Here's a review on diabetes posted last week at a NJ web site. It doesn't talk about Rezulin or Targretin, but it begins to define the target population:
Diabetes is the leading cause of adult blindness in the
United States. It is the single leading cause of kidney
failure and non-traumatic amputations. This year alone,
160,000 Americans will die from diabetes-more than from
breast cancer, AIDS and other chronic diseases. Diabetes
costs the U.S. more than $92 billion in health care costs
and lost productivity annually.
It is estimated that although about 16 million Americans
have diabetes, only half of them have been diagnosed with
the disease. Furthermore, many people who are aware of
their condition do not take it seriously enough and develop
severe complications.
What's most tragic about all this is that diabetics can live
long, healthy lives. Many of the health problems
associated with the condition can be prevented or
moderated by maintaining a normal body weight, engaging in regular physical
activity, eating well, and taking medication if advised to do so by a physician. In
certain instances, diabetes can be avoided altogether by following these life-style
recommendations.
Who Gets Diabetes?
Anyone can get diabetes, but the following factors may put you at higher risk of
developing it:
Being overweight (see weight chart)
Having a family history of diabetes
Being of African-American, Hispanic or Native American origins ups the
risk of developing diabetes two to six times as that of the general
population. In addition, African Americans experience higher rates of
blindness, amputation and kidney failure due to diabetes.
Not exercising regularly (see All the Right Moves)
Being over age 45
Delivering a baby over nine pounds
What Is Diabetes?
When we eat, our body turns food into glucose (the sugar that cells use for fuel),
and a hormone called insulin helps the glucose get into body cells. In diabetes,
however, too much glucose stays in the blood. As a result, two problems occur:
body cells become starved for energy, and, over time, the high glucose levels can
damage the nerves, eyes, kidneys, heart and blood vessels.
There are two main kinds of diabetes:
1) The most common form of diabetes, accounting for 90 to 95 percent of all
diabetes cases, is noninsulin-dependent diabetes (type II diabetes). People with
this condition either don't produce enough insulin to control glucose levels or their
cells simply do not respond to the insulin.
2) Insulin-dependent diabetes (type I diabetes) is less common but much more
severe. This condition is caused by damage to the pancreas, an organ near your
stomach that contains beta cells, which produce insulin. Many things can destroy
beta cells, but in most people with insulin-dependent diabetes, a glitch in the
immune system causes it to attack the beta cells. Without insulin-producing beta
cells, glucose builds up in the blood.
Can I Tell If I Have Diabetes?
That depends. Most people with Type II diabetes cannot tell they have it, which
is one of the reasons only half of all the people with the condition have been
diagnosed. However, if their blood glucose levels get way too high (most likely
when the person is sick or under a lot of stress), signs may include: headache,
blurry vision, excessive thirst, frequent urination, or dry, itchy skin.
Type I, on the other hand, is more likely to be apparent. People with this form of
diabetes can experience one or more of the following: an inexplicable weight loss,
very frequent urination, constant hunger and thirst, trouble seeing, fatigue, lapsing
into a coma. A simple blood test that detects how much glucose is in the blood
can reveal whether a person has diabetes. Then a doctor must consider various
factors to determine if it's type I or II. Generally, people with type I are diagnosed
when they're under 30 years old, lean, and have high levels of ketones (toxins
your body produces when it breaks down fat for energy) in their urine. People
with type II are most often diagnosed when they're obese and over 30. They
usually do not have urine ketones.
How Is Diabetes Treated?
Diabetes is a chronic disease that can be managed, but not cured. The goal of
treatment for both types of diabetes is to lower blood glucose levels and improve
the body's use of insulin. The recommended ways to do this include:
Eating a healthy diet. Since your body changes food into glucose, what
you eat is very important when trying to control glucose levels. In the past,
people with diabetes were told to stay away from sweets, but diet
recommendations have changed. Experts now believe the best dietary
recommendations for diabetics are the same as they are for everyone:
minimize fat intake, consume moderate amounts of protein, and plenty of
complex carbohydrates. Consistency and moderation are also very
important dietary factors for diabetics. It's best to eat about the same
number of calories each day, keep track of how much carbohydrate is
eaten, have meals and snacks at the same time each day, and never skip
meals.
Since each person is different, it's important for people with diabetes to see
a dietitian who can work out a unique eating plan. To create such a plan,
the dietitian needs to know details about preferred foods, daily activities,
other health problems, and exercise habits.
Exercise. Being active plays an important role in the treatment of diabetes
because it helps cells take in glucose and lowers glucose levels in your
blood. Ideally, it's best to exercise three or four times a week for at least
20 minutes. People who are not used to exercising, should start slowly.
Even a five-minute walk is a step in the right direction.
Glucose Testing. Home glucose tests can help keep track of how well
you are controlling glucose levels. To test blood, a special device called a
glucose meter is available in most drug stores. To perform the test, you
prick your finger and put a drop of blood on a special test strip that the
meter analyzes and then displays how much glucose it contains. Your
doctor will tell you how often to test your blood. You should keep a diary
of the results.
How Does Treatment For Type I and II Differ?
The strategies mentioned above can help control both types of diabetes. But there
are a few ways in which treatment varies depending on which form of the disease
a person has. These are:
Type II Diabetes
People with noninsulin-dependent diabetes are often advised to lose weight
if they are 20 percent over the recommended weight for their sex and
height (see weight chart). Losing weight helps your body use insulin better.
In fact, sometimes losing 10 or 20 pounds is all that's needed to bring type
II diabetes under control.
Still, sometimes healthful habits like eating well, losing weight and exercising
are not enough. In that case, people with type II diabetes may have to take
one or both of the following:
Diabetes pills do not contain insulin, but they help the body better use the
insulin it produces. There are two kinds of diabetes pills: sulfonylureas and
biguanides. There are many kinds of sulfonylureas, but metformin is the
only type of biguanide. According to the American Diabetes Association,
no one pill is better than any other. What differs is how often they need to
be taken, how long they take to act and their side effects. The main side
effects of metformin are upset stomach and diarrhea. The sulfonylurea
drugs can cause low blood sugar reactions. Both kinds of drugs may
interact with other medicines.
It is very important to keep in mind that taking pills does not replace
healthful habits. You still need to eat a good diet or the pills won't work.
Sometimes diabetes pills do not help. In some people they help at first and
then stop working. When this happens, a combination of both sulfonylurea
and metformin may be effective.
Insulin Shots. If all else fails, insulin supplements may be necessary either
alone or along with the pills.
There are various sources and types of insulin from which to choose. The
hormone may come from pigs or cows, or it may be made in a lab (the
latter has the fewest side effects). Insulin also comes in three speeds, or the
time it takes for the insulin to enter the bloodstream and reach its peak
action, and the duration of time it stays in the blood. Doctors can use these
differences to tailor treatment to a particular patient's schedule and lifestyle.
Most people take regular insulin at least twice a day, before breakfast and
dinner, since it acts quickly on the glucose produced by their meals. The
longer acting insulins are helpful because they control glucose levels during
the late part of the day or overnight. Usually the two speeds of insulin are
mixed together and given at breakfast and dinner, but different
combinations can be used to suit individual needs.
Type I Diabetes
Type I diabetes is known as insulin-dependent diabetes because people
with this form of the disease don't produce the vital hormone and take
insulin every day to get glucose out of their blood and into their cells for
fuel. Without insulin, a type I diabetic can die. Insulin shots must be taken
every day. Doctors teach their patients how to give themselves shots and
to smoothly incorporate this critical treatment into their lives.
Type I diabetics can also get insulin by using a pump. The small
computerized device can be hooked on to a belt or pocket. A plastic tube
leads from the pump to a needle inserted under the skin and provides a
constant supply of insulin. It can deliver a bigger dose before meals. The
benefit of a pump is that it gives precise, accurate doses and releases
insulin in much the same way the body does. Some people are able to get
their glucose under better control with pumps, but they cost more than
shots and take some time to learn to use. If you want to find out more
about the pump, discuss it with your doctor. glucose testing. Most
insulin-dependent diabetics monitor their glucose levels at least four times a
day.
Treatment Complications
1) Ketoacidosis. Sometimes blood glucose levels can get too high. This may
happen if a person eats too much or doesn't take enough insulin. Stress can also
make blood glucose levels rise. Without enough insulin, the body is starved for
energy and starts breaking down fat for fuel. As a result, the body produces toxic
chemicals called ketones, which can cause vomiting, difficulty breathing, thirst,
dry, itchy skin, or coma. Diabetics who feel any of these symptoms must test both
their glucose level and their urine for ketones, using test strips that can be bought
at the drugstore. Diabetics should also check their urine when glucose levels are
over 240 mg/dL and when they are sick. Immediate medical attention is
necessary when ketones are persistently found in the urine.
2) Hypoglycemia. Sometimes, insulin or sulfonylurea pills lower glucose levels
too much and cause a person to feel tired, confused, shaky, sweaty and/or
hungry. When this happens, glucose levels should be tested at once. Diabetics are
urged to do the same thing whenever they feel "odd" or "funny." A low glucose
reading (less than 70 mg/dL) can be remedied by eating 15 grams of a fast-acting
sugar right away. For example, 1/2 cup of fruit juice, 2 tablespoons of raisins, 1
cup of skim milk, 3 hard candies, 4 teaspoons of sugar or 4 ounces of non-diet
soft drink.
What Can Go Wrong?
Too much glucose in the blood over many years can damage the eyes, kidneys,
and nerves. It also increases the risk for heart and blood vessel disease. The best
defense against diabetes complications is to keep glucose levels under control.
Nerve Damage
The damage diabetes causes to nerves is called diabetic neuropathy and
there are several types, depending on which part of the body is affected.
The symptoms of nerve damage can include:
Feelings of prickling, tingling, burning or jabbing
Loss of feeling
Weak muscles
Fainting
Vomiting
Bladder infections
Diarrhea
Sexual problems
To prevent nerve damage, diabetics are encouraged to keep glucose levels
well under control, eat a healthy diet, exercise regularly, avoid smoking,
and drink alcohol in moderation-if at all.
If nerve damage does develop, improving glucose control can help. Also,
pain caused by the damage can be treated with certain drugs, exercises or
special skin creams. Surgery may sometimes help. Other treatments are
available depending on where the nerve damage occurs.
Kidney Damage
The kidneys are essential to filter wastes from the blood. But diabetes may
cause the kidneys to lose their ability to filter properly. As a result, protein
that the body needs is lost in the urine, and wastes that the body doesn't
need build up in the blood. Ten to 21 percent of all people with diabetes
develop kidney disease (diabetic nephropathy). This type of disease
causes no symptoms until the kidneys are severely damaged. Therefore,
people with diabetes should have their urine tested for protein each year.
Blood tests can also be performed.
Kidney disease may be prevented by controlling glucose levels, keeping
blood pressure down, and eating a healthful diet. This is critical because
once kidney damage occurs, it cannot be reversed. Two treatments are
available for kidneys that are severely compromised. One is dialysis, in
which a patient is hooked up to a machine that filters the blood. Dialysis
must be performed frequently and for long periods of time, often three
times a week for over four hours each time. The other option is a kidney
transplant.
Eye Damage
Diabetes can lead to diabetic retinopathy, or eye disease. There are two
types of eye damage that can occur from diabetes. In the milder form,
nonproliferative retinopathy, blood vessels leak blood and fluid into the
eye. The more severe-and luckily less common-type of eye damage is
proliferative retinopathy, in which new blood vessels sprout and grow
out of control. Both types cause eye damage by putting pressure on the
retina (the lining at the back of the eye that senses light and acts like the film
in a camera). If left unchecked, this damage can cause blindness. Like
kidney disease, retinopathy may not cause any symptoms, so diabetics
should see an ophthalmologist each year after the age of 30. Those under
30, are also advised to see an eye doctor every year after they've had
diabetes for five years. A trip to the eye doctor is in order if there are
warning signs like blurry or double vision, spots or floaters, pain or
pressure in the eyes, difficulty reading, or loss of peripheral vision (the
ability to see things from the outer corners of the eyes).
The best way to prevent eye damage is to keep glucose levels normal.
However, if damage occurs, the earlier it's caught, the better treatment
works. The two main treatments are: Photocoagulation (sealing leaky
blood vessels with a laser), and Vitrectomy (surgically removing blood and
scar tissue from the eye).
Heart and Blood Vessel Damage
Diabetes increases the risk for hardening of the arteries, stroke, and
peripheral vascular disease, in which an insufficient amount of blood
reaches the areas farthest from the heart. This occurs because diabetes
changes body chemistry. As a result, blood may clot too easily, blood
vessels may narrow, and fat may build up in the blood vessels faster.
Symptoms include poor circulation, frequent infections, itchy skin, shiny
legs that lose their hair, calves that hurt excessively during exercise and, for
men, difficulty having an erection. High blood pressure and cholesterol
levels signal that a person has a higher risk for heart or blood vessel
damage (see our Special Report In Tune with the Beat of Your Heart).
Preventive measures for these problems include:
Keeping blood glucose levels under control
Not smoking
Eating a low-fat, low-salt diet
Keeping blood pressure normal
Keeping your blood cholesterol level below 200 mg/dL
Exercising regularly
Losing weight if needed
Poor lifestyle habits are linked to 50 to 80 percent of all cases of type II
diabetes-the most common form of the disease. That means you can
significantly reduce your risk of developing diabetes by maintaining a
healthy body weight, engaging in regular physical activity and eating well.
Other Problems
Often, damage to one organ will affect other parts of the body.
Common problems of this type include:
Skin. Damaged nerves and narrowed blood vessels can both
lead to dry, itchy skin. Poor circulation makes infections more
likely and longer lasting, and can cause spots, blisters, yellow
bumps and rashes. Skin on the hands and toes may become
waxy and tight. Moisturizing skin (except between toes and
other places where skin touches skin) can help. Cuts should
be washed carefully, but avoid harsh cleaners like alcohol.
Mouth. High glucose levels provide an inviting home for
germs, so people with diabetes are more likely to get gum
infections. In addition, poor circulation can slow down the
healing process. Professional cleaning every six months can
help protect teeth, as can brushing with a soft brush at least
twice a day, and flossing every day.
Impotence. One out of every four impotent men has
diabetes. Both nerve damage and poor circulation can make
it difficult to have an erection. If the doctor determines that
impotence is caused by diabetes, getting glucose levels under
control can help. Also, quitting smoking will improve
circulation.
Feet. People with diabetes often have problems with their
feet. Nerve damage and reduced circulation can affect feeling
in the feet, making it difficult to detect if they've been scraped
or injured. Poor blood flow can keep any sores from healing,
which can lead to gangrene (when the tissue dies because of
inadequate circulation in the area). That is why diabetes is the
most frequent cause of non-traumatic lower limb amputations.
Each year 54,000 people lose their foot or leg to diabetes.
To protect their feet, diabetics should: Wash them and dry
them carefully; check for injuries; have shoes fit by a trained
fitter; wear only comfortable, supportive shoes with low heels
and plenty of wiggle room for the toes; check for pebbles or
other irritating objects before slipping shoes on; wear socks
without seams or mended areas; avoid going barefoot-even
to walk to the bathroom during the night.
Our thanks to Seth N. Braunstein, M.D., Associate Professor of Medicine, Division of
Endocrinology, University of Pennsylvania, Philadelphia, PA, for reviewing this article. |
