The Potential Threat of Diabetes

You know what scares me more than a crazy North Korean man with nuclear weapons?...  Diabetes. Yeah that's right, the extreme poor health of our citizens scares me more than having missiles fired at my house. This may sound absurd to some, but for those of us who work in the trenches of healthcare this my friends is a reality. As a nurse you start to worry about things that most other people wouldn't pay attention to; like washing your hands before and after you go to the bathroom, just to be safe. I was at the beach the other day just relaxing when I noticed a group of school children getting off a bus. For a moment I had trouble determining who were the children and who were the teachers because virtually every one of them was obese. I eventually discovered that the children were all wearing the same color shirt... Smart on the teachers part (I'm sure I am not the only one who has noticed this phenomenon). I was extremely bothered by this but didn't quite realize why.  I didn't think too much more about it until I went to work the next day and met one of the nicest young ladies I have ever met. This young lady came in to the ER complaining of shortness of breath, fatigue and that she was peeing a lot (which are all hallmark signs of diabetes). Now, because she is only 21, no one, including her doctors even considered diabetes as a potential diagnosis. Not only was she diabetic, but she was also suffering from DKA (diabetic ketoacidosis) which is a potentially life threatening complication of diabetes. DKA occurs when there is not enough insulin to transport sugar into the cells; if the sugar doesn't make it into the cells than the body assumes that there is no sugar present and begins to breakdown fat as an alternative fuel. This may sound awesome for those trying to lose weight but I promise you this is not the way to go. The breakdown of fat causes a build up of acids in the body, causing a whirlwind of life threatening problems. DKA usually occurs in patients who have type 1 diabetes but it can also occur in type 2 diabetics in some instances. This patient was officially diagnosed with type 2 diabetes and a urinary tract infection, which is what most likely caused her to be in DKA.
This patient was very aware of what diabetes was because her father had it but was unaware of how serious the disease really is. I truly believe that most people do not understand the seriousness of diabetes and all the potential health complications associated with it; such as losing their eyesight and limbs, increased risk for infection and slower healing, increased risk for heart attack and stroke, chronic pain from nerve damage, vascular disease, kidney disease leading to dialysis and even death. A survey completed in 2006 indicated that a substantial number of people with prediabetes were unaware that they even had it. Prediabetes means that you are already starting to have higher than normal blood sugars but aren't officially diabtetic. How are we suppose to prevent people from going into full blown type 2 diabetes if they don't even know that they are going down that road? How do we recognize the risk factors for diabetes and prediabetes before it's too late?

Risk Factors We Can Control

• Obesity - BMI and Waist circumference are commonly used screening tools to identify weight problems and associated health risks. BMI calculators and charts are available online. A "normal" BMI is considered 18.5 and 24.9. Waist circumference can be done at home. Place a tape measure around the bare abdomen just above the hip bone. Excess waist circumference is considered 40 inches for men and 35 inches for nonpregnant women. If you have a BMI greater than 24.9 and you have excess waist circumference you are very likely to develop diabetes and cardiac disease. If you are concerned that your child is overweight please seek the help of someone who can help you improve your nutritional habits. Fast, processed and sugary foods are the main reason for childhood obesity.
• Sedentary Lifestyle - I think most people know in the back of their minds whether or not they are exercising enough. There are different types of exercise and finding the one that fits your lifestyle is going to be the most beneficial. A lot of people go "all or nothing" and become easily discouraged when starting. Instead, try easing into an activity such as walking. 
• Low HDL cholesterol and high tryglyceride levels - To improve your HDL score you have to exercise. Some studies show eating Omega 3 fatty acids also helps. To decrease your trigylceride levels avoid sugary foods such as soda and pastries as well as trans fats, which are identified as hydrogenated oils on a food label and are also found in fried foods. 
• Polycystic Ovarian syndrome - Many physicians believe that this cannot be prevented but I have heard of and know a few woman who have reversed this disease with proper nutrition so I am going to count this one as one we can control.

Risk Factors Out of our Control

• Age older than 45 years
• Family History of diabetes (parent, brother or sister)
• Belonging to certain racial and ethnic groups, including African Americans, Hispanic/Latino, Asian Americans, Pacific Islanders, American Indians, Alaska Natives
• History of gestational diabetes
• Women who have delivered a baby weighing 9 pounds or more
• History of cardiovascular disease
• Receiving antipsychotic therapy for schizophrenia or bipolar disorder

It wasn't until after I left work that day that I realized the significance of those school children at the beach and my patient. Seeing those kids was like seeing the life of the healthcare system flashing before my very eyes. Not only is there a large amount of baby boomers getting older but now there is even larger amount of young people getting sicker. Most of those obese schoolchildren are or will suffer from diabetes at some time in their life. The annual economic burden of diabetes in the U.S. exceeds $200 billion and spending is expected to triple in the next 25 years. If we don't do something about this sometime soon this country will not only be broke, we will also be unproductive, unemployed, not motivated, and unhappy; in other words North Korea has nothing on diabetes. 

The first step to prevention is recognizing what puts us at risk and becoming mindful of our bodies and our lifestyle. We often know in the back of our minds and our bodies will often tell us exactly what we need to be doing to stay healthy. You cannot wait for government to provide you with healthcare to make yourself healthier. Many of these changes only require education and motivation. There are many healthcare professionals and health coaches, including myself, out there for those of you who need guidance in the areas of nutrition and lifestyle changes. Find someone to inspire and support you in this process. Now is the time to improve your health. 

I will be hosting monthly online webcasts starting next month on how to improve your health. I'm looking for suggestions on topics for my webcasts. Feel free to comment on this blog with any suggestions.