a special program of the National Emergency Medicine Association (NEMA)
Week: 566.6 Guest: Belinda Childs, RN, President for Health Care and Education, American Diabetes Association Topic: Diabetes awareness, risk and warning signs Producer/Host: Steve Girard
NEMA: Diabetes is a killer...make no mistake about it. But it's symptoms can be vague, and seemingly unconnected... and so the American Diabetes Association puts out the word, constantly, about how at least one type of the disease can be prevented, how someone can live very well with the disease...if they follow advice and take care of themselves. Today, we're with Belinda Childs, an RN, and president for Health Care and Education for the ADA....
CHILDS: There are two different types of diabetes... and what they have that's alike is that they both cause high blood sugars. And Type 1 diabetes primarily occurs in young people and in normal weight individuals, and Type 2 diabetes occurs primarily in older adults who are overweight. The high blood sugars of both diseases are what cause the complications of diabetes...and that's what makes it really serious. And the primary defect is that the insulin either isn't there....the body doesn't make enough insulin...or it doesn't work. And in Type 1....there is not insulin, the beta cells that produce insulin in the body don't work. And in the Type 2, there's lots of insulin, but it's not used by the body.
NEMA: Two different diseases...so, very different forms of treatment....
CHILDS: The treatment for the person with Type 1 diabetes, or insulin dependent diabetes... medication wise, the only treatment is insulin, and that's given by injection. In addition to that, like the Type 2, they do meal planning, exercise, and then the Type 2, from the medication side, today, have lots of options. In the last 18 months, three additional new drugs...oral medications... have been released for use. So the Type 2's regimen, or treatment point is different. It can start out with diet and exercise only, and then the individual may go on oral medications...and then the person may need insulin. So there's a lot of different options for treatment.
NEMA: You mentioned that in Type 2's, there is insulin in the body, but there's something wrong and the body doesn't utilize it. What does the medication do for this system?
CHILDS: [It] makes it work better. And certainly science has improved a lot over the last few years in relationship to what we know about diabetes. We used to explain, as I did pretty simplistically, that the insulin just doesn't work, doesn't get through....doesn't work right in the cell to bring the glucose across. We talk about it from the standpoint of insulin going into the keyhole...it's what unlocks the cell for the insulin and glucose to go across. We now know there are defects inside the cell and outside...there are just lots of different defects. But treatment wise...exercise is one of the most effective ways to make the insulin work better. Reducing your weight allows the insulin to work better. And then you add the medications, which then work in the body to make the insulin more effective.
NEMA: Let's talk about the kinds of behaviors and the warning signs of diabetes..
CHILDS: Fatigue, blurred vision, unexplained weight loss, slow healing wounds, pain and burning in the hands and feet. For women: frequent vaginal infections, increased thirst, increased urination, sometimes increased appetite. The difficulty with diabetes is the symptoms are vague, and they're slow onset...and that's why we know that most people with type 2 diabetes have had it 7 to 10 years prior to their diagnosis.
NEMA: So, many people are feeling these seemingly unconnected ills, not really putting it together... that it may be diabetes....
CHILDS: That's exactly right. Many times they're contributed to, "I'm getting older".
NEMA: But if they have a good relationship with their doctor...and they get their checkup....
CHILDS: ....they ought to be doing their annual screening...that's right. And you have to throw in there, in that checklist, almost...the at-risk.... people who are at risk should have, certainly, an annual evaluation for diabetes. And those folks who are at risk...which is kind of the other checklist: family history of diabetes, being overweight, being underactive...people who are African American, Hispanic, Native American...have a significantly higher incidence of diabetes.
NEMA: What are the reasons for that...is it known why?
CHILDS: Genetically related...the ability of their body to use the insulin...from a genetic standpoint...they are coded that it just doesn't work as well. It's just a higher incidence...
NEMA: It's very high for Hispanic women, I understand....
CHILDS: ...over the age of 55, one out of three has Type 2 diabetes...it's an incredible number.
NEMA: Is there a recommended age after which people should be regularly screened?
CHILDS: Over 45 as well....those people over 45 with the other risk factors should be screened.
NEMA: People can get along pretty well with diabetes... but you mentioned many people don't know they have it until it's progressed...
CHILDS: Diabetes is a disease that can be lived with, but must be taken seriously. And half...about 8 million people...Half of the 16 million who have diabetes....8 million of them don't know they have it. Early identification and treatment is the key to preventing the complications.
NEMA: It seems diabetes is a disease that many victims don't take seriously...they don't take the medication correctly, they don't watch their weight closely enough, they have too much alcohol....and maybe it's because the symptoms don't always affect them right away, or very strongly...
CHILDS: That's exactly right...and we know that if people can get their blood sugars in the normal range, which is achievable, and if they do that, they can prevent the long term complications. And even for someone 60 years old who's diagnosed with diabetes, we want them to have a good quality of life at 70 or 80! And if they don't take care of themselves, you end up with amputations, and the vision changes, and kidney failure.
NEMA: At a recent conference in Spain, experts from around the world agreed that despite the growing numbers of people affected with diabetes, people don't take it seriously enough, and ignore the advice about the lifestyle that can eventually earn them the disease. In Europe, there are 25 million people who have diabetes, and in 20 years, double that number will have the disease. Does the same projection apply to the U.S.?
CHILDS: Yes, we have pretty poor lifestyle habits around the world. And the numbers are indeed predicted to only increase. And that...the key message that I would get out is that lifestyle changes, including meal planning, normalizing your weight and exercise, can prevent much of the type 2 diabetes today. When we talk about finding a prevention and cure for diabetes...we know today that if people maintained their weight and exercised, much of the Type 2 diabetes wouldn't be there. And it is the cornerstone of treatment for both Type 1 and Type 2 diabetes.
NEMA: Like my Dad used to say....gout is a disease of the affluent...when his toe, ankle or knee would swell up. Not that we were affluent, but his diet reflected his aspirations, and he had gout. Diabetes increases as our standard of living, and laissez-faire attitude about eating, increases. Is eating to prevent diabetes a matter of avoiding certain types of food?
CHILDS: It isn't even restricting foods, it's restricting the amounts. We don't believe there's necessarily a bad food that you shouldn't eat. It's a matter of eating a good, healthy low-fat meal plan.. which then is going to help one maintain, or get their weight in the near normal range.
NEMA: If someone's interested in the things we talked about today, or if they have a friend or family member who they believe would benefit from this information....where can they get more?
CHILDS: The American Diabetes Association has a chapter or an affiliate in every major community...there's an affiliate office in every state, and those are listed in the white pages....but in addition, you could call 1-800-DIABETES, and get the American Diabetes Association for information.
NEMA: Picture yourself about 10 or 15 years from now...maybe your parents had diabetes, but you didn't take the clue, and had too much alcohol and high protein foods and not enough fruits and vegetables. Oh yeah, and you didn't really get into exercise. So, in that future picture, you begin to have the symptoms of diabetes: fatigue, blurred vision, burning in the hands and feet, increased thirst, weight loss, increased urination. What will you do then? If the pattern continues...you'll ignore it...and have full blown diabetes. That picture is now developing for millions of Americans...who should know that they have the information and the power to halt the process. Our thanks to Belinda Childs, the president of health care and education with the American Diabetes Association.
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...for a look at transcripts of this or past programs, or to find out more about the National Emergency Medicine Association. I'm Steve Girard at The Heart of the Matter.