The consequences of developing Type 2 diabetes hit close to home yesterday. My uncle went in for an operation to have his leg amputated below the knee. Not long before, he developed cellulitis in his toe from a cut that went untreated. Why did it go untreated? He was unaware of the cut because he had lost partial feeling in his feet–a common symptom of Type 2 diabetes.
Diabetes is a medical condition in which too much sugar, or glucose, levels build up in your bloodstream. When you consume foods, your body breaks down the sugars in your blood and turns it into glucose and fructose which travels through your bloodstream and provides your body with energy. To accomplish this, your pancreas needs to produce a hormone called insulin. In a person with diabetes (diabetes mellitus), the pancreas either produces too little insulin or none at all, or the insulin can’t be used effectively. This allows blood glucose levels to rise while the rest of your cells are deprived of much needed energy.
When an individual develops Type 2 diabetes their system becomes insulin resistant. In this sort of diabetes, the pancreas starts off producing adequate amounts of insulin. However, cells that need energy don’t respond normally to the usual amounts of insulin due to the damage done by the constant high levels of glucose in the blood. The pancreas has to produce much higher levels of the hormone in order to manage blood glucose levels. Over time, the insulin-producing cells in the pancreas burn out due to this overproduction. When this happens your body has to rely on alternative energy sources in your tissues, muscles, and organs. This is a chain reaction that can cause a variety of symptoms.
Type 2 diabetes can develop slowly. As the disease progresses, symptoms become more severe and can include:
- yeast infections
- slow-healing cuts or sores
- dark patches on your skin
- foot pain
- feelings of numbness in your extremities, or neuropathy
- kidney disease
- heart disease
Cellulitis is a fast moving skin infection. My uncle felt some pain in his foot but didn’t think it was bad enough to have it checked. Eventually there was a trip to the emergency room that was cut short because the wait time was so long. When the pain became unbearable he called an ambulance and was finally seen by a doctor. By that time cellulitis was the diagnosis and the decision was to amputate his toe. Upon further examination it was determined that amputating part of the foot was necessary. But by the time surgery was agreed on the doctors felt it was best to amputate the entire lower leg to make certain the infection was removed.
At 82 years old my uncle did not take this news well. Losing his leg was difficult to hear but the inevitable discomfort, the necessity of a prosthetic and rehabilitation was daunting. On top of this his wife, my aunt, has cervical cancer and suffers from Alzheimer’s disease. Her time is limited and my uncle, knowing this and not wanting to be a further “burden” on his children, initially decided against surgery and to let the infection run its course and take his life. The doctors gave him a few pain filled weeks to live. Fortunately, his daughter, his brother (my father) and his doctors were able to convince him to have the surgery. The surgery went well and today he is recuperating in his hospital bed, hopefully relieved to be alive, as we all are. But he is certainly anxious about what lies ahead and the looming prospect of losing his wife.
As terrible as this may sound, my uncle will be a “burden” on his children. They have full time jobs and their own family obligations. I am not trying to be crass but merely using this story to point out the far reaching ramifications of developing a disease like type 2 diabetes. Not only will the golden years of my uncle’s life be uncomfortable but his adult children will have to make special arrangements for him and take the extra time to attend to his eventual needs. Of course they will do this without regret because they love their parents but nonetheless it will be physically and mentally taxing at times.
Just today a report was released by the United Health Foundation stating the next generation of senior citizens, which is the baby boomer generation, will be sicker and costlier to the health care system over the next 14 years than any previous generation.
The report looks at the current health status of people ages 50 to 64 and compares them to the same age category from 1999. The disturbing results are that there will be about 55 percent more senior citizens who have diabetes than there are today, and about 25 percent more who are obese.
Overall, the report says that the next generation of seniors will be 9 percent less likely to say they have good or excellent overall health. That's bad news for baby boomers and for taxpayers. Health care costs for people with diabetes are about 2.5 times higher than for those without, according to the study.
"The dramatic increase has serious implications for the long-term health of those individuals and for the finances of our nation," says Rhonda Randall, a senior adviser to the United Health Foundation and chief medical officer at United Healthcare Retiree Solutions, which sells Medicare Advantage plans. Most of the costs will be borne by Medicare, the government-run health care system for seniors, and by extension, taxpayers.
- Over 29 million people 9.3 % of the US population has diabetes. Over 95% of which have type 2 diabetes.
- 1.4 million cases of diabetes are diagnosed every year. One in four people have no idea they have diabetes.
- More than one in three adults or 86 million Americans age 20 and older had prediabetes, and 15 to 30 percent of them will develop type 2 diabetes within five years.; this is up from 79 million in 2010.
- In 2012, diabetes cost the United States $245 billion in direct medical costs and reduced productivity.
- The average medical expenses for people with diabetes are about 2.3 times higher than they would be in the absence of diabetes.
- Diabetes is the seventh leading cause of death in the United States, either as the underlying cause of death or as a contributing cause of death.
- The 2014 global prevalence of diabetes was about 9 percent for adults.
- Diabetes caused about 1.5 million deaths worldwide in 2012.
A study published in the journal Diabetologia has found adults with diabetes die earlier and suffer longer with disabilities than men and women without the blood-sugar disease.
"People with diabetes are spending a significant proportion of life with disability," said lead researcher Dianna Magliano. She is head of the diabetes and population health laboratory at Baker IDI Heart and Diabetes Institute in Melbourne, Australia.
Elevated blood sugar levels associated with diabetes lead to blood vessel complications that can cause vision loss, movement problems and amputations. Other disabilities not usually tied to diabetes include a decline in brain functioning, Magliano said.
Prevention measures for Type 2 diabetes generally include lifestyle changes, such as weight loss, exercise, a healthy diet and not smoking.
More than 400 million people worldwide have diabetes, with most nations reporting sharp increases in recent decades, due to rising rates of obesity, according to background notes in the report. And, approximately one-third of people 25 or younger are likely to eventually develop diabetes, the study authors said.
Not only is developing diseases like type 2 diabetes a burden on one’s self, their family and employer but also on society at large.
Type 2 diabetes, for the most part, is an avoidable disease. It falls into the category of a lifestyle disease. Which is something unique to industrialized wealthy nations. A lifestyle disease is caused by the excesses in which the citizens of a wealthy nation can and do enjoy but at their peril. Excesses like smoking, drinking and having readily available cheap, abundant high caloric foods. Cases of Type 2 diabetes has exploded in the last few decades at the same time the consumption of sugar has increased dramatically.
Since 1960 the rates of diabetes, sugar consumption, obesity and heart disease have spiked in tandem. According to The United States Department of Agriculture (USDA) the average American consumes between 150 to 170 pounds of refined sugars in one year! To put this in context less than 100 years ago, the average intake of sugar was only about 4 pounds per person per year.
You’re probably thinking there is no way I consume that amount of sugar every year. You may be right but for every American who eats only 5 pounds of sugar each year, there is one who eats about 295 pounds per year. Eating 150-170 pounds of sugar in one year is also equivalent to consuming 1/4 to 1/2 pounds of sugar each day. That is 30-60 teaspoons of sugar in a 24-hour period. Which is the equivalent to drinking four 12 ounce cans of soda per day. You might not drink that much soda but what about sweetened coffee or tea, fruit juices, sports drinks and maybe a couple glasses of wine every night? It adds up quick.
Americans consume refined sugars in numerous forms – there are the obvious sugary culprits such as baked goods, ice cream and candy. However, sugar is hidden in so much of what we consume every day. Sweeteners such as high fructose corn syrup can be found in:
- barbecue sauces
- frozen dinners
- hot dogs
- peanut butter
- salad dressing
Keep in mind all carbohydrates, which include table sugar or high-fructose corn syrup, mainly break down into glucose and fructose. So on top of the table sugar or simple carbohydrates you consume every day, the foods you should be eating like breads, rice, fruit and vegetables are adding to the sugar upload as well. When you add all the ways we are potentially consuming sugar you can see how it can easily add up to 150 to 170 pounds every year.
A high fructose intake, especially from sweets and sugary beverages, is associated with high triglycerides, which increase your risk of suffering from cardiovascular diseases, according to a 2010 scientific article in "Physiological Reviews."
Of course there are simple solutions to reducing the amount of sugar we consume. Like limiting our beverage choices to black coffee, unsweetened tea and water. Cutting out baked goods, ice cream, and the amount of condiments we use. Limiting our carbohydrate intake to whole grains, vegetables and fruits that also provide the benefit of fiber.
The industrial food complex has constantly produced and marketed foods that are bad for us. Foods that contain large amounts of sugar, salt (consuming large amounts of salt leads to hypertension, high blood pressure and cardiovascular disease) and other unhealthy additives. These additives are in foods to make them taste better and to make them addictive. So what are we to do?
Our government is unlikely to do anything meaningful about the health epidemic in our country due to the enormous amount of money associated with the food industry and the special interests that lobby our leaders and control the public message. Often these messages are misleading at best, and outright lies at worst. There are of course tens of thousands of jobs at stake as well.
So the best thing we can do is educate ourselves about proper nutrition and exercise. The internet is awash with health, wellness, nutrition and fitness information. Seek out reputable organizations like the American Diabetes Association or the American Heart Association. Ignorance is no longer an excuse. Start making sacrifices by making healthier lifestyle choices. Quit smoking or drinking excessive amounts of alcohol. Pay attention to food labels and limit the amount of sugar you consume. Help your children develop healthy eating habits. For example, soda should not be considered, under any circumstance, as a beverage option. Water is the perfect liquid to do the job. My kids, who are 10 and 13, have heard me preach the ills of too many ‘carbs’ to the point now they know to restrict the amount they eat on a daily basis. If they have bread in the morning they know to not have it on a sandwich for lunch or to not eat pasta for dinner. In addition to changing our eating habits, exercise is vital to preventing and even combating existing diseases.
According to the USA federal report on obesity, over the last two decades, physical activity in the US has declined significantly. This is at the same time rates of diabetes, obesity and cardiovascular disease have been increasing. Correlation? I think so. Numerous studies have shown that regular exercise lowers blood sugar levels and blood pressure, increases metabolism and improves insulin sensitivity. Studies have also shown that regardless of body weight, subjects that are more physically active or fit consistently have a lower risk of adverse health outcomes compared with those who are inactive or unfit.
Physical inactivity increases the risk of cardiovascular disease, cancer, diabetes, hypertension, obesity, and premature death. Aging causes muscle mass and strength to decrease which challenges older adults who want to remain active. Increasing physical activity prevents and helps manage numerous chronic diseases. Physical activity has also been shown to increase bone density, reduce falls, prevent memory loss, and decrease depression. Growing evidence illustrates the importance of environment and community design to promote physical activity for seniors. Inadequate levels of physical activity in American adults is associated with an estimated $117 billion in health care expenditures per year after adjusting for body mass index. (United Health Foundation)
Studies are now showing that burning at least a 1000 calories per week through physical activity is the best way to improve insulin sensitivity and human growth hormone. Wearing heart rate monitors when exercising helps to track the number of calories burned. In the beginning a goal of burning at least 1000 calories per week should be set. This may not be easily achieved at first but as your fitness improves it is important to ramp up the intensity during your workouts to burn more calories. Exercise intensity contributes to a number of health benefits. One particular advantage is it causes the body to burn even more calories long after you have finished your workout.
An easy way to start a fitness routine is to download one of the numerous fitness apps on the market today. They’re convenient because they exist on your phone which allows you the flexibility to follow a workout anywhere you are. We like Phyzseek because it was developed by a doctor and incorporates a variety of features that motivate you and make it easy to start, follow and stick to its very effective program.
My uncle may not have had the benefit of all that we know today about egregiously erroneous marketing, proper nutrition and the importance of physical activity but in the age of information you should know. It’s never too late to make healthy lifestyle changes and to start making fitness a priority in your life. The benefits will allow you to enjoy a more active, comfortable and disease free life even late into your golden years. We call this functional longevity. You can call it whatever you want but do it for yourself, your family and our communities.
Jacob, Aglaee. “Do All Sugars Transported to the Liver Convert to Glucose?” SF Gate.
Pietrangelo, Ann. “Understanding Type 2 Diabetes.” Healthline. 31 March 2016.
Regan, Jennifer. “Not So Sweet – The Average American Consumes 150-170 Pounds of Sugar Each Year.” Bamboo Core Fitness 10 December 2004
Reinberh, Steven. “Diabetes Steals Years, Adds Disabilities.” Health Day Reporter. 15 April 2016.
United Health Foundation. “Senior Report.” United Health Foundation. May 2016.