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Many Diabetics Tempt Health Risks

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FRIDAY, Jan. 13 (HealthDay News) -- From regular blood testing to insulin injections, from diet alteration to increased exercise, people with diabetes are asked to radically alter the way they live to protect their health.

The stakes are high. Untreated diabetes can lead to a wide range of terrible complications, including heart disease, loss of vision, kidney malfunction, nerve damage, oral disease, decreased sexual function and lower-limb amputation.

Yet a surprisingly large number of people with the disease aren't doing enough to avoid those health threats, experts say.

"This is the classic disease where if you are treated, you are fine," said Dr. Robert Rizza, a professor of medicine at the Mayo Clinic College of Medicine and president of the American Diabetes Association. "But if you don't, very, very bad things can happen."

Diabetes occurs when the body's ability to convert blood sugar to energy for cells breaks down.

Type 1 diabetes results when the body's immune system destroys its ability to make insulin, the hormone that regulates blood sugar. Type 2 diabetes occurs when the body becomes resistant to insulin and fails to use the hormone properly.

An estimated 18.2 million Americans suffer from diabetes, about 6.2 percent of the population, according to the U.S. Centers for Disease Control and Prevention. Of those Americans, about 5.2 million do not know they have the disease, and nearly all the undiagnosed cases are people who suffer from type 2 diabetes.

Type 2 diabetes usually is controlled through diet and exercise, although some people may need medication. Type 1 diabetes requires injections of insulin.

But CDC statistics show that complications from diabetes continue to kill or debilitate sufferers:

  • Heart disease is the leading cause of diabetes-related deaths, and adults with diabetes have a risk of stroke or death by heart disease about two to four times higher than adults without diabetes. About 65 percent of deaths among people with diabetes are due to heart disease and stroke.
  • About 73 percent of adults with diabetes have high blood pressure.
  • Diabetes is the leading cause of new cases of blindness among adults 20 to 74 years old, with 12,000 to 24,000 people going blind from the disease each year.
  • Diabetes also is the leading cause of kidney failure, accounting for 44 percent of new cases.
  • About 60 percent to 70 percent of people with diabetes have mild to severe forms of nervous system damage. The damage can cause impaired sensation or pain in the feet or hands, slowed digestion of food in the stomach, carpal tunnel syndrome and other nerve problems.
  • More than 60 percent of lower-limb amputations occur among people with diabetes.

Diabetes also carries with it a doubled risk of gum disease, a chance of birth defects, and an increased susceptibility to other diseases.

These risks are controllable. But doctors need to do a better job laying out both the risks of not treating diabetes along with the rewards for managing the disease well, said Dr. John Buse, an associate professor of medicine at the University of North Carolina School of Medicine and director of the UNC Diabetes Care Center.

"The bad news is you're going to die of a heart attack. The good news is knowing that we can modify the risk and make sure it is 20 or 30 years from now, rather than five or 10 years from now," Buse said. "Doctors are reluctant to be that blunt with patients."

Doctors also need to realize that patients are the only people who can control their diabetes, that "the patient is the one that does 99 percent of this," Buse said.

"We're just coaches," Buse said. "We need to make sure the patient is well-informed and we don't sugar-coat things for them, so they realize everything they do has consequences good and bad."

To that end, Buse recommends that diabetes patients make sure all of their questions are answered either by a doctor or by a diabetes educator.

That way, the patients can make informed decisions about lifestyle changes they can or cannot live with.

"The cookie-cutter way of taking care of diabetes would be eat this, take these medications, check your blood sugar, exercise," he said. "That's almost always the right answer. If people could do that, everything would be hunky-dory. But virtually no one can do that.

"I always resist the temptation to judge people, because fundamentally it is their life. I think it is quite natural for people to have an inclination to make the most of the moment. The key thing is to find a balance there."

The changes that diabetes patients agree to make to extend their lives and avoid complications can be hard to get used to, but it can be done, Rizza said.

"It's really a matter of just learning to live this way, and then you're very comfortable from there on in," Rizza said. "Bad habits are hard to break, but when you're in good habits they're also hard to break."

More information

To learn more, visit the American Diabetes Association.

SOURCES: U.S. Centers for Disease Control and Prevention; Robert Rizza, M.D., professor of medicine, Mayo Clinic College of Medicine, Rochester, Minn., and president of the American Diabetes Association; John Buse, M.D., associate professor of medicine, University of North Carolina School of Medicine, and director, UNC Diabetes Care Center
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