Meeting the Diabetes Challenge -- S. Sethu K. Reddy, MD. -- 11/18/02
By S. Sethu Reddy
In recognition of National Diabetes Month, WebMD Live helped our members get the facts they need to prevent and properly treat this rapidly growing problem. S. Sethu K. Reddy, MD, from the Cleveland Clinic joined us to answer our members' diabetes questions.
The opinions expressed herein are the guest's alone and have not been reviewed by a WebMD physician. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.
Moderator: Welcome to WebMD Live. Joining us now is S. Sethu Reddy, MD, who is here to discuss meeting the diabetes challenge. Welcome, Dr. Reddy. Can you explain what is behind the rapid rise in diabetes over the last ten years or so?
Reddy: Very good question. Clearly in developing segments of American society and even across the world type 2 diabetes is increasing. People are paying more attention to dietary intake, but unfortunately, the amount of physical activity has declined even more, and this had led to increasing obesity over the last 20 years. This means if you belong to a high-risk group to begin with like Hispanic, East Indian, or African American and you develop obesity on top of this genetic risk, one is going to develop diabetes sooner. And this is part of the concern in that in many communities more adolescents and young people are developing type 2 diabetes. This is only the tip of the problem. These individuals will live longer and will have a chance to develop some long-term complications that are even more costly to the individual with diabetes, as well as to our healthcare system in general, of course.
Moderator: Are type 1 diabetes rates holding steady?
Reddy: I think the rates for type 1 diabetes have been relatively flat with an occasional flurry of cases sometimes in the spring or in the fall. But in general across the world the incidence of type 1 diabetes has been relatively steady. Over the last 50 years it's clear some countries have a much higher risk of type 1 diabetes. In particular it appears the further you are from the equator, the higher the chances of developing type 1 diabetes. For instance, some provinces in Canada and Finland have a higher incidence of type 1 diabetes than countries in the tropics. This may be linked to genetics as well as differences in environment in these regions.
We must remember type 1 diabetes is an autoimmune disease, where the individual develops high blood sugars in a short period of time, but in fact the pancreas is being attacked for many years before the high blood sugars. In general in the U.S. type 1 diabetes accounts for approximately 10% of all people with diabetes, and the remainder is type 2.
Member: What are the pros and cons of switching to an insulin pump? Are there any reasons not to use one?
Reddy: Good question. Insulin pumps are excellent devices to deliver insulin to someone in an elegant fashion. However, the patient must still control the pump. The commonest misconception I see in practice is that the patient thinks of a pump as a technique to automatically manage their sugars without having to check their blood sugars or having to think about their diet, or exercise activity. So typically, a patient using an insulin pump will monitor their sugars at least four to five times per day and will tell the pump how much insulin to give before their meals.
Currently, the pumps are indicated for people with type 1 diabetes. They are approved by Medicare if the individual's doctor can prove that the pancreas is not making any insulin. In the future when we have available a reliable implantable glucose sensor, we should see most people with type 1 diabetes on insulin pump therapy. The hope is that the glucose sensor will send information to the pump and regulate the amount of insulin being injected. This type of "closed loop" system will truly liberate the insulin-requiring patient.
Member: Does cholesterol-lowering medication reduce the risk of diabetes, or just heart disease?
Reddy: This is a fascinating question and there is recent information suggesting the class of medications we know as statins, which are powerful at lowering cholesterol seem to have some additional beneficial "side effects." There are some early research findings that suggest that Zocor and Lipitor may improve insulin sensitivity and thus may reduce the incidence of type 2 diabetes. Even more interesting is data from the West of Scotland Study, which looked at preventing heart disease with Pravachol. It was able to reduce the incidence of diabetes in the drug-treated group. Thus although more information is needed, this is interesting knowledge, but the most important facet for these medications would still be lowering cholesterol and preventing heart disease.
Recently, the highly publicized Diabetes Prevention Program trial was published in the New England Journal of Medicine, demonstrating that lifestyle intervention was able to reduce the development of type 2 diabetes by 60% and metformin was able to reduce the rate by about 30%. Other medications being studied at present to try and prevent type 2 diabetes include acarbose and rosiglitazone, nateglinide, and ramipril (an ACE Inhibitor). We will get information from these studies in the next two to three years.
An additional note regarding statins: There are preliminary reports that they may also be helpful in osteoporosis.
Member: Is there any truth to the claim that a diet high in refined carbohydrates can lead to the onset of type 2 diabetes?
Reddy: I think for years we have grown up with the misconception that highly refined carbohydrates (table sugar and sugar-containing foods) will cause diabetes. We can only safely say that diet rich in simple sugars is associated with cavities and not necessarily type 2 diabetes.
It appears that the overall number of calories we eat -- be it from fat or carbohydrates, simple or complex -- is more related to developing type 2 diabetes. The American Diabetes Association has recognized this and in their nutritional guidelines recommend that if desired, a person with diabetes may be able to eat up to 15% of their total daily calories from simple sugars.
As an example, it would be healthier for a person with diabetes to have a whole grain cereal with skim milk and a little bit of sugar rather than a low-fiber cereal with whole milk and no sugar. Another reason for this rationale is to get both patients and physicians to focus on the overall diet rather than just avoiding simple sugars alone.
Member: I am staying dizzy off and on during the day. Is that a sign of diabetes?
Reddy: Dizziness by itself is not necessarily a sign of diabetes. However, if it's related to dehydration from excessive urination from hyperglycemia, then it might be diabetes. The classic symptoms are usually: