the glucose in the blood: insulin. Since that discovery was made, scientists have found ways to extract insulin and purify it so it can be given to people whose insulin levels are too low.
After insulin was discovered, diabetes specialists, led by Elliot Joslin and others, recommended three basic treatments for diabetes that are as valuable today as they were in 1921:
✔ Diet (see Chapter 8)
✔ Exercise (see Chapter 10)
✔ Medication (see Chapter 11)
Although the discovery of insulin immediately saved the lives of thousands of very sick individuals for whom the only treatment had been starvation, it did not solve the problem of diabetes. As these people aged, they were found to have unexpected complications in the eyes, the kidneys, and the nervous system (see Chapter 5). And insulin didn’t address the problem of the much larger group of people with diabetes now known as type 2 (see Chapter 3). Their problem was not lack of insulin but resistance to its actions. (Fortunately, doctors do have the tools now to bring the disease under control.)
The next major leap in the effort to treat diabetes, occurring in 1955, was the discovery of the group of drugs called sulfonylureas (see Chapter 11), the first drugs that could be taken by mouth to lower blood glucose levels. But even while those drugs were improving patient care, the only way to know if someone’s blood glucose level was high was to test the urine, which was entirely inadequate for good diabetic control (see Chapter 7).
Around 1980, the first portable meters for blood glucose testing became available. For the first time, doctors and patients could relate treatment to a measurable outcome. This development has led, in turn, to the discovery of other great drugs for diabetes, such as metformin, exenatide, and others yet to come.
If you are not using these wonderful tools for your diabetes, you are missing the boat. You can find out exactly how to use portable meters in Part III.
Tracking diabetes around the world
Diabetes is a global health problem. Type 2 diabetes is especially prevalent where obesity is common. In 2008, more than 1.5 billion people were overweight (body-mass index greater than 25 kilograms/meter squared – see Chapter 7) and 500 million people were obese (body-mass index greater than 30) in the world. Currently 366 million people have diabetes. Diabetes is most concentrated in areas where large food supplies allow people to eat more calories than they need, causing them to develop excessive fat. Several different types of diabetes exist, but the type usually associated with obesity, called type 2 diabetes (see Chapter 3), is far more prevalent than the other types.
Another reason diabetes cases have continued to grow in number throughout the world is that the life span of the population is increasing. What’s the connection? Well, as a person ages, his or her chances of developing diabetes increases greatly. Along with obesity, age is a major risk factor for diabetes. (See Chapter 3 for more risk factors.) So as other diseases are controlled and the population in general gets older, more diabetes is being diagnosed.
One very interesting study traced people of Japanese ancestry as they went from living in Japan to living in Hawaii to living in the United States mainland. In Japan, where people customarily maintain a normal weight, they tended to have a very low incidence of diabetes. As they moved to Hawaii, the incidence of diabetes began to rise along with their average weight. On the U.S. mainland, where food is most available, these Japanese had the highest rate of diabetes of all.
In general, as people migrate to areas of the world consuming a Western diet, not only the number of calories they consume but also the composition of their diets changes. Before they migrate, they tend to consume a low-fat, high-fiber diet. After they reach their destination, they adopt the local diet, which tends to be higher in fat and lower in fiber. The carbohydrates in the new diet are from high-energy foods, which do not tend to be filling, which in turn promotes more caloric intake.
Explaining the Obesity (and Diabetes) Epidemic
Many changes explain the epidemic of obesity and diabetes that began to explode in the 1950s and ’60s. Here are some of them:
✔ The availability of fast-food restaurants and vending machines
✔ The frequency of television commercials for foods filled with fats and sugar
✔ The large number of screens watched passively all day, from TVs to smartphones
✔ The larger, higher-calorie meals that tend to be eaten, both at home and at restaurants
✔ The dependence on vehicles for much movement
✔ The huge increase in mass-produced, high-calorie convenience foods
What steps can people take to reverse this trend? Some of the ideas developed to reverse the high rate of cigarette smoking can be recycled, but the process takes years for the whole population. What you can do immediately is contained in Part III. Some of the population-wide measures include the following strategies:
✔ A tax on low-nutrition foods like sweetened beverages
✔ Better labeling of foods; for example, a red label for low-nutrition, high-calorie foods; a yellow label for intermediate foods; and a green label for low-calorie, high-nutrition foods
✔ A ban on or reduction of advertising of junk foods
✔ School-based programs promoting healthier eating and elimination of soft drinks and sugared juices
✔ A low, fixed amount of screen time for children
Putting Faces to the Numbers: Sharing Some Real Patient Stories
The numbers that are used to diagnose diabetes don’t begin to reflect the human dimensions of the disease. People end up with test results after days, months, or even years of minor discomforts that reach the point where they can no longer be tolerated. The next few stories of real (though renamed) patients can help you understand that diabetes is a disease that happens to real people – people who are working, relaxing, traveling, sleeping, and doing many other things that make life so complex.
