Do not miss this recent NY Times article by Gina Kolata, Looking Past Blood Sugar to Survive With Diabetes. It is a must read for anyone associated with type 2 diabetes, including patients, family caregivers and doctors. I am very encouraged to see a feature on type 2 diabetes in such a well-read newspaper. Many doctors are uninformed on the best ways to treat a person with type 2 diabetes, they spend much more time with type 1 patients. Furthermore, type 1 and type 2 are very different diseases, but since they both end in 'diabetes' there is deep confusion -- see Diane's previous post on this topic. Undoubtedly, we need Big Media to provide greater coverage on the differences and unique treatments for both type 1 and type 2 diabetes.
First off, type 2 diabetes is a form of the disease that usually appears in adulthood where the body does not produce enough insulin or the cells are resistant to insulin. Kolata's article focuses on one man's battle with type 2 diabetes, as well as the importance of other treatments beyond blood sugar control that can markedly prevent heart disease -- the number one threat to a person with type 2. Dave Smith, a pastor from Fairmont, Minnesota, has dealt with type 2 diabetes for nine years. From the start, his doctor advised him to control his blood sugar, so he was a faithful carbohydrate counter, finger pricker, type 2 pill taker. Nothing worked, so he added insulin.
Unfortunately, his fixation on controlling blood sugar ignored the most crucial treatment of all -- lowering cholesterol. According to Kolata's article, heart disease kills nearly everyone with diabetes. The second treatment Smith did not consider was the importance of controlling blood pressure. The third treatment is taking aspirin to control blood clots. Last October, Smith had a major heart attack and nearly died. He had never thought about heart disease, and his doctor never advised him to take a cholesterol-lowering statin or a blood pressure drug. The American Diabetes Association reports only 18 percent of people with diabetes know their increased risk for cardiovascular disease. Grrrr! This lack of awareness among patients and doctors must change for lives to be saved. It took a near-fatal heart attack for Smith to receive the combination of drugs he should have been prescribed at diagnosis: a statin, two drugs to lower blood pressure, aspirin, insulin and two drugs to reduce his blood sugar level.
The article also points out the myth of obesity and type 2 diabetes. While obesity does increase the risk for type 2, only 5 to 10 percent of obese people have the disease, and many people with type 2 are not obese. Genetics is a big determiner. Losing weight can definitely improve type 2 control, but most are not cured. Smith lost 40 pounds and still has type 2.
Dr. Irl B. Hirsch, a professor of medicine and director of the diabetes clinic at the University of Washington, stated it plainly. The first priority for a typical middle-age person with type 2 diabetes is to take a statin and lower the LDL cholesterol level. FYI, a person with diabetes should keep LDL cholesterol below 100 milligrams per deciliter, ideally 70 to 80. Keep in mind, this is even lower than the recommended LDL levels of 100 to 139 for a healthy person. Dr. Michael Brownlee, director of the JDRF International Center for Diabetic Complications Research at the Albert Einstein College of Medicine in New York, stated beyond a statin, blood pressure control and taking an aspirin to prevent blood clots are two other important measures.
1. I agree that this is an important article. I've written a blog followup to this which you can find at:
http://blog.aesisgroup.com/2007/08/22/diabetes-looking-past-blood-sugar-.aspx
It discusses some of the wider implications of this "paradigm shift" in diabetes care.
Posted at 2:07PM on Aug 22nd 2007 by Ogan Gurel