovative non-profit organization to encourage our peers to live a healthy, active lifestyle.

As this blog entry notes, Diabetes affects millions of Americans and as you enter your 40's the chances of becoming diabetic increases greatly. Our goal is to challenge Generation Y to live a healthy, active lifestyle. To lead by example we have started a bike tour down the California coastline over 10 days in May. If your interested in learning furhter about our cause, please visit the Tour for Health web site.
I am a pharmacist and diabetes educator and have developed a unique program that motivates patients to increase their physical activity with the use of a pedometer.
We can monitor our calories, our cholesterol, our blood pressure and write them all down.
Using a pedometer and recording your steps has worked with over 300,000 patients to increase their steps.
A pedometer that just measures steps, can reduce your risk of diabetes, lower your blood pressure, your cholesterol and even improve your sex life, all for the cost of less then 15 dollars.
Study upon study has shown that it works.
Get yourself a pedometer and log your steps and you will find out for yourself that it works.

Steve Freed, R.Ph., CDE
Publisher
www.diabetesincontrol.com
This article implies that Type 2 diabetes is always caused by poor diet and lack of exercise, which simply isn't true -- it would be like saying that EVERYONE who gets lung cancer must have been a smoker.

My husband and I are both Type 2 diabetes. I am quite obsessive about diet and exercise, yet I still need to take twice-daily injections of Byetta to keep my blood sugar under control. My husband gets at least 10 hours of exercise a week and very carefully watches his diet, yet he has not been able to get his blood sugar controlled even with twice-daily shots of Byetta plus a once-daily shot of insulin and the maximum doses of two oral medications (metformin and Actos.)

As for the person who was able to get their diabetes under control with a vegan diet, I've been there, done that. I've been a vegetarian for 26 years, and used to be a vegan, eating nothing other than whole grains, beans, fruits and vegetables. Not only didn't this fix my diabetes, my cholesterol actually went UP (slightly) when I moved from a lactovegetarian diet to a vegan diet. Some things just aren't fixable with lifestyle.

I am sick of the media constantly blaming type 2 diabetics for their illness and implying that we all sit around stuffing ourselves. If you read to the end of the article, there is a quote from a doctor saying the risk of diabetes is reduced 60% if you are slim & active. This implies that of the 20 million or so Type 2 diabetics, 8 million (40%) would still have the disease even with an ideal lifestyle. But, most people won't understand this statistic and will just believe the first few paragraphs of the article, and leave thinking that type 2 diabetics are a bunch of lazy pigs. Thanks for promoting prejudice, CNN.
My brother had Type 2 Diabetes along with Congestive Heart Failure at the age of 27 (at 16 his blood pressure was already high). He was overweight since he was 9 and continued to lead a sedentary life along with eating lots of meat and fast food against doctor's wishes. He chose not to eat fruits and vegetables and to start walking. He died at the age of 29. We all have a choice but many of us choose to continue the "easy" life of not exercising and eating poorly. There is an easy fix to not getting Type 2 Diabetes. The question is - are you willing to work on your health?
I neglected to add - joining a gym is cheap. I go to one for $19 a month - that's less than a dollar a day!
Hi,

As a social worker in a dialysis unit I see what devastation long-term diabetes and hypertension can cause. While we do what we can to improve the quantity and quality of life with kidney failure, it is still a life of treatment and, if you are lucky, transplant. One of the issues that our inner city Detroit patients have shared is that there are no easily accessible grocery stores available for buying healthy foods. The fast food restaurants, however, are everywhere - and they all take the Medicaid Food Stamp card! What kinds of food are our citizens with the most limited resources buying, the food that most compromises their health. Equal access to healthy food and education about healthy food choices is vital in preventing the diabetes epidemic from worsening, especially among the most vulnerable of our population.

Cinda Hocking, MSW
Advisor, Children's International Obesity Foundation
Internal Energy Plus Consultant
Well I hate to dump my two cents into this being you are more interested in type 2 diabetes. But my grand daughter (age 15) has been diagnosed with type 1 diabetes about 8 years ago. She has been taking insulin shots two to three time EVERY day. She's coping well but it on heck of a life!! It affects us all in one fashion or another. I just hope they can come up with something to ease or even cure the dreaded curse. Sorry for dumping but....as her grand father it just hurts me to see her endure this disease!!!
Patient self management. Designed by Stanford University, adapted for use with chronic disease.

My community while tiny has some huge numbers with Type II Diabetes. We are a small community of 600. We have approximately 100 people who have been diagnosed with Diabete.
What was once a disease for grandparents is now being diagnosed in children as young as 11. Men and women in there early thirties are also being diagnosed.
We are doing what we can to combat this disease. But it takes time to get these types of programs in place such as... childhood obesity prevention strategies and diabetes prevention strategies.
I am hopeful that thru research and preserverance that this disorder may once again be rare and unheard of.
I was diagnosed with Type 2 diabetes about 1 year ago, I am 60. Only my father had a very mild case in the family. The doctor said it was from stress and not weight. I was on the high of normal weight and did lose 25 lbs now. I'm confused, if it isn't a strong family history or weight is it stress?
Hi Val, I have a diabetes story for you. On December 21, 2007, my son and granddaughter found me on the kitchen floor in a coma. Ihave no memory of my fall or ambulance ride or the first two days in the hospital. I had no history or symptoms of diabetes. My blood sugar level was 1786. I am 71 years old. I took no medications and rode a recumbent bike three miles daily, lift 5 and 10 pound weights at least three days a week, and use a swiss ball for balance stuff and do some fit TV stuff almost daily. I started this routine in September to lose weight and to stay strong to stay independent.
The skill of doctors and nurses and Foote hospital in Jackson MI not only saved my life, but they saved it without brain or organ damage and I will be forever grateful to them.
Now I am on Glucophage and Amaryl which is a small price to pay. I do not have to take Insulin.
I have heard of others with a 1700 blood sugar but they died.
Also, now I am now the consummate carb watcher and my blood sugar with the diet and medication stays between 90 and 122. My goal is for a perfect 100 at least 90% of the time. Lofty goal?

Judy Stage
Brooklyn MI
My father is being diagnosed diabetic now in his 50's. He has a lot of the classic symptoms (waist larger than 40 inches, gout, etc.) The doctor told him to cut out grains, rice, sugar, starches and eat more salads and vegetables.

I went to a herbalist who put me on an elimination diet years ago and I went from a size 10 to a size 4. I found out I was gluten intolerant - celiac,lactose intolerant, peanut/walnut allergy, and diabetic potential). I cut those things out of my diet and my health does good with it.

My daughter just got told to limit the same things by her doctor.

I have been told that it is common for people who are part Cherokee (Native American) to be diabetic.

I have eaten this way for over 7 years now and I have maintained a size 4 or 6 (depending on how much carb intake).

I also learned that Green tea, cinnamon and fenugreek help lower the blood sugar levels as well.

There is a lot of really good info out there but it doesn't seem as if people want to take it serious yet, until their health declines.

Thank you for providing it to those of us willing to really listen and pass it along.
Dr. Gupta,

Can you clarify for your viewers sometime what the difference between pre-diabetes and metabolic syndrome is? I am 43, am five two, weigh 180, wear much of my weight around my belly, have normal blood pressure but higher-than-normal resting blood sugar (usually between 110 and 130). My cholesterol is OK (180) even though my good cholesterol is a little low (don't have the numbers). I have been told I am a candidate for pre-diabetes. Is that the same as diabetes but not as severe? Is diabetes and metabolic syndrome related? Diabetes doesn't run in my family that I know of, although my mother's mother died of high blood-pressure-induced kidney failure at age 43, and my body type is exactly like hers. Am I doomed to get diabetes or can dieting and exercise alone fix this?? (I am planning on joining a gym this week and hope to knock 25 pounds off by summer). Thanks, Lauren in Appalachia.
In February, it will be 4 years since we said goodbye to my husband's diabetes. In a small town in Spain, Dr. Aniceto Baltasar performed the laparascopic Duodenal Switch with no gastric restriction on my normal weight hubby. That was it; diabetes gone immediately.

2 weeks later, the retinopathy went away. His vision went back to 20/20 without glasses. Then the pain in the feet was gone. But some of the nerve damage was permanent. The tingling and poor circulation will never go away.

My husband now has the cholesterol of a 10 year old. He can eat whatever he pleases including sweets. He is on no prescription medication but he does take vitamins.

Was it worth it? To us, yes. We had been picturing our retirement with me pushing his wheelchair. We made him brand new for the price of a good used car.
Just a quick comment on not being able to afford a gym membership. If you look at Craiglist or in the local want ads, you wouldn't believe how much exercise equipment is available for practically nothing. You can buy a $600 used Nordic Track for $25-$50 now. So don't use that excuse! Let your fingers do the walking online and get exercising, folks! You won't regret it and I guarantee you will feel better!
Please discuss the latest technology in glucose monitoring, CGMS (continuous glucose monitoring systems). We are fighting to have it covered by BlueCross BlueShield of ND. It is a critical technology that could assist many people with both types of diabetes, but because of the insurance company's resistance to pay for the well studied and proven technology most people cannot afford it. Thanks.
I wanted to let everyone know of a wonderful free resource for people interested in a powerful new dietary approach to type 2 diabetes.

Our organization offers free weekly online seminars on the many benefits of a low-fat vegan diet. The seminars include cooking classes and lectures by doctors and dietitians. We also offer a free online nutrition discussion group moderated by dietitians. Please join us at http://www.pcrm.org/diabetes.

Ms. Simon Chaitowitz
Physicians Committee for Responsible Medicine
Washington, D.C. 20016
My mother was diagnosed with Type 2diabetes in her 40's. She could have controlled it with diet and exercise. Easy enough..but she didn't. Now my mother is 64 years old and her pancreas has completely stopped functioning. She has been rushed to the hospital too many times to count. I love my mom more than anything yet I'm angry with her and also saddened by her actions. I am 34 years old and she has scared me enough to do everything I possibly can to prevent myself from the same fate in my 40's.
My husband was in his mid-20s when he was diagnosed with Type 2 Diabetes. He was not overweight, was an active college student and had no family history of Diabetes. While I agree that many people with Type 2 Diabetes can prevent the disease, he had no warning signs and no indicators that he was at risk. His doctors still do not know what "caused" him to get the disease. He does everything his doctors tell him to, eats a very strict diet, exercises six days a week and still has complications. To imply that if you have Type 2 Diabetes that is is "your fault" is unfair. Please be more sensitive to the fact that some people can, and do, get this disease despite being in near perfect health in all other areas of their life.

Mary Lynn
They are finding that diabetes is in fact many times a disease caused by a mutation in the mitochondria DNA. This is DNA that you inherit solely from your mother. Though some forms of regular DNA mutation inheritance exist, the mitochondria DNA disease seems to be more common. So lets get the facts straight. Diabetes is not "caused" by you being fat. Diabetes in fact CAUSES you to get fat. Or another way to look at it, Diabetes causes a misregulation in the way you metabolize glucose, so eating a regular american diet that people eat who do not have the gene mutation will result in weight gain. The severity of the disease depends on the severity of the gene mutation. So all this guilt that people feel about gaining weight when they are diabetic is useless. Instead, the best course is to except that your body does not metabolize food as well as others and to eat less and exercise more to make up for it. Since it is a dysregulation in the ability to metabilize GLUCOSE the best course of action is to eat less GLUCOSE. This means to have a higher proportion of protein and low carb foods. But a lower proportion of food overall. Basically, eat meat and vegetables. AVOID bread, grains, potatoes, and sugar. Bread and potatoes metabolize into glucose faster than even pure sugar does. So this american diet pyramid that most doctors often recommend even to diabetic patients is not so good. Good for the norm perhaps. And yes, whole grains do digest and convert to glucose more slowely, so they are better than refined grains. But they still produce far more glucose than a serving of green beans. When your body has more glucose than it can deal with in your blood the result is that your body sweeps it out with insulin and converts it to fat. So it is the SUGARS/GLUCOSE that turns to fat. Not fat. So eat meat. By all means eat lean meat when you can. But it is sugar that is the problem. Not fat. And this excessively high sugar in your blood that is followed by an excessively low sugar in your blood after the insulin sweeps it away into fat cells causes and up and down blood sugar cycle. This up and down blood sugar cycle causes you to be HUNGRY. When your blood suger gets too high you feel tired (remember feeling tired after a meal?) then a few hours later you will again crave carbohydrates to bring your blood sugar back up (remember wanting to go to the fridge just a few hours after eating?) So going on a low carb/glucose producing diet, high is protein and good green vegetables will regulate your blood suger causing a reduction in your appetite allowing you to maintain weight. So I suggest that the next time you get hungry, go for a chicken breast or some tuna and celery, and keep feeding yourself protein and vegetables every time you get hungry. In a matter of days your blood sugar will start to level out and your hunger will reduce and you will feel ohh so much better. Of coures I'm not a doctor so discuss all of this with your doctor. And this relates just to type 2 diabetes. I have no information on type 1. Here is a link for further research.

http://www.mitoresearch.org/mitodiseases2.html

BTW, I weighed 127 lbs and was a size 0 when I first started getting sick with diabetes symptoms. I also biked 10 miles a day. Thankfully I didn't buy the whole "You are getting fat because you are lazy, eat like a pig, and it is all your fault" guilt trip and I demanded to know what was wrong from the doctor. Several doctors later and tons of research I learned what I needed to keep my sugar under control levels under control. Also if you have diabetes, be sure to have your thyroid checked because a lack of thyroid hormone is also indicated to interact with the mutated genes, perhaps triggering the expression of the genes. Make sure you have enough thyroid hormone.

Best Wishes!

Lisanne
A recent study indicates that lowering blood sugar to control diabetes leads to heart problems.

Perhaps this is due to the 'shock' method of administering very large doses of insulin via syringe.

From my own personal experience caring for a now-deceased friend, in the extreme case - of insulin overdose - with subsequent blood sugar counts in the single numbers - the patient goes into 'diabetic coma'.

I believe that a 'slow drip' method such as performed with an insulin pump would be the preferred administration technique and would lead to a greatly reduced risk of heart attacks and/or heart stoppage.
I was recently diagnosed as having Type 2 diabetes. I am 34 years old, 5'5'', 130, and physically active (yes, I even have a gym membership). I rarely, if ever, eat fast food, but I do admit to having a bit of a sweet tooth. I have no family history of diabetes. For those of you stating type 2 is always preventable and caused by overweight gluttons, please tell me what I could have done to prevent it??
For the person who responded,

As for the person who was able to get their diabetes under control with a vegan diet, I've been there, done that. I've been a vegetarian for 26 years, and used to be a vegan, eating nothing other than whole grains, beans, fruits and vegetables. Not only didn't this fix my diabetes, my cholesterol actually went UP (slightly) when I moved from a lactovegetarian diet to a vegan diet. Some things just aren't fixable with lifestyle.

Thank you for sharing your experience. This is what makes a blog like this useful for people.

As a follow-up, I just want to make sure that I was clear in that I was describing a "low-fat" diet. Being vegan is just a way of getting to the right level of saturated fat intake, i.e. very low. Also, my submission is only my experience, I know it has worked for many people, but I don't know that it can work for everyone who is diagnosed with type 2 diabetes.

Also, I certainly don't think that anyone should be blamed for being the cause of their diabetes. I wish you and everyone who is struggling with these disease every success at finding a way of managing it.
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