Are You At Risk?March 2010 Your guide to tYpe 2 diabetes prevention and ManageMent

diabetes

2

CONTENTS2 HowWillYouStopDiabetes?

4 Diabetes:DoesThatAffectMe?

4 WhatWillYouDoToStop

Diabetes?

7 HowToLoseWeight–AndKeep

ItOff

8 BloodGlucoseMonitors

10 ManagingYourType2Diabetes

12 DentalAndVisionHealth

13 Pre-Diabetes

14 PanelOfExperts

15 TestingForType2Diabetes

16 ManagingMultipleMedications

16 SleepApnea

19 It’sComplicated

DIABETES

Publisher: Paul Herron paul.herron@mediaplanet.com

Contributor: Laura McCafferty

Designer: Carrie Reagh carrie.reagh@mediaplanet.com

Photos: ©iStockphoto.com

For more information about supplements in the daily press, please contact: Kayvan Salmanpour, 1 646 922 1400 kayvan.salmanpour@mediaplanet.com

This section was written by Mediaplanet and did not involve USA Today News or Editorial Departments.

www.mediaplanet.com

How Will You Stop DiabetesSM? Know Your Risk

If left untreated, diabetes can lead

todeadlycomplications—includ-

ingheartdisease, stroke,kidney

disease,blindnessandamputation.

OneinfiveAmericansisatriskfor

developing type 2 diabetes. Nearly

6 million Americans are unaware

that they already have the disease.

If current trends continue, one in

three children born today will face

afuturewithdiabetes.Thenumbers

are startling, and the truth is, we

must do something to change this

future.WemusttakeactiontoStop

DiabetesSM.

Tuesday, March 23rd is the 22nd

annual American Diabetes Asso-

ciation Diabetes Alert DaySM. This is

an opportunity for all Americans,

to take charge of their health and

join the movement to Stop Diabe-

tes.Oneway to join themovement

is to take the American Diabetes

Association’sDiabetesRiskTesttode-

termineyourriskfortype2diabetes

and to speak with your health care

provider if you are at high risk for

developingthedisease.TheDiabetes

RiskTestisavailableatstopdiabetes.

com/usatoday or by calling 1-800-

DIABETES.

Understanding Risk

for Type 2 Diabetes

Primary risk factors for type 2

diabetes include being overweight,

maintaining a sedentary lifestyle,

beingovertheageof45andhaving

a family history of diabetes. African

Americans,Hispanics/Latinos,Native

Americans, Asian Americans and

Pacific Islandersareatan increased

risk, as are women who had diabe-

tesduringapregnancy(Gestational

Diabetes) or who have had babies

weighingmorethanninepoundsat

birth.

Unfortunately, people with type

2 diabetes can go years without

realizingthattheyhavethedisease.

While people with diabetes can

exhibit noticeable symptoms, such

asfrequenturination,blurredvision

and excessive thirst, most people

diagnosed with type 2 diabetes do

nothavetheseovertwarningsigns

at the time that they develop the

disease.Often, type2diabetesonly

becomes evident when people

develop one or more of its serious

complications,suchasheartdisease,

stroke, kidney disease, eye dam-

age,ornervedamagethatcanlead

toamputations.

Reduce Your Risk—Take

the First Step Today!

Studies have shown that type 2

diabetes can be prevented or de-

layed by losing just 5-7 percent of

bodyweightthroughregularphysi-

cal activity (30 minutes a day, five

days a week) and healthy eating.

Armedwiththisinformation,gather

yourfriends,family,lovedonesand/

orco-workersandtakea30minute

walkandgetstartedwithahealthier

lifestyletoday!

Together, we can change the fu-

tureofdiabetes.Jointhemovement

toStopDiabetesby takingthe free

DiabetesRiskTest (EnglishorSpan-

ish) at stopdiabetes.com/usatoday

orbycalling1-800-DIABETES.Learn

how you can get healthier and

reduce your risk. Although Diabe-

tes Alert Day is a one-day event,

the Diabetes Risk Test and

information about healthy eating

and getting active is available all

yearlong.

Remember,inordertopreventor

treattype2diabetes,youmustfind

outfirstifyou,orsomeoneyoulove,

couldbeatrisk.

Special thanks to the WellPoint

Foundation for supporting our ef-

fortsto“soundthealert”onDiabetes

AlertDaythisMarch.

There are many faces of diabetes—it can affect anyone regardless of age,ethnicityorsocialstatus. Intype2diabetes,oftensymptomsdonotappearuntilit’stoolate.

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a very special thanks to...

ThecontentinthisspecialadvertisingsectionwasnotdevelopedbytheAmericanDiabetesAssociation.TheAmericanDiabetesAssociationdoesnotendorseanyoftheadvertisersappearingwithinthisspecialadvertisingsection.

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diabetes

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Am

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1-866-MY-DIABETES www.DiabetesAmerica.com

Take control of your diabetesand live better now.

One in three people born in

the United States in 2000

and beyond are expected

to develop diabetes in their lifetime,

accordingtothecenters forDisease

controlandPrevention.Already,nearly

24millionAmericanslivewiththisdis-

ease.Another57million,oroneinfive,

havepre-diabetes,whichmeansthey

areonthepathtodevelopingtype2

diabetesunlesstheytakerealstepsto

reverseitscourse.

What is Diabetes?

Diabetesisaseriousillnessthattakes

severaldifferentforms:type2diabetes,

whichisthemostcommon;type1dia-

betes,whichtypicallydevelopsduring

childhood; and gestational diabetes,

whichcandevelopduringpregnancy.

Most people who have diabetes

developitasadults,andmostofthem

havetype2diabetes,whichaccounts

forroughly95percentofallcasesand

which will therefore be the focus of

our report. Type 2 diabetes occurs

when the body does not produce

enoughinsulinorisnotabletouseit

properly.Insulinhelpsthebodyturn

glucose(whichcomesfromthesugars

andstarchesinthefoodweeat)into

theenergyweneedtolive.Whenthe

bodyisn’tmakingenoughorusingit

properly,insulinbuildsupintheblood

streamandbeginstocauseproblems

intherestofthebody.

What Causes Type 2 Diabetes?

Thereisnoone,singlecausefortype

2diabetes,butthereareseveralfactors

thatcontributetoit.First,researchers

believethatyoumustinheritagenetic

predisposition for the disease. Then,

somethinginyourenvironmentmust

triggeritsdevelopment.

Type 2 diabetes starts when the

body develops a resistance to insu-

lin—thebodyisstillproducinginsulin,

butthebodydoesnotrespondto it

properly.Beingoverweightincreases

the body’s insulin resistance, and

being overweight is the most com-

montriggerfortype2diabetes.Aging

andlowphysicalactivityalsoincrease

insulinresistance.

How Do I Know If I Am At

Risk For Type 2 Diabetes?

Some people are more at risk for

diabetesthanothers.Familyhistoryis

oneriskfactor:Ifyourmother,father,

sister or brother had diabetes, you

haveamuchhigherriskofdeveloping

itthanthosewhosefamilymembers

don’thaveit.

Some ethnic groups are also at

much higher risk. For example, Na-

tive Americans, African Americans,

Latinos/Hispanics, Asian Americans,

Native Hawaiians, and other Pacific

Islanders are more susceptible than

other groups. And, as said before,

being older, overweight, and inac-

tivealsoincreasesyourriskfortype2

diabetes.

Infact,theobesityepidemicinthe

UnitedStateshasledtoanincreasing

numberofchildrenbeingdiagnosed

with type 2 diabetes, which leads

to them developing complications

much earlier in life than they would

havehadtheydevelopeditasadults.

Thediagnosisoftype2diabeteswas

extremely rare in children until the

pastfewdecades.

Why Should I Worry

About Type 2 Diabetes?

Diabetesisachronicandoftende-

bilitating disease. If left untreated, it

canleadtoseriouscomplications,such

as blindness, nerve damage, kidney

andheartdisease,andstroke.Someof

thesecomplicationscanbefatal.

However, type 2 diabetes—and

its complications—can often be

preventedordelayedthroughlifestyle

change, which is, losing moderate

amounts of weight and increasing

physicalactivity.

Butyoucannotpreventwhatyou

donotknowyouhave.Thesymptoms

of type 2 diabetes are often subtle,

andappeargradually.Becauseofthis,

they may go unnoticed for years—

oftenuntilitistoolatetochangethe

courseofthedisease.

The cDc estimates that currently,

about5.7millionAmericanshavedia-

betesanddonotknowit.Thatmeans

the disease may already be causing

damagetotheirbodiesthatisdifficult

orimpossibletobereversed.

Diabetes: Does That Affect Me?diabetes affects almost everyone. chancesare, ifyou’rereadingthis,youeitherhavetype2diabetes,youmaybeatriskforit,oryouknowsomeonewhoalreadydoes.

The 22nd annual American

Diabetes Association Alert

DaySM will be held March 23,

2010,focuseduponthetheme:What

Will You Do to Stop Diabetes? Know

Your Risk.

Because diabetes—also known

as the “silent killer”—is often not

diagnosed until 7 to 10 years after

it strikes, the American Diabetes

Associationisencouragingpeopleto

jointhemovementtoStopDiabetes

by taking the Diabetes Risk Test,

whichwillletthemknowiftheyare

atriskfortype2diabetes.Thegood

news about type 2 diabetes is that

eventhosewhoareathighriskcan

often prevent or delay onset of the

diseasebytakingstepstochangetheir

lifestyle.

Why bother? Because diabetes

kills.

Early diagnosis is critical.Join the

movementtoStopDiabetesbytak-

ing the free Diabetes Risk Test at

stopdiabetes.com/usatoday or call

1-800-DIABETES(342-2382).

What Will You Do To Stop DiabetesSM?Everyyear,theAmericanDiabetesAssociationissuesawake-upcalltoremindpeopleoftherisksoftype2diabetesandwhattheyshoulddotopreventit.

some ethnic groups are

also at much higher risk.

INDIVIDUAL RESULTS MAY VARY.

HER PASSION: CHASING THE WINDHER POWER: LANTUS® 24-HOUR INSULIN

Angela was born to be wild; she also has type 2 diabetes. Some people take two insulin shots a day to get 24-hour blood sugar control. But Angela takes one shot of Lantus,® the only 24-hour insulin approved exclusively for use once a day. Lantus® works steadily all day with no pronounced peak, so you don’t have to eat at a specific time to balance a peak. And as part of your overall diabetes treatment plan, including regular blood sugar testing, just one shot of Lantus® at the same time each day helps control blood sugar all day long.

THE LANTUS® SOLOSTAR® PEN PREFILLED WITH LANTUS®

• 24-hour blood sugar control• Just one shot a day

• No pronounced peak• #1 prescribed insulin*IMPORTANT SAFETY INFORMATION FOR LANTUS®

Do not take Lantus® if you are allergic to insulin or any of the inactive ingredients in Lantus.®

You must test your blood sugar levels while using insulin, such as Lantus.® Do not make any changes to your dose or type of insulin without talking to your healthcare provider. Any change of insulin should be made cautiously and only under medical supervision.

Do NOT dilute or mix Lantus® with any other insulin or solution. It will not work as intended and you may lose blood sugar control, which could be serious. Lantus® must only be used if the solution is clear and colorless with no particles visible. Do not share needles, insulin pens or syringes with others.

The most common side effect of insulin, including Lantus,® is low blood sugar (hypoglycemia), which may be serious. Other possible side effects may include injection site reactions, including changes in fat tissue at the injection site, and allergic reactions, including itching and rash. In rare cases, some allergic reactions may be life threatening.

Tell your doctor about other medicines and supplements you are taking because they can change the way insulin works. Before starting Lantus,® tell your doctor about all your medical conditions including if you have liver or kidney problems, are pregnant or planning to become pregnant, or are breast-feeding or planning to breast-feed.

INDICATIONS AND USAGEPrescription Lantus® is a long-acting insulin used to treat adults with type 2 diabetes and adults and children (6 years and older) with type 1 diabetes for the control of high blood sugar. It should be taken once a day at the same time each day to lower blood glucose.

Do not use Lantus® to treat diabetic ketoacidosis.

Lantus® SoloSTAR® is a disposable prefilled insulin pen.

Please see additional important information on the next page.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch, or call 1-800-FDA-1088.

* Based on TRx data from IMS Health. National Prescription Audit™ Monthly database, time period from May 2003–Dec. 2009.

ANGELA YOUNGER, LANTUS® PATIENT SINCE 2003

1-866-4LANTUS LANTUS.COM

©2010 sanofi-aventis U.S. LLC US.GLA.10.03.040

Ask your doctor if Lantus® fits into your overall diabetes treatment plan, which includes diet, exercise, and other diabetes medications.

insulin tus,® theeadily all

nce a peak.gar testing, all day long.

THE LAPREFIL

• 24-• Ju

• N•

LantusLantus.®

make any changes too yyoumake any changes to yyou

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US.GLA.10.03.040.indd 1 3/10/10 3:49:53 PM

BRIEF SUMMARY OF PRESCRIBING INFORMATION

HIGHLIGHTS OF PRESCRIBING INFORMATION

These highlights do not include all the information needed to use LANTUS safely andeffectively. See full prescribing information for LANTUS.

LANTUS (insulin glargine [rDNA origin] injection) solution for subcutaneous injection

Initial U.S. Approval: 2000

———————————— INDICATIONS AND USAGE ————————————LANTUS is a long- acting human insulin analog indicated to improve glycemic control inadults and children with type 1 diabetes mellitus and in adults with type 2 diabetes mellitus.(1)Important Limitations of Use:

• Not recommended for treating diabetic ketoacidosis. Use intravenous, short-actinginsulin instead.

——————————— DOSAGE AND ADMINISTRATION ———————————• The starting dose should be individualized based on the type of diabetes and whether

the patient is insulin-naïve (2.1, 2.2, 2.3)• Administer subcutaneously once daily at any time of day, but at the same time every

day. (2.1)• Rotate injection sites within an injection area (abdomen, thigh, or deltoid) to reduce the

risk of lipodystrophy. (2.1)• Converting from other insulin therapies may require adjustment of timing and dose of

LANTUS. Closely monitor glucoses especially upon converting to LANTUS and duringthe initial weeks thereafter. (2.3)

—————————— DOSAGE FORMS AND STRENGTHS ——————————Solution for injection 100 units/mL (U-100) in

• 10 mL vials• 3 mL cartridge system for use in OptiClik (Insulin Delivery Device)• 3 mL SoloStar disposable insulin device (3)

—————————————— CONTRAINDICATIONS ——————————————Do not use in patients with hypersensitivity to LANTUS or one of its excipients (4)

——————————— WARNINGS AND PRECAUTIONS ———————————• Dose adjustment and monitoring: Monitor blood glucose in all patients treated with

insulin. Insulin regimens should be modified cautiously and only under medicalsupervision (5.1)

• Administration: Do not dilute or mix with any other insulin or solution. Do not administersubcutaneously via an insulin pump or intravenously because severe hypoglycemia canoccur (5.2)

• Do not share reusable or disposable insulin devices or needles between patients (5.2)• Hypoglycemia: Most common adverse reaction of insulin therapy and may be life-

threatening (5.3, 6.1)• Allergic reactions: Severe, life-threatening, generalized allergy, including anaphylaxis,

can occur (5.4, 6.1)• Renal or hepatic impairment: May require a reduction in the LANTUS dose (5.5, 5.6)

————————————— ADVERSE REACTIONS —————————————Adverse reactions commonly associated with Lantus are:

• Hypoglycemia, allergic reactions, injection site reaction, lipodystrophy, pruritus, andrash. (6.1)

To report SUSPECTED ADVERSE REACTIONS, contact sanofi- aventis at 1-800-633-1610 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.

————————————— DRUG INTERACTIONS —————————————• Certain drugs may affect glucose metabolism, requiring insulin dose adjustment and

close monitoring of blood glucose. (7)• The signs of hypoglycemia may be reduced or absent in patients taking anti-adrenergic

drugs (e.g., beta-blockers, clonidine, guanethidine, and reserpine). (7)

——————————— USE IN SPECIFIC POPULATIONS ———————————• Pregnancy category C: Use during pregnancy only if the potential benefit justifies the

potential risk to the fetus (8.1)• Pediatric: Has not been studied in children with type 2 diabetes. Has not been studied

in children with type 1 diabetes <6 years of age (8.4)

See Prescribing Information for PATIENT COUNSELING INFORMATION and FDA-approved patient labeling.

Revised: 09/2009

GLA-BCPH-GT2-SEP09 Rx Only

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7

diabetes

3639_BDA_USAToday.indd 1 2/18/10 12:34 PM

But fad diets had gotten him

nowhere. Diet after diet

failed to help him keep off

any significant amounts of weight;

onedietevencausedhimtogain.

Finally, his doctor told him: “I

don’t believe in fad diets, but I do

believeinlifestylechange.”

He presented Kemp with a re-

duced calorie meal plan and told

himtochaseitwithadailydoseof

exercise. His wife christa, who also

wantedtoloseweight,preparedthe

meals.Sheboughtascaleformea-

suringportionsizesandlearnedhow

toproperlycountcalories.Together,

theybeganwalkingeverynightfor

10to15minutes.

By starting out gradually, the

Kemps followed rule number one

forasuccessfulweightlossandex-

erciseplan:Setrealisticgoals.After

six months, Herman Kemp lost 70

pounds.Hiswifelost30.

The American Diabetes Associa-

tion’s website reminds people that

evenlosingsmallamountsofweight

(just five to seven percent of body

weight) can lower blood glucose,

bloodpressureandcholesterollevels.

Butit’simportanttokeepitoff,which

isoftenthehardestthingtodo.

“The key is consistency,” said

christaKemp.“That’swhat ittakes.

With faddietsyoudo it forawhile

andthenstop.”

But by counting calories, main-

tainingreasonableportionsizesand

increasing exercise goals as they

wereable, theKempsnotonly lost

more weight, they kept it off—for

fiveyearsandcounting.

Their15minutesofwalkinggrad-

ually developed into longer walks

andthenruns,saidchrista.Shenow

runsthreemilestwiceaweek,does

pilatesandweighttraining.Heruns

eighttotenmilesfourtimesaweek

andweighttrainsat thegymthree

timesaweek.

Today, both Kemps are down

to much healthier weights. Her-

man is holding steady at 222

pounds, and christa, who was

282 when she started, is down to

182pounds.

Mostimportantly,Hermannolon-

gerhashighbloodpressure.Neither

henorhiswifehavehighcholesterol

anymore.Hehasstoppedtakingall

medications.Andhisbloodglucose

levels?They’renormal.

And, there’s one other ben-

efit they hadn’t initially consid-

ered: Their 13-year-old daughter is

learning what an appropriate food

portionlookslike.

“Wedon’t tellhershecan’thave

apieceofcakefordessert,”Herman

said.“Wejustshowherwhatsizeit

shouldbe.”

How To Lose Weight—And Keep It Off!Fiveyearsago,HermanKempweighed454pounds,hadhighbloodpressureandelevatedcholesterollevels.Hewasalsodiagnosedwithpre-diabetes.

their 15 minutes of walking gradually developed into longer

walks and then runs. she now runs three miles twice a week, does

pilates and weight training.

diabetes

8

Thanks to advances in technol-

ogy,therearenownumerous

options available to people

withdiabetestohelpthemmaintain

goodcontrol.

Whether you have poor vision,

memory problems or work in dim

lighting,youshouldbeabletofinda

bloodglucosemonitorthatworksfor

you.Beforechoosingameter,how-

ever, it’s important to consult with

yourhealthcareteamtomakesure

youareselectingthemeterwiththe

bestfeaturesforyou,andwithyour

insurancecompanytomakesureyou

knowwhat’scovered.

Blood glucose meters are small

devices (usually about the size of a

cellphone)that“read”yourglucose

levelanddisplayitonascreen.Test-

ingbloodglucoseinvolvesthreeim-

portantcomponents:alancet,atest

strip,andthemeteritself.

Thelancetisusedtopricktheskin

(usuallyonthesideofafingertip)and

drawadropletofblood,whichisthen

touchedtotheendoftheteststrip.

chemicalsonthestripreactwiththe

glucose in the blood, measuring its

concentration. When the test strip

isplacedinthemeter,anumberap-

pearsonthemeterscreen,givingyou

thereading.

For those who have poor vision,

metersareavailablewithlargerbut-

tons and audio instructions. Meters

thatgive results inSpanisharealso

available.

Meters vary in size and features;

some give readings in just a few

seconds, some allow for alternate

site testing, some include storage

forlancetsandteststrips.Allmeters

can store readings and download

themtoacomputer.Thereareeven

metersthatwillsendtheresultsvia

text message to a parent’s or other

caretaker’scellphone.Oneofthebig-

gest variables among meters is the

costoftheirteststrips,withstripsfor

somemeterscostingtwiceasmuch

asothers.

Continuous Glucose Monitoring

The latest development in mea-

suring blood glucose levels is con-

tinuous glucose monitoring (cGM),

whichusesanunder-the-skinsensor

tomeasureglucoselevelsandtrans-

mittheresultstoahandheldreceiver

every few minutes. The benefit of

usingacGMisthatyoucanseethe

trendinwhetheryourbloodglucose

levelsaregoingupordown,notjust

whatthelevelisatasinglemoment.

AndthecGMcantellyouwhatyour

glucoseisdoingatallhours—espe-

cially overnight. All cGMs include

warningsystemsthatalertyouwhen

blood glucose levels are going too

highortoolow.

cGMs do not eliminate the need

for regular glucose testing, since

thedevicemustbecalibratedwitha

standard glucose meter. And cGMs

andtheirsuppliesareexpensive,and

are not covered by many insurance

plans. Even if you don’t use a cGM

on a permanent basis, some doc-

tors like to have their patients use

a cGM for at least a few weeks, so

boththepatientandthedoctorcan

get a better idea of that patient’s

daily glucose ups and downs, and

make appropriate adjustments

totreatment.

Blood Glucose Monitors: something for everyone

blood glucose meters are small devices (usually about the size of a cell phone)...

Monitoringbloodglucoselevelsisimportantwhenyouhavetype2diabetes,asyoutrytokeepyourlevelsinahealthyrange.

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diabetes

10

In the next 24 hours, diabetes will claim the lives of 200 people.

That’s 1,400 friends, neighbors,co-workers or family members

every week.

stopdiabetes.com/usatoday • 1-800-DIABETES

USA Today Feb 22 10.indd 1 2/23/10 1:50 PM

However,ifleftuntreated,dia-

betes can cause irreversible

damage to the body and

ultimatelyprovefatal.

Your Diabetes Health Care Team

Thefirststepintreatingtype2dia-

betesistoestablishahealthcareteam

tohelpyoudevelopacomprehensive

treatmentplan.Everyone’sneedsare

different,soyourteamandtreatment

planmightnotlookthesameasthat

ofanotherpersonwhohasdiabetes.

Speaktoyourprimarycarephysician

aboutwhoshouldbeonyourteam.

yourteammayincludesomeorall

ofthefollowing:

• you: you are the most important

memberoftheteamasyouarethe

onewhomustcarryoutthestepsin

yourtreatmentplan.

• Primarycaredoctor:Thiscanbea

familypracticephysician,endocri-

nologist or internist. Just be sure

thatthedoctorhasalotofexperi-

ence working with patients who

havetype2diabetes.

• certified Diabetes Educator: A

professional with special training

incaringforpeoplewithdiabetes.

Thispersoncanhelpyouwiththe

day-to-day aspects of living with

diabetes.

• Registered Dietitian: This person

canhelpyoufigureoutamealplan

based on your weight goals, life-

styleandmedications.

• youmayalsowishtoincludeanex-

ercisephysiologistorsocialworker,

andyou’llwanttoletyoureyedoc-

toranddentistknowthatyouhave

diabetes.

Takinggoodcareofyourdiabetes

meansmonitoringandaddressinga

numberofhealthfactors:

Blood Glucose Levels

It’s importanttocheckyourblood

glucoselevelsonaregularschedule.

Howoftenyoushouldcheckdepends

onhowyouaremanagingyourdiabe-

tes.Thegoalistokeepyourbloodglu-

coselevelsaslowaspossiblewithout

causingthemtogotoolow.

Keeping blood glucose levels as

low as possible can help prevent or

delay complications, such as kidney,

eyeandnervedisease.Bloodglucose

levelsarekeptundercontrolthrough

a combination of diet and exercise,

and,insomecases,insulininjections

andmedications.

Inadditiontocheckingyourblood

glucose levels on your own, you

should also get an A1c test at your

doctor’sofficetwotofourtimesayear.

A1c gives you an overall picture of

youraveragebloodglucoselevelsfor

aperiodoftwotothreemonths;A1c

canalsobereportedasestimatedav-

erageglucose,oreAG.TheAmerican

Diabetes Association recommends

that most people with diabetes try

tokeepA1clevelsatorbelowseven

percent,oreAGbelow154mg/dl.

Blood Pressure

and Cholesterol Levels

Did you know that 75 percent of

peoplewithdiabetesalsohavehigh

bloodpressure?Manyalsohavehigh

cholesterol.Thesearetwoleadingrisk

factorsforheartdiseaseandstroke.In

fact,peoplewithdiabetesaretwoto

fourtimesaslikelytohaveastrokeor

diefromaheartattackaspeoplewho

don’thavediabetes.

Diet and Exercise

Many people who have type 2

diabetes are overweight or obese.

Numerousstudiesshowthatreducing

weightandincreasingphysicalactivity

canhelpreversethecourseofdiabe-

tesandprovideotherhealthbenefits.

consult your health care team for a

planthatfitsyourgoals.

Smoking

Finally, if you are a smoker, quit.

Smokingnotonly raisesyour risk for

lung cancer, it doubles your risk for

heartdiseaseandincreasesyourriskfor

otherdiabetes-relatedcomplications,

suchasvisionandnerveproblems.

Managing Your Type 2 DiabetesOnce you receive a diagnosis of type 2 diabetes, it’s important to begintreatmentimmediately.Whenproperlymanaged,diabetesneednotinterferewithleadinganormallife.

When is a good time to have a low?I

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diabetes

12

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©2010 Vision Service Plan. All rights reserved.VSP and VSP WellVision Exam are registered trademarks of Vision Service Plan.

Infact,sinceasmanyasone-fourth

of people who have diabetes

don’tknowtheyhaveituntilcom-

plicationsarise,itcouldwellbeyour

dentistoreyedoctorwhofirstclues

you in to the symptoms that could

lead to a diabetes diagnosis. Prob-

lems such as gum disease or vision

problemscouldbethefirstsignsthat

somethinghasgoneamiss.

Vision Problems

Problems with the eyes are

very common among people with

diabetes, which is the leading

cause of blindness in the United

States. However, most people with

diabeteshaveonlyminorproblems

with their eyes. If blood glucose

levels are kept within the target

range, vision problems and other

diseasesthataffecttheeyecanoften

beprevented.

Ifnotproperlymanaged,however,

diabetescancauseseriouseyeprob-

lems.Peoplewithdiabetesaremore

likelytosufferfromglaucoma,which

happenswhenpressurebuildsupin

theeyeandpinchesoff thevessels

thatcarrybloodtotheretinaandthe

opticnerve,causingvisionloss.The

riskfordevelopingthisdiseasegoes

up with age as well as the length

oftimethatyouhavehaddiabetes.

Glaucoma can be treated with sur-

gery or medications to reduce the

pressure.

People with diabetes are also

more likely to develop cataracts,

inwhichtheclear lenscloudsover,

preventingclearvisionandcausing

glare. cataracts develop faster and

atayoungerageinpeoplewithdia-

betesthaninthosewhodon’thave

diabetes.Theproblemistreatedby

removingthelens,orgettingatrans-

plant,whensevere.

The most direct link between

diabetes and vision problems is

duetodamageto the retinacalled

retinopathy. There are two main

kinds of retinopathy: nonprolifera-

tive, which can have no symptoms

andcanrange frommild tosevere,

andproliferative,which isthemost

severeformofthedisease.

In nonproliferative retinopathy,

bloodvesselsbecomeblockedand

cancauseleakinginthepartofthe

eye needed to focus (the macula).

Thiscanbecomeseriousandleadto

visionloss,althoughinmostpeople

thistypeofretinopathyremainsmild

anddoesnotrequiretreatment.

Proliferative retinopathy is more

serious,andcanleadtoblindness.In

thiscase,vesselsbecomesoblocked

thattheycloseoffentirelyandnew

blood vessels begin to grow in the

retina.Thesevesselstendtobeweak,

and can break and leak blood into

theeye,cloudingvision.Scartissue

can also grow, eventually causing

theretinatodetach.

Most people with diabetes will

eventuallydevelopatleastmildreti-

nopathy. The longer you have dia-

betes,themorelikelyyouaretoget

it.Somepeoplearealsogenetically

morelikelytogetitthanothers.But

keepingbloodglucoselevelswithin

targetrangegreatlyreducestherisk

ofdevelopingthemoresevereforms

of the disease. controlling blood

pressurealsohelps.

Ifyoudodevelopvision-threaten-

ingretinopathy,therearenumerous

treatments that can ease, and in

somecases,reverseit.Onetreatment

makestinyburnsontheretinausing

aspecial lasertosealbloodvessels

andpreventthemfromleaking,but

itcanonlybeusedintheearlystages

ofthedisease.Oncetoomuchleak-

age or detachment occurs, surgery

may become necessary to remove

scartissueandcloudyfluidfromthe

eye.Inseverecases,itisalsopossible

tosurgicallyreattachtheretina,but

this treatment is difficult and only

worksinabouthalfofallcases.

Because retinopathy can often

developwithoutanyobvioussymp-

toms, getting your eyes checked

regularly is important.Mostpeople

with diabetes should get a dilated

eyeexameveryyear.

Dental Problems

Dental problems—particularly

gum disease—are also quite com-

mon among people with diabetes.

What’s more, the relationship be-

tween diabetes and gum disease

appears to be a “two-way street.”

Thatis,havingdiabetesputsyouat

higherriskforgumdisease,buthav-

ing gum disease likewise makes it

hardertokeepglucoselevelsunder

control and may contribute to the

progressionofdiabetes.

Gumdisease ismorecommonin

peoplewithdiabetesbecausehigh

glucose levels in thebloodmake it

harderforthebodytofightoffinfec-

tions ingeneral, includingbacterial

infectionsinthemouth.Peoplewith

uncontrolled blood glucose levels

arethereforemorelikelytolosetheir

teethanddevelopotheroralprob-

lems,suchasthrushanddrymouth,

cavities,andulcers.

To prevent dental problems, in-

cluding gum disease, people with

diabetesshouldworktokeepblood

glucose levels in the target range,

brush and floss regularly, and see

a dentist every six months for

acheck-up.

Dental And Vision Health: Yes, diabetes affects these, too!Did you know that diabetes affects just about every part of your body—includingyoureyesandteeth?

13

diabetes

Atrip to the doctor told him

hewasright:youhavepre-

diabetes, his doctor told

him. Stop eating fast food. Lose

weight.Andexercise.

Pre-diabetes is a state that oc-

curs when blood glucose levels

climb higher than normal, but not

high enough to result in a diagno-

sis of type 2 diabetes. A landmark

government study called the

DiabetesPreventionProgram(DPP)

foundthatpeopleinthepre-diabetic

stage could actually reverse the

course of their disease and reduce

their chances of developing type 2

by up to 58 percent if they lost

weightandincreasedphysicalactivity

levels.

Toyoshima, whose mother had

diedofkidneyfailurecausedbytype

2diabetes, tookhisdoctor’sadvice

toheart.

“Ireallywentcoldturkey,”hesaid.

Hestoppeddrinkingsugarysodas—

immediately.Gaveupfastfood.And

begananexerciseprogram.

“Istartedeatingasensiblelunch:

chicken with no skin, vegetables,

moderateportionsofeverything.”

Fordinner,heatefishorchicken.

Every day after work, he took his

beagle for a long walk along the

beach near his southern california

home. To keep himself motivated,

he measured his blood glucose

levelsfourtimesaday.Inlessthan

threemonths,hedroppeddown

to 170 pounds and his blood

glucose levels fell fromover130to

under100—normal.

Toyoshima proved what the DPP

hadalreadyshown:Eveninthoseat

highest risk—people with a family

history of diabetes and blood glu-

cose levels well above normal—it

ispossibletohalt thedisease in its

tracks, if you are willing to change

yourlifestyle.

Specifically,theDPPshowedthat

losingroughlyfivetosevenpercent

ofyourbodyweightandexercising

atleast150minutesperweekcould

keepbloodglucose levels fromris-

ingtothediabeticrangeinmostof

the participants. People like Toyo-

shimaarelivingproofthatitworks.

Three years later, weighing in at

163pounds,Toyoshimacontinuesto

eatareasonabledietandtowalkfor

anhourortwoseveraldaysaweek.

Henolongerfeelsthehungerpangs

hedidatfirst,andnolongercraves

fattyorfriedfoods.

What saved him, he said, was

determination.

“I did it because it killed my

mother.Isaid,‘I’mnotgoingtoletit

happentome.’”

Pre-Diabetes: Catch it early and stop it!David Toyoshima knew something wasn’t rightwhen any attempt to walk up stairs left himwinded. At 5’8” and 213 pounds, eating a diet ofjunk food and sugary colas, he was pretty surethefaintnesshefelthadsomethingtodowithhisbloodglucoselevels.

...the dPP showed that losing roughly 5 to 7 percent of your body weight and exercising at

least 150 minutes per week could keep

blood glucose levels from rising to the

diabetic range in most of the participants.

diabetes

14

Q: How important is it to monitor blood glucose

levelsthroughouttheday?

A: yourglucosemeterisyourpersonallaboratory

inthepalmofyourhand.Everypersonliving

with diabetes uses a glucose meter. Knowing

yourbloodglucoselevelinrelationtoeating,ex-

ercising,sleeping,concurrentmedicalillnesses,

stress,medications,andalloftheotherfactors

thatcanaffectglucoselevelsisinvaluable.

Homeglucosemonitoring(HGM)isnotjust

prickingyourfingerandwritingtheresultina

logbookforyourhealthcareprovidertolookat

duringyournextappointment.HGMisknowing

what your individual blood glucose goals are

anddoingsomethingaboutabnormalvalues.

OneofthebiggestbarriersIseeasadiabetes

specialist isthatpeoplewithdiabetesarenot

educated about how to act on their results,

leadingtofrustration,inactionandchronicpoor

control.

consider thischallenge: Ifyouarenotcon-

tentwithyourA1c,takea lookattheaverage

bloodglucoseonyourmeter.Mymetergives

meanaveragefor the last twoweeks,aswell

asthenumberoftimesI’vetestedinthosetime

periods. If you’d like to use your meter more

effectively,trytogetthe14dayaverageinside

yourgoalbloodglucosevaluewindow.Asfor

frequency, thekey is to testat times thatwill

giveyouinformationonhowyourmedications

areworkingand/orhowyourdaily lifestyle is

affectingyourcontrol.

Formoreinformationseewww.tcoyd.org.

Panel Of Experts

PAULEDELMAN,MDProfessorofMedicineUniversityofcaliforniaSanDiegoVeteransAffairsMedicalcenter

ROGERH.PHELPS,OD,FAAO,cDEOptometristOjaiEyesOptometry

SHERIcOLBERG,PHD,FAcSMExercisePhysiologist

Q: If I have diabetes, what can I do to protect

myeyes?

A: Notmanyyearsago,mostpeoplediagnosed

withdiabetesassumedtheywouldeventually

losetheireyesight.However,withtoday’srecent

advancesinresearchandtreatment,mostdia-

betic-relatedblindnessispreventable.Hereare

sometipstomakesureyoureyesstayhealthy:

1.Getadilatedeyeexameveryyearfroman

eye doctor you’ve established a relationship

with.youreyedoctorcandetecttinychanges

inyoureyesbeforeyouexperienceanyprob-

lemswithyourvision.Ifyouwaituntilyouhave

visionproblems,itmaybetoolateforeffective

preventativetreatment.

2.Keepbloodpressureundercontrol.High

bloodpressurecanimpactthebloodvesselsin

youreyes.

3.Don’tsmoke.Ifyoudosmoke,quit.Smok-

ingincreasesyourriskofdiabeticeyedisease.

4.Keepyourbloodglucoselevelswithinyour

targetrange.

I’vehaddiabetesformorethan20years,and

Istillhavegreatvision.youcan,too.Although

yourhealthcareteamplaysan important role

inyouoverallcare,90percentofyourdiabetic

control is your responsibility. Properly learn-

inghowtohandleyourdiabetescanleadtoa

healthierandlongerlife.

KRISSWENSON,RN,cDEDiabetesManagement&Trainingcenters,Inc.

Q: Does everyone who has diabetes need to

takeinsulin?

A: No,notallpeoplewithdiabetesmust take

insulin.Insulinisusedwhenthebetacellsinthe

pancreasarenotabletomakeenoughinsulin

themselvestomeetdemandinthebody.

A person with type 1 diabetes, an autoim-

munedisease,musttakeinsulintosurvivebe-

causethebetacellsintheirbodieshavebeen

destroyed.Butmostpeoplewithdiabeteshave

type 2 diabetes, a genetic disease fueled by

livingintoday’sworldoflessphysicalworkto

survive,higherstressandplentifulfood.People

who have type 2 diabetes do not necessarily

havetotakeinsulin.

For many, type 2 diabetes begins in pre-

diabetes,whenthebetacellsmakeexcessively

highlevelsofinsulintocompensateforinsulin

resistance.Thedemandforhighinsulinlevels

putsextraworkonthesebetacellsandtheycan

becomeexhausted.

Manyneworalagentshelplowerthebody’s

needforinsulinorkickthebetacellstomake

more insulin. But eventually, this may not be

sufficientandmanypeoplewithtype2diabe-

teswillneedtoaddinsulintotheseagentsto

keeptheirbloodglucoselevelsinasaferange.

Inthatcase,insulinisusedasasupplementto

theinsulintheirbodiescurrentlymake.

Q:Isittruepeoplewithdiabetescan’teatcer-

tainkindsoffoods?

A:Havingdiabetesdoesnotmeanyou’resub-

ject to a restrictive diet that deprives you of

certainfoods.Ahealthydietforsomeonewith

diabetesisthesameasahealthydietforanyone

else.Itislowinfat,moderateinsaltandsugar,

with meals based on whole grain foods, lean

meats,vegetablesandfruit.

Beingsmartaboutwhatyoueat—andhow

much—is especially important, whether your

goal is to lose weight or avoid gaining it. For

example,peopletakingbloodglucose-lowering

medication (insulin or oral medications) may

experiencehypoglycemiaor lowbloodsugar.

correcting lowbloodsugar immediatelywith

fast-acting carbohydrates is very important;

however, it’snot the timeto‘binge’oncandy,

cookies and other high calorie, high fat, high

carbohydrate foods.These‘treats’ take longer

to raise blood sugar than pure glucose, such

as glucose tablets, liquid or gels, and usually

containcaloriesthatdonotraisebloodsugar

levels effectively.you’re almost certain to eat

toomuchofthemwhilewaitingforyourblood

sugartorise.

When you have diabetes, your nutritional

needsarethesameaseveryoneelse’s—nospe-

cial foods or complicated diets are necessary.

Balancing healthy food choices, moderation,

andregularmealtimesisthewaytogo.

15

diabetes

If you want to find out your risk

for developing type 2 diabetes,

theAmericanDiabetesAssocia-

tionofferstheDiabetesRiskTestthat

asksyouaseriesofquestionstohelp

determinebothyourlevelofriskand

the individual risk factors you may

needtoaddress,suchasbeingover-

weight.

TaketheAssociation’srisktestat

stopdiabetes.com/usatoday or by

calling1-800-DIABETES(342-2383).

Do I Have Type 2 Diabetes?

Whetheryour risk ishighor low,

there’sonlyonesurewaytofindout

whether you have type 2 diabetes:

Gettested.

There are several different tests

your doctor can use to tell you

whether your blood glucose levels

arenormal,pre-diabetic,orcallfora

diagnosisofdiabetes.However,each

usesdifferent“cutpoints,”ornumer-

icalresultsthatindicatewhereyour

healthstands.yourdoctorwillhelp

youunderstandtheresults.

Therearethreetests thatcanbe

used to diagnose diabetes or pre-

diabetes. Two of them, the fasting

plasma glucose (FPG) and the oral

glucosetolerance

test (OGTT) re-

quirethatyounot

eat or drink any-

thing but water

for at least eight

hours before

the test. A

third, the

A1c test,

doesnot.

Testing For Type 2 Diabetes: am i at Risk?

Areyou45yearsoldormore?Doyouhaveafamilyhistory of diabetes? Do you have high bloodpressure?Areyouoverweightforyourheight?Areyoupartofanethnicorminoritygroupthat isathighriskfordiabetes?

Gastroparesis• Gastroparesis is a type of neu-

ropathy(nervedamage)inwhich

foodisdelayedfromleavingthe

stomach.

• Thisnervedamagecanbecaused

by long periods of high blood

sugar.

• Delayed digestion makes the

management of diabetes more

difficult.

• Itcanbetreatedwithinsulinman-

agement,drugs,diet,orinsevere

cases,afeedingtube.

Gastroparesisisadisorderaffect-

ingpeoplewithbothtype1andtype

2 diabetes in which the stomach

takestoolongtoemptyitscontents

(delayed gastric emptying). The

vagusnervecontrolsthemovement

offoodthroughthedigestivetract.If

thevagusnerveisdamagedorstops

working,themusclesofthestomach

andintestinesdonotworknormally,

andthemovementoffoodisslowed

orstopped.

Justaswithother typesofneu-

ropathy, diabetes can damage the

vagusnerveifbloodglucoselevels

remain high over a long period of

time. High blood glucose causes

chemical changes in nerves and

damagesthebloodvesselsthatcarry

oxygenandnutrientstothenerves.

©2009AmericanDiabetesAssociation

The skin may be the largest organ, but it’s also the most sensitive. So BD uses three distinct techniques to engineer every BD Ultra-Fine™ Pen Needle and Insulin Syringe to be thinner and smoother for a more comfortable injection.

Millions of tiny nerve endings will be happy you chose BD.

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Micro-bonded lubrication: a special double-lubrication process that creates more glide and less friction.

For more information, visit www.bd.com/us/diabetes.

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diabetes

16

DIABETIC FOOTPAIN? For more information:www.diabeticproducts.comOr call toll-free: 1-877-ZOSTRIX

CLINICALLY TESTED

7out of 10 users with diabetic foot painexperience relief of pain

Odorless & Greaseless

and other retailers nationwide!

In the Diabetic Section at:

In addition, many people may take

medications such as antidepres-

sants, pain relievers, laxatives,

birthcontrolpills,andvitaminsupple-

ments.

Taking lots of medication, pre-

scribed by a number of different

doctors,canalsobepotentiallydan-

gerous,duetopossibledruginterac-

tions.Sinceeachofyourhealthcare

providers may not know what the

otherisprescribing,youneedtomake

surethateverydoctoryouseeknows

abouteverythingyou’retaking.

Theeasiestwaytodothisistokeep

alistofallthemedicationsyouaretak-

ing,andwhatyouaretakingthemfor.

Thelistshouldalsoincludethedosage

for each medication and the brand

name,aswellasthegenericname,of

thedrug.Manypharmaciescanhelp

makethiseasierbyprintingoutalist

foryouofeverythingyouaregetting

from that pharmacy. Don’t forget to

include over-the-counter drugs and

drugsthatyoumighttakeonlyonoc-

casion.Evennutritionalsupplements

cansometimesinteractwithmedica-

tions, so these should go on the list

aswell.

Who should have this list?

Any health care provider who

prescribesmedicationtoyoushould

haveacopyofthelist,asshouldyour

pharmacist. If you have a certified

DiabetesEducator(cDE)orsomeone

who advises you on food supple-

ments,theyshouldalsobeawareof

what you take. Finally, one or more

familymembersshouldhaveacopy

ofthelistincaseofamedicalemer-

gency.Keepacopyofthislistsome-

where in thehousewhere itcanbe

easilylocated.

Organization is key

Rememberingwhento takewhat

—and whether or not you took it

—isalsoavitalcomponentofgood

medicationmanagement.Ifyoudon’t

already have one, pick up a pillbox

that lists each day of the week and

hascompartmentsfordifferenttimes

oftheday.

Onceaweek,fill theboxwiththe

appropriate pills for each day and

timeofday.Thisisthesafestandeasi-

estwaytoensurethatyoudon’tskip

pillsordoubledosethembecauseyou

can’t remember ifyoutookthemor

not.Besuretokeeptheboxinaplace

whereyoucan’tmissitasareminder

totakeyourmedication(thoughout

ofreachofsmallchildren).

Managing Multiple MedicationsHaving diabetes often means taking more than one medication, perhaps more than once a day.

Sleep Apnea: Need Not be scary

Peoplewhohavetype2diabetesmaytakeinsulin,medicationforhighbloodpressureandhighcholesterol,and/orglucose-loweringdrugs.

Once a week, fill the box with the appropriate pills for each day and

time of day.

Are you ever jolted awake by

thesoundofyourownsnor-

ing? Loud snoring is a sign

thatyoumayhaveOSA.yourfamilyor

partnermaymakejokesaboutsnor-

ingatyourexpensebutsleepapnea

is no laughing matter. Sleep apnea

canbedangeroustoyourhealth.Un-

treatedsleepapneacanincreaseyour

riskofhavinghighbloodpressureand

evenhavingaheartattackorstroke.

Sleepapneacanalsoincreasetherisk

ofdiabetesandtherisk forwork-re-

latedaccidentsanddrivingaccidents.

Although anyone can have sleep

apnea,thegreaterriskfactorsinclude:

• Beingmale

• Smoking

• BeingOverweightorobese

Ifyoufitthisprofile,youshouldtalk

to your health care provider about

takingatesttodetermineifyousuf-

ferfromsleepapnea.”

©2009AmericanDiabetesAssociation©2009AmericanDiabetesAssociation

“Manymenwithdiabetesalsosufferfromobstruc-tivesleepapneaorOSA,abreathingdisorderwheretheairwayisblockedwhenthemouthandthroatrelaxduringsleep,oftenformorethan10seconds.

depressionThe rate of depression in people

with diabetes is much higher than

in the general population.Women

experiencedepressionabouttwice

asoftenasmen.

The risk of depression increases

in women with diabetes. Many

hormonalfactorsmaycontributeto

the increasedrateofdepression in

women—particularlysuchfactorsas

menstrualcyclechanges,pregnancy,

miscarriage, postpartum period,

pre-menopause, and menopause.

Many women also face additional

stresses, such as responsibilities

bothatworkandhome,singlepar-

enthood,andcaringforchildrenand

foragingparents.

Previous studies have shown in-

dividuals who are insulin-resistant

mayhavehigherserotoninconcen-

trations and may be more prone

to depression and even suicide.

Womenwithdiabetesmaybemore

likely to suffer depression because

oftheclinicaldiagnosis.”

ARE YOU AT RISK?

Calculate Your Chances for Type 2 or Pre-Diabetes

AT-RISK WEIGHT CHART

HEIGHT WEIGHT

148 LBS

153 LBS

158 LBS

164 LBS

169 LBS

175 LBS

180 LBS

186 LBS

192 LBS

198 LBS

203 LBS

209 LBS

216 LBS

222 LBS

228 LBS

235 LBS

241 LBS

248 LBS

254 LBS

261 LBS

4’10”

4’11”

5’0”

5’1”

5’2”

5’3”

5’4”

5’5”

5’6”

5’7”

5’8”

5’9”

5’10”

5’11”

6’0”

6’1”

6’2”

6’3”

6’4”

6’5”

I-800-DIABETES diabetes.org/risktest

HIGH RISK: You are at higher risk for having type 2 diabetes. However, only

your doctor can tell for sure if you do have type 2 diabetes. Talk to your doctor to see if additional testing is needed.

LOW RISK: Right now your risk for having pre-diabetes or diabetes is low.

But your risk goes up as you get older. Talk to your doctor about how to keep your risk low.

AT RISK FOR PRE-DIABETES: You are at higher risk for pre-diabetes

which means your blood glucose is higher than normal but not high enough to be diagnosed as diabetes. Talk to your doctor about ways to reduce your risk for diabetes.

NO

NO

NO

NO

Q: Have you ever been told by a doctor or other health professional that you had hypertension (high blood pressure)?

YES

Q: Are you Caucasian (white)?

YES

Q: Does your mother, father, sister or brother

have diabetes?

YES

Q: Are you under 57 years of age?

NO

YES

NO

NO

Q: At your height (see AT-RISK WEIGHT CHART), is your weight equal to or

more than the at-risk weight?

Q: At your height (see AT-RISK WEIGHT CHART), is your weight equal to or

more than the at-risk weight?

QUESTION:ARE YOU UNDER

45 YEARS OF AGE?YES

START HERE

NO

Q: Have you ever developed diabetes during pregnancy?

YES

YES

YES

This simple tool can help you determine your risk for having pre-diabetes or diabetes. Using the flow chart, answer the questions until you reach a colored shape. Match that with a risk message shown below.

The American Diabetes Association has revised its Diabetes Risk Test according to a new, more accurate statistical model. The updated test includes some new risk factors, and projects risk for pre-diabetes as well as diabetes.

DIABETES RISK TEST

*

*Your risk for diabetes or pre-diabetes depends on additional risk factors including weight, physical activity and blood pressure.

19

diabetes

When left untreated, dia-

betescan leadtoserious

complications. Some of

them—suchasheartdisease,kidney

failure or stroke—can be fatal. Oth-

ers, such as nerve damage, can be

quitepainful.

What’s more, diabetes-related

complications don’t affect every-

one in the same way. For example,

womenaremorelikelythanmento

sufferfromdepression;AfricanAmer-

icansaretwotofivetimesmorelikely

toexperiencekidneydiseaseand50

percentmorelikelytodevelopvision

problems related to diabetes; and

menaremorelikelytohaveproblems

withsexualfunction.

However, many diabetes-related

complications can be prevented or

delayed through lifestyle changes

and proper treatment or manage-

ment. Here are some of the most

commondiabetes-relatedcomplica-

tions, and what you can do to help

preventthem:

Heart Disease, Stroke

and Associated Risk Factors

People with diabetes are more

than twice as likely as people with-

out diabetes to have heart attacks

orstrokes.Theyarealsotwotofour

timesmorelikelytodieprematurely

fromheartdisease.

One of the biggest risk factors

forheartdisease—highbloodpres-

sure—isalsoverycommoninpeople

withdiabetes.Roughlythreefourths

of all adults with diabetes have it.

Likewise,highcholesterol levelsare

commonlyfoundinpeoplewithtype

2diabetes.

The first step in preventing heart

diseaseanditsassociatedriskfactors

istoknowyournumbers:Haveblood

pressureandcholesterollevelstested

regularly. The American Diabetes

Association recommends that most

people with diabetes keep blood

pressurelevelsbelow130/80mmHg.

cholesterolismeasuredas“good”

cholesterol (HDL), which protects

your heart, and “bad” cholesterol

(LDL), which can lead to heart dis-

ease. A good target for HDL would

be 40 mg/dl or above for women;

50 mg/dl for men. The Association

recommends that people with dia-

beteskeepLDLlevelsbelow100mg/

dl, and that people with diabetes

whoalsohavesignsofheartdisease

maintainLDLlevelsbelow70mg/dl.

Increased physical activity and

proper nutrition, such as eating a

low-fat, low-salt,high-fiberdiet,are

twoofthebestwaystolowerblood

pressure and cholesterol levels and

prevent heart disease and stroke.

However,thismaynotbeenoughfor

some people and medications may

becomenecessary.

Kidney Disease

Whenexcessglucosebuildsupin

theblood, itmakesitharderforthe

kidneys to do their job—filtering

wasteproductsfromthefoodweeat

outofourblood.Overtime,thisdam-

agesthekidneysandcausesthemto

leak.Eventually,itcancausethemto

failcompletely.

Thebestwaytoprotectthekidneys

fromfailing is throughtightcontrol

ofbloodglucose levels.Whendiag-

nosed early, kidney decline may be

stopped,andpossiblyevenreversed.

However, once the kidneys fail, it’s

necessaryforpatientstoundergodi-

alysis(inwhichamachinecleansthe

patient’s blood) or transplantation

tosurvive.

Diabetes is the leading cause of

End Stage Renal Disease (ESRD), or

kidney failure; it currently accounts

for 44 percent of all new cases.

However, a study by the centers

for Disease control and Prevention

noted that renal failure has been

declining steadily in recent years,

possibly due to better treatment,

suchasmoretightlymanagingblood

glucoselevels.

Nerve Damage

Highlevelsofglucoseintheblood

can also lead to nerve damage,

known as neuropathy. This causes

a wide variety of symptoms, from

tinglingsensationsinthehandsand

feet to problems digesting food. At

itsmostextreme,nervedamagecan

leadtoamputatingthelowerlimbs.

Some type of nerve damage is

common in most people with dia-

betes:between60and70percent

of people with diabetes suffer at

least mild symptoms. Diabetes

is the leading cause of lower-

limbamputations intheUnited

States;morethan60percentof

amputations are attributed to

thisdisease,arate25timeshigherfor

peoplewithdiabetesthanforthose

without.

Thebestwaytopreventneuropa-

thyistokeepbloodglucoselevelsin

your target range. you should also

haveyourfeetcheckedregularlyfor

problems.Agoodruleofthumbisto

haveyourdoctorcheckyourfeetat

everyvisit,sincesymptomsoftengo

unnoticed.

Other Complications

Diabetesisalsotheleadingcause

ofblindnessandcancausenumerous

visionanddentalproblems,aswellas

depression and sexual dysfunction

inbothmenandwomen.Itcanalso

makeyoumoresusceptibletoillness

andslowthehealingprocess.

It’s Complicated: What Happens When diabetes Goes UntreatedGettingadiagnosisofdiabetescanbeabitoverwhelmingatfirst.There’salottolearnabouthowhighbloodglucoselevelscanaffectyourbodyandwhatyouneedtodotokeepyourlevelsundercontrol.

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some of them—such as heart disease, kidney failure or stroke—can be fatal. Others, such as nerve

damage, can be quite painful.

© 2010 Except where notedd, all trademarks are owned by Société des Produits Nestlé S.A., Vevey, Switzerland. Gluucerna® is a registered trademark of Abbott Laboratories. NeestleNutrition.com/us

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