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SANJAY GUPTA MD
Diabetes: The Growling Epidemic
Aired April 9, 2011 - 07:30 ET
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
DR. SANJAY GUPTA, HOST: Good morning. I'm Dr. Sanjay Gupta.
Today, we're talking about diabetes. In fact, we're dedicating a whole episode to the concerns about this growing epidemic.
You know, it may surprise you to hear that researchers say half of Americans, all Americans, will either be pre-diabetic or diabetic by 2020.
It's an illness that affects almost all of us in some way. In fact, chances are, as you are watching right now, you may know someone who has a form of diabetes.
So, why is this illness at epidemic proportions, especially here in the United States? And how can we as a nation fight this deadly condition? That's where we're going today.
Let's get started.
GUPTA: Now, health officials say diabetes could become the epidemic of the 21st century. Think about that. Studies say, again, if we in the United States keep living sedentary lifestyles with poor diets, hardly any exercise, then half of all Americans will either be pre-diabetic or have diabetes by the year 2020. That is less than 10 years from now.
Let's take a look at this map from the CDC. Take a look at those dark blue areas, especially in the Southeast, the Appalachian states, and parts of the Southwest. Those are areas that have the highest number of diabetes cases. We show you this because we want you to look at this map now that shows the highest levels of obesity. They are pretty much the same areas.
So, what does obesity have to do with diabetes? Well, in order to answer that question, we need to look at what causes the illness in the first place.
Diabetes is caused when there's too much glucose or sugar in the body. Now, we, of course, get sugar from the things that we eat. And the body is designed to process sugar so it can enter our cells and provide us with energy. But glucose can't enter our cells without insulin. That's a hormone that's produced by the pancreas.
Now, if you have diabetes, your body isn't making enough insulin or is not making enough insulin, or it can't properly use the insulin it is producing. As a result, you get too much sugar, stays in the blood. And if this occurs over a long period of time, it can lead to serious medical problem.
Now, there are two main types of diabetes. People call them type 1 and type 2.
Now, type 1 diabetes is used to be known as juvenile diabetes because it's usually diagnosed in children and young adults. Roughly about 5 percent to 10 percent of all with diabetes have this type 1, which is not reversible because their pancreas is simply not producing enough insulin.
The remainder have type 2 diabetes. And for these people, their body can no longer process insulin correctly. That's the way to think about it.
Some people with type 2 have a genetic predisposition for it, but the majority developed the condition because they're overweight. People who carry excess weight, especially in their midsection, are more likely to develop type 2 diabetes because the fat in their tissues causes imbalance of insulin in the body, the insulin is also called insulin resistance.
And some minority groups such as African-Americans, Hispanic, certain Asian Americans have a higher risk of developing diabetes type 2. Now, because of the way their bodies store fat and their genetic makeup, it sort of puts them at this increased risk.
But the good news is this: in some cases, with diet and exercise, that alone, type 2 diabetes is reversible. Not everyone can do it, but some of them may need the help of medications as well. It all depends on your willingness in some ways to make some drastic changes.
GUPTA (voice-over): This is the story of two men. Both are successful, active, have families. And both have been diagnosed with type 2 diabetes.
Robert Howard, Sr. grew up surrounded by diabetics. His parents had diabetes. His siblings had it. But when he was told he had type 2 diabetes in 1996, he was in denial.
ROBERT HOWARD, SR., DIABETIC: I was really shocked. I kind of didn't believe it although it was in my family because I was kind of asymptomatic. I hadn't any symptoms.
GUPTA: It took Howard almost a year to go to a diabetes specialist because he didn't want to conform to the lifestyle.
HOWARD: Diabetes -- I mean, that's a headache. I mean, you have to control your diet and so much stuff.
GUPTA: Jonathan Legg's father died of a heart attack in his 40s. So, he was always watching his health. Although he had gained some weight after college, he was still active. Two years ago, Legg was in his late 30s when he was diagnosed with type 2 diabetes. It opened his eyes.
JONATHAN LEGG, DIABETIC: It was a big wake-up call, more than anything that wasn't what I was doing and what my current weight was not OK.
GUPTA: The doctor wanted to put him on medications but Legg said he'd rather try and turn his diabetes around with diet and exercise.
LEGG: I wanted to know that changes I was making were making a difference and it wasn't the drug.
GUPTA: Now, both Robert and Jonathan got their diabetes under control. In fact, one of them reversed it all together. We're going to show you how they did it, their trick, so to speak, that's later in the show.
And, next, you've heard the statistics and they are staggering. So, what is causing the number of diabetes cases in the United States to skyrocket? Could it simply be that we're becoming a heavier nation?
I'm going to sit down and talk to a leading expert on obesity about how we can help the next generation. That's next on SGMD.
(BEGIN VIDEO CLIP)
GUPTA (voice-over): According to the Centers for Disease Control and Prevention, almost 26 million children and adults have diabetes. Approximately 79 million or one-third of adults are pre-diabetic. And 1.9 million new cases of diabetes were diagnosed in people over the age of 20 last year alone.
(END VIDEO CLIP)
GUPTA: The numbers are pretty hard to digest and pretty staggering.
So, today, to help us, we have Dr. Gary Foster. He's director of the Center for Obesity Research and Education at Temple University in Philadelphia. He's also a former president of the Obesity Society.
Welcome to -- welcome to the program, Doctor.
DR. GARY FOSTER, TEMPLE UNIVERSITY: Thank you. It's a pleasure to be with you.
GUPTA: These numbers are staggering. People paid a lot of attention to the fact that they say a third of Americans may have diabetes by the year 2050. People seem to understand diabetes or know about it at least somewhat. What's going on here? Why do you think these numbers are expected to continue increasing?
FOSTER: I think what's behind this is the epidemic of obesity. They are often called "twin epidemics" of both diabetes and obesity. We know that adverse body weight adversely affects every organ system in the body. So, it shouldn't be surprising as obesity increases, as it has over the last 30 years, that medical conditions, especially conditions like type 2 diabetes, will also increase.
GUPTA: This is the sort of work you do. And, you know, as a television person who's a doctor, I talk about this issue all the time. People seem to intuitively understand obesity and what causes it and that it's really problematic.
Why don't people act on that? Why doesn't the message seem to get through?
FOSTER: I think the message does get through, but I think there's a big disconnect between knowing something, much like people can know it's not good for you not to wear a seat belt. It's not good for you to smoke. It's not good for you to not exercise. These are tough behavioral things, especially on the eating and activity side.
So, we're placed in an environment where we asked our patients to swim upstream chronically -- so there are lots of bombardment to eat more and to move less and we're asking them to do just the opposite. So, it's a lot harder than it seems.
GUPTA: Have you come across things that work? What seems to actually make an impact?
FOSTER: I think what makes an impact is to first start with children, and because that's where the -- that's what's going to drive the future generations of diabetes. As you well know, there are now childhood cases of so-called adult diabetes or type 2 diabetes.
And I think when it comes to childhood obesity, there's three things that you can focus in on. And this would be, I think, generally relevant to adults as well. One is to decrease portion size. We have a portion distortion going on in this country about what's an appropriate portion to consume. So, that would be one thing.
I think simplicity counts here. Worry less about fat, fiber, carbohydrates, protein. And whatever you're eating, eat a little bit less with that. Operationalize it as about a third less, a quarter less and make that small change.
Second, spend less time in front of screens, whether it's watching DVDs, computer games, TV. That will make a big difference.
And then the third factor would be to decrease consumption of sugar, sweet and beverages. We as a country drink too many calories. If we get children especially to focus on water and skim milk, it would make a big difference.
GUPTA: I worry about diabetes just because of the genetic likelihood. By the way, really, quickly, you said type 1 versus type 2. Type 1 used to be considered juvenile or kids because of genetic causes and type 2 because of lifestyle changes.
But we're seeing kids develop diabetes that was traditionally associated with lifestyle changes -- too much weight. What is the -- is there a misconception about diabetes? People always say to me, if you eat a lot of sugar, you're going to get diabetes. Perhaps. But that's because of obesity, right?
What are other misconceptions about diabetes?
FOSTER: I think that's a major misconception. When it comes down to obesity, it's consuming more calories than your body burns and obesity, independent on how you got there, whether you ate too much sugar, too much fat, too much carbohydrate, too much protein, it's obesity that leads to the consequences of type 2 diabetes, actually developing type 2 diabetes. Obesity leads to developing type 2 diabetes. And from type 2 diabetes, consequences will happen.
You're right that type 2 diabetes certainly has genetic components, but the increase has to result from lifestyle factors. And what we're seeing is that the lifestyle factors that used to not bear its fruit so to speak until the 40s or 50s of an adult life span is now happening in teenagers. It's really troubling for what's both the individual consequences for the children who suffer from this, but the economic consequences of type 2 diabetes for our country.
GUPTA: There are foods out there that are obviously worse for you. And they are plentiful, especially in urban locations.
What do you do about that? It's easy to get unhealthy food, Doctor, is I guess what I'm saying. It's cheap. It's easily assessable. What should be done about that?
FOSTER: There's an impending national menu labeling law which I think will help, that will put in chain restaurants what are the calories of the foods that people are buying at the point of purchase. That could be a big help. I think that we could do a better job in city planning of making it easier again, not making it hard for people to swim upstream all the time, to make it easier to bike. Make it easier to walk.
Taxes have certainly been considered on certain foods. I'm not sure there's the political will to do that. But a smoking precedent would suggest that that may decrease the consumption of some unhealthy foods.
GUPTA: We have 40 years before the staggering number takes effect. And, hopefully, some things at least making our cities more healthy, will make a difference at that time period.
Doctor, thanks so much for being on the program.
FOSTER: My pleasure.
GUPTA: All right. So, here's a question: what do a lizard and huge oxygen tank have to do with diabetes? We'll answer that question. That's next.
GUPTA: And we are back with a very special edition of SGMD, "Diabetes 20/20."
You know, millions of dollars are spent every year on diabetes treatment, research, prevention. And as technology improves, so does care of diabetes. But monitoring and controlling blood sugar is the key to preventing diabetes complications, like poor circulation, heart problems, high blood pressure, kidney disease, amputations and even death.
Now, products such as these insulin pens that you're looking at and also painless glucose monitors can help diabetics keep sugar levels in check with very little effort. A lot of the glucose monitoring systems look something like this. You have a little needle that's placed in a kit here.
You basically take that and cause a little prick there in your finger. You get a little bit of blood. You take a strip over here, you place that in a glucose monitor over here. And if you turn that, you basically, you get a little bit of blood on the finger, you place that on the strip, and it gives you a reading. It's so important to get those readings.
And in patients who have to take insulin, there are pumps as well that can be implanted in patients that monitor their insulin levels and alert them when the levels are to low or too high.
Now, others take drugs to help insulin actually work better. Now, many of those medications can also cause minor weight gain.
Last November, there was an interesting report presented to American Heart Association found a drug that was made out of the saliva of a lizard known as the Gila monster, helps diabetics keep their glucose levels down while also helping them lose weight.
So, there are always things being developed and there are other drugs as well in the research pipeline.
Now, even with all these new technologies, diabetics can still become ill. And that's what we're talking about today. What might surprise some of you is that one of the most common and most dangerous problems is actually injuries of the foot. That's because diabetes constricts the blood vessels, can also damage the nerves, causing neuropathy, numbness of the hands and feet.
But because we can't see our feet as well as we see our hands, you get an injury on your foot sometimes too late by the time you notice it. That's what happened to this next woman. (BEGIN VIDEOTAPE)
GUPTA (voice-over): Tynetra Herndon-Duke is a type 2 diabetic. So, when she broke her toe a few months ago, she never even knew it, until it began to turn dark.
TYNETRA HERNDON-DUKE, DIABETES PATIENT: My foot was hard and my toe didn't look right.
GUPTA: Her doctor diagnosed her with a major infection. It was so severe surgeons had to amputate her toe.
DR. SHARON HENRY, UNIVERSITY OF MARYLAND SHOCK TRAUMA CTR.: Generally, an injury that's minor can occur and before you know it, it gets out of control.
GUPTA: Because Tynetra's amputation left a large wound, doctors recommended she have treatment in a hyperbaric oxygen chamber. Designed to infuse large amounts of oxygen into the blood stream, the chamber is used to heal wounds much quicker and with fewer side effects.
DR. ROBERT ROSENTHAL, DIR., HYPERBARIC OXYGEN MEDICINE/UMMC: By putting a person to a hyperbaric chamber, we're essentially able to super saturate their blood, allowing oxygen to reach areas that normally aren't reached by oxygen and help in the healing process.
GUPTA: After several treatments, Tynetra's wound has healed -- something her doctors thought would never happen when she first came to the emergency room.
GUPTA: And I can tell you, Tynetra was actually treated in a smaller chamber than this one. These chambers are catching on as an excellent treatment for wound healing. And as a result, they are popping up all over the country.
Now, for many diabetics being diagnosed with the illness comes as a shock because many never have any symptoms or they are so subtle that they had no idea.
Teen heartthrob Nick Jonas of the Jonas Brothers didn't know he had diabetes either. How has it changed his life? We'll talk about that next on SGMD.
GUPTA: Welcome back to our diabetes special.
You know, millions of people today are living with diabetes and they don't know it. Sometimes, the symptoms like exhaustion, thirst, frequent urination, weight loss are so subtle that people never realize they're ill until the symptoms get worse, forcing to go to the doctor.
In fact, that's what happened to teenage rock star Nick Jonas.
GUPTA (voice-over): The Jonas Brothers had been one of the most successful young acts for the past several years, having sold millions of records and entertaining audiences all over the globe. They just completed a world tour, which took them from the United States to Argentina, Brazil, Europe and the United Arab Emirates.
Now shortly after the group signed their first recording contract, Nick, the youngest Jonas brother, was diagnosed with type 1 or juvenile diabetes.
NICK JONAS, JONAS BROTHERS: I was diagnosed November of 2005. So, I was about 13. I lost 15 pounds in a total of about three weeks, which was a bit startling considering I only weigh about 105 pounds to start with.
GUPTA: Nick was told his blood sugar was over 700, a normal level is below 100.
JONAS: My commitment to myself on the way to the hospital was that I would not let this slow me down.
GUPTA: Nick has learned to live with his disease and hasn't let it get in the way of the Jonas Brothers' success.
Two and a half years after his diagnosis, on a day when Nick says his blood sugar was a little out of control, he wrote a song about having diabetes. He says writing a little bit longer was therapy for him and fans have told him it's helped them cope as well.
JONAS: I think just the fact that I can say, look, you're just like everybody else, you can do what you want to do. And you can do it with diabetes. That's the best thing in the world.
GUPTA: Jonas says he's thankful to do what he loves and uses his fame to educate people about the disease. But the Jonas Brothers' Change for the Children Foundation, Nick has been raising awareness and funds for diabetes research for several years now.
JONAS: What we can do financially is great, and I'm always happy to do that. But if there's something I can do personally to inspire or encourage somebody, that means the world.
GUPTA: Coming up next on our special SGMD "Diabetes 20/20," we're going to revisit the two gentlemen we introduced you at the beginning of the show, to find out how they did it, how they got their diabetes under control. We'll tell you. That's right after the break.
GUPTA: Welcome back to SGMD. Today, we're focusing on diabetes as you know. At the beginning of our program, we profiled Robert Howard and Jonathan Legg, two men who had both been diagnosed with type 2 diabetes. One refused to take medication, the other refused to accept the fact that he had diabetes for some time. But now, both are doing well.
The question is: how did they turn their lives around?
Let's take a look.
GUPTA (voice-over): After Robert Howard was diagnosed with diabetes, it took him a while to admit he had to change his lifestyle. An avid runner, Howard couldn't figure out how he'd become a diabetic.
HOWARD: Athletic all my life, high school, in the military, in college.
GUPTA: But once he realized his poor eating habits and his family history led to the condition, he got serious. He now gets regular checkups, keeps active. He eats on a schedule, cutting out carbs and sugars.
HOWARD: I found in managing my diabetes, you have to eat regularly, frequently, and specifically. There are things you got to eat and things you can't eat.
GUPTA: He also takes medication and monitors his glucose levels daily. His doctors say he's doing very well.
DR. MICHELLE MAGEE, HOWARD'S DOCTOR: With some further diabetes self-management education, he's now doing really well on just two pills.
GUPTA: As for Jonathan Legg, after being diagnosed with type 2 diabetes, he wanted to avoid medication. So, he went back to running. He cut out the beer he loved so much. He started eating a low carb diet and he dropped 40 pounds.
LEGG: I enjoy what I eat, but I just sort of one, basically educated myself by reading the carbs. Two, I met with a couple nutritionists and they really helped me kind of build a core game plan.
DR. LUCY MCBRIDE, JONATHAN'S DOCTOR: Cut out significant amounts of sugar in his diabetes, really changed how he ate, increased fiber, increased protein, cut back on alcohol, which is really a sugar.
GUPTA: Since his diagnosis, Legg has turned his life around. His sugar levels are normal and technically he's no longer a diabetic. His doctor notes he's an exception.
MCBRIDE: I told him, as encouraged as I was and proud and pleased, he's got to keep up the lifestyle habits for things to stay in the right direction. GUPTA: The story of two men, Jonathan Legg, Robert Howard, who dealt with their diabetes in different ways, made some changes, and are now living healthier lives.
GUPTA: You know, it's obvious that the diabetes problem in the United States is not going to be solved overnight. But people are working on it. In fact, right now, the CDC is looking at a new program that brings diabetes experts to urban neighborhoods where they can try to catch pre-diabetics before they ever develop the disease. And also because obesity is one of the many causes of type 2 diabetes, there is so much focus on weight overall.
And you may have seen this already, but there's a new federal law out there requiring restaurant chains to start listing calories on their menus. We'll see if that makes a difference.
Bottom line is this: health experts say if more people are aware of the causes of diabetes, and realize in many cases it can be avoided, it could make a difference -- a huge difference in the future, especially for our children.
Hope you learned something today about diabetes, an important topic, obviously, for all of us.
And if you missed any part of today's show, be sure check out my podcast, CNN.com/podcasting, set your DVR, 7:30 a.m. Eastern. And always remember, this is the place for the answers to all of your medical questions. Thanks for watching.