Diabetes: Living By The Needle

November 15, 1987|By Bill Stokes.

How about a little understanding for those hundreds of thousands of people who lawfully and quietly use needles to inject themselves?

Consider that the chances are about 1 in 20 that you and I may join them in a milder form of their disease: An estimated 5 million of us in this country, in fact, already may have it and not know it.

The disease is diabetes, and considering its impact on so many people, it is amazing how little some of us know about it. A diabetic friend said recently that a lot of people think that you get diabetes from eating cookies and that you can cure it by staying out of the cookie jar.

In a sense, his assessment is not all that far off. Some basics:

The body gets energy by absorbing sugar from the blood. To do this, the cells that absorb sugar need the stimulation of insulin. Insulin is a protein produced by the pancreas, but for reasons not yet understood, the pancreas sometimes falls down on the job. When that happens, the blood-sugar level rises. This is diabetes.

There are two types: Type 1 is most often diagnosed in children aged 5 to 15; those who have it are dependent on daily doses of insulin to replace what isn`t provided by the pancreas. Its onset is sudden, and it involves about 1 million Americans.

Type 2 comes on most often after age 45, and its onset is usually gradual. This type frequently can be controlled by diet and exercise, as the pancreas may be able to provide sufficient insulin if the patient is not obese. It is estimated that 5 million to 6 million Americans have been diagnosed with Type 2 diabetes; 5 million more have the disease but do not know it.

Both types are caused by a lack of insulin, and if this condition continues and if sugar in the blood builds up enough, the body begins to use fat as fuel. This results in poisonous byproducts that can be fatal.

Diabetes is No. 2 in disease-caused deaths, claiming an estimated 300,000 victims annually.

Diabetes also can cause a breakdown of blood vessels, resulting in blindness (6,000 new cases each year); it is a factor in about 1 million cases of kidney disease; it contributes to one-half of all amputations and aggravates cardiovascular conditions.

But behind these grim facts and assessments is a glimmer of hope.

``There is more optimism today,`` said Dr. Boyd Metzger, professor of endocrinology, metabolism and nutrition at Northwestern University and a member of the board of directors of the American Diabetes Association`s Northern Illinois Affiliate.

``Years ago diabetes was totally frightening,`` Metzger said. ``People thought it was inevitable that they would go blind, their kidneys would fail or they would end up as amputees. But treatment is much more advanced now, and there is hope that complications can be stopped and prevented from getting worse.

``We do not have the answers yet, but a lot of research is being done to find the fundamental cause of the disease,`` Metzger said, ``and there is much more understanding about both types.``

Northwestern Medical School is one of 27 sites at which the National Institutes of Health is conducting a seven-year study to determine the relationship between the control of blood-sugar levels and the complications of diabetes.

``The results are not in yet,`` Metzger said, ``but there are a lot of indications that better control-keeping blood-sugar levels as close to normal as possible-prevents serious complications.``

To enable diabetics to do this, there are numerous detection devices coming onto the market. Those that test blood instead of urine are more effective, Metzger said.

Diabetes research projects being conducted include implanting insulin pumps, transplanting pancreases, injecting insulin-producing islet cells into the body, taking insulin orally in plastic-wrapped packets and even

``snorting`` it into the nasal passages.

But so far all of these involve only a few people, and most diabetics are left to control their disease with insulin injections or by diet and exercise. ``The most important thing to do in controlling Type 2 diabetes is to lose weight,`` Metzger said. ``From two-thirds to three-fourths of the people who have Type 2 diabetes are overweight. In most cases, if they lose weight, their insulin production is sufficient to keep their blood sugar at normal levels.``

November is National Diabetes Awareness Month. Special efforts are being made to screen for the disease. Early diagnosis is crucial to the prevention of complications, and in northern Illinois more than 100 hospitals are cooperating in screening clinics.

Some diabetes warning signs are ravenous hunger, increased urination, intense thirst, blurred vision, fatigue, frequent infections and weight loss. Information can be obtained by calling the American Diabetes Association at 800-232-3472 or the Northern Illinois Affiliate at 800-433-4966.