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Case
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HS2002-01
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Diabetes
The diabetes way of life
Diabetes: A lesson in living
Blood-vessel inflammation may
signal diabetes, stroke
Young type 2 diabetics face severe
problems
Companies seek alternatives to
injected insulin
Cooking up a balance
With over 17 million American afflicted and over 30 million projected by 2050, diabetes
has become an alarming problem in this country. In the past it affected primarily older
people but because of our sedentary life styles and poor eating habits younger
generations are now suffering. This case study will focus on the disease, those who are
affected by it, how to cope with it and promising new research and developments.
Cover story
The diabetes way of life
Americans with disease learn to eat well, exercise
In trial, drug curtails diabetes
Researchers weigh in on soaring
diabetes rates
Cell infusion is a ‘miracle’ for
diabetic
Damage often precedes diabetes
detection
—By Anita Manning
Case Study Expert:
Francine Ratner Kaufman, M.D.
By Anita Manning
Ted DeLeon’s family is plagued by
diabetes on all sides. His parents, aunts
and uncles and seven of nine siblings
have it.
Yet, when it came to him, he didn’t
recognize it.
“I was thirsty all the time. I gained 30
pounds over summer, was going to the
rest room a lot at night,” he says. When,
by chance, he saw an article about
diabetes symptoms, “I said, shoot, that’s
me.” He went to a doctor who tested the
level of sugar in his blood. Normal is 70 to
149. DeLeon’s reading was 360.
President, American Diabetes Association
“I was almost on the verge of a diabetic
coma.”
DeLeon’s story is one that is becoming
all too common in the USA. An estimated
17 million Americans have diabetes — an
increase of nearly 1.5 million in two
years. Of these, nearly 6 million are
undiagnosed, yet the disease is silently at
work in them, damaging blood vessels,
nerves, eyes, heart, kidneys, legs and feet.
The American way of life — too much
food, too little exercise — has contributed
to an epidemic of diabetes that is striking
people of all ages. Even adolescents are
being diagnosed with type 2 diabetes, a
form of the disease usually seen only in
midlife.
Once diagnosed, diabetes becomes a
way of life for the patient and his family.
While diabetics may live long and active
lives, the disease is chronic and incurable,
and may lead to symptoms that can
cause disability and death.
Type 2 diabetes is caused by the body’s
inability to use efficiently the hormone
insulin, which helps convert sugar into
energy. Up to 95% of people with diabetes
have type 2. Type 1, or juvenile diabetes,
occurs when insulin-producing cells in
the pancreas are destroyed. Type 1, which
strikes one in every 400 to 500 children
and adolescents, requires daily insulin
injections.
Type 2 diabetes is mushrooming in the
USA. Most affected are minority
communities, where a combination of
lifestyle and genetics combines to
increase risk.
DeLeon, 54, who is Mexican-American,
and his wife, Debbie, 48, who is Native
American, are well aware of that and are
spreading the word in their communities
in Lansing, Mich., through an ethnic
alliance that focuses on access to
medical care.
Reprinted with permission. All rights reserved.
AS SEEN IN USA TODAY LIFE SECTION- TUESDAY - April 16, 2002 - 1D
$14.95). “This is because everything you do
affects your blood sugar levels.”
The weight connection
For Sandra Henson, 50, of Beaumont,
Texas, diabetes meant major changes in her
eating habits. “In southeast Texas, we eat a
lot of rice, and I had to change to brown rice,
change portion size, always watching to not
eat too much at one time,” she says. Now,
“I’ve lost weight, yes, but I’ve still got a long
way to go.”
By Al Goldis, USA TODAY
She’s not worrying about her figure out of
vanity. Being overweight reduces insulin
sensitivity in people with diabetes, and it
increases the risk of developing the disease
in the first place. Because exercise has been
found in several clinical studies to improve
control of blood sugar, Henson, who rarely
worked out before she was diagnosed, has
become faithful about going to the gym.
Ted and Debbie DeLeon walk their dog, T’Tonka, Saturday, March 16, 2002, in Bancroft Park in Lansing, Mich.
Ted was diagnosed with diabetes nine years ago and exercises every day with a brisk walk with the dog in a
large park adjacent to their home.
“Being indigenous,” DeLeon says, “we’re way ahead of the rest
of the population in terms of prevalence.”
Debbie says she doesn’t have diabetes, “yet,” but it’s “rampant
in my family. It has been devastating. Many have not made it to
their 50s.”
Diabetes is so common among American Indians, affecting
more than 25% of the population in some tribes, that casinos and
public buildings on reservations are equipped with hazardous
waste disposal boxes mounted in rest rooms for safe disposal of
insulin syringes and lancets used in testing blood.
While genes may set you up for diabetes, Ted DeLeon says, it
“kicks in when you gain a lot of weight and you don’t exercise.
Where our family’s ancestors came from in Mexico, they don’t
have it. Why? They eat beans and tortillas. Meat is a treat. There’s
no McDonald’s. They work a lot (physically), and we don’t.”
By watching his diet and walking — or being walked by — his
90-pound dog, T’tonka, every day, DeLeon has successfully kept
his blood sugars under control. But for many people, managing
diabetes is a complex balancing act that involves monitoring
blood sugar levels two or more times a day, gaining an
understanding of how foods interact with metabolism and how
exercise affects blood sugar levels.
Many diabetics take medications and some require insulin
injections.
“Diabetes, perhaps more than any other chronic disease, must
be managed in large part by the patient,” says biologist and
medical writer Gretchen Becker of Halifax, Vt., in the introduction
to her book, The First Year: Type 2 Diabetes (Marlowe & Co.
But it’s not always easy. “I travel a lot, and
sometimes I work late. When I get home I’m
tired, and I don’t want to exercise. You have
to discipline yourself and, hopefully, get other people to motivate
you.” Like many new diabetics, she attended diabetes education
classes to learn such survival skills as what to do if her blood
sugar level plummets, how to cook without added fat, the
difference between complex and simple carbohydrates and much
more.
Family members play an important supporting role in diabetes
management, experts say, and that may require sacrifices of their
own. No more ice cream in the freezer. Fewer rich dinners in
fabulous restaurants. Less drinking. Constant attention to diet and
exercise. And, in some cases, it means tending to the needs of a
patient whose feet have been amputated or whose vision is lost.
The demands of the disease on patient and family can lead to
depression, marital discord and other stresses that John Zrebiec,
associate director of mental health services at the Joslin Diabetes
Center in Boston, calls “diabetes burnout.”
The emotional impact of diabetes and its effect on the family
may require professional help, he says, identifying three specific
points that send patients to a counselor: “We tend to see people
when they’re newly diagnosed, when something about their
diabetes care is going off track — there’s frustration, depression,
anxiety, it’s not going smoothly — and third, is when there is the
onset of long-term complications of diabetes. The most common
diagnosis we see is depression.”
People with diabetes are four times more likely to be depressed
than non-diabetics, Zrebiec says. “I don’t know of research on
how it affects the rest of the family, but I wouldn’t be surprised if
they have more depression, too.”
While there may be a physical explanation for the increased
Reprinted with permission. All rights reserved.
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Diabetes
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rate of depression, he says, it’s clear the psychological cause is “a
feeling of helplessness,” he says. “There are many times in trying
to live with diabetes that you feel out of control and helpless.
There are times you can do 110% of what you’re asked to do and
still have blood sugars that make no sense.”
Knowing your body
Still, many people manage to balance the demands of the
disease to enjoy full, happy and healthy lives.
One of these is Gabriel Caro, a Boston Web site developer. At 6foot-1, a fit 174 pounds and only 29 years old, he doesn’t fit the
stereotype of an overweight, middle-aged diabetic. Caro was
training for a marathon when he was diagnosed two years ago
with type 2 diabetes.
While he has to remain ever vigilant, he says, a combination of
medication and a lot of exercise keep his diabetes under control,
allowing him flexibility to commit the odd dietary indiscretion
without serious repercussions. “I will never let something like
having diabetes get in the way of me enjoying my life,” he says.
“There are times when I know I should not be having a glass of
wine or piece of cake, but I will have it.”
He refuses to feel guilty. “Diabetes comes with this mystique
around it. People are incredibly afraid of making a mistake or not
eating well, or they just punish themselves for not exercising,” he
says, but “it’s OK and natural and human to enjoy life and food.
Ultimately, the most effective technique of controlling your disease
is approaching it from different levels, physically, spiritually and
emotionally. It’s a matter of quality of life. Yes, you have to watch
what you eat, and you have to exercise, but you should view those
things as positive.”
Living with diabetes means a lot of reading, he says. “You have
to understand your metabolism and how your body works, then
you have to read about food and the properties of food, how to eat
in proportions, the correct amounts of food, how to space your
meals,” he says, but there is a benefit that others who don’t have
diabetes may not experience. “You also have to study yourself a
lot,” he says. “I think that among other things, it really tunes you
in and makes you aware of your body.”
Reprinted with permission. All rights reserved.
Page 3
AS SEEN IN USA TODAY LIFE SECTION- TUESDAY - April 16, 2002 - 7D
Diabetes: A lesson in living
Diabetes can’t chill an adventurous Will
By Anita Manning
Will Cross wants the world to know that
diabetes doesn’t have to mean disability. To
prove that, Cross, who was diagnosed 25
years ago at age 9 with type 1 diabetes, is
getting ready to trek across the Antarctic to
the South Pole. The expedition will set out
in November, with a goal of reaching the
pole by New Year’s Day.
Last year, Cross went to the North Pole.
He also has climbed several mountains,
including Alaska’s Mount McKinley, the
tallest peak in North America, and taken
part in expeditions to the Sahara, Patagonia
and India’s Thar Desert.
On his latest mission, the “Ultimate Walk
to Cure Diabetes,” his aim is to raise money
for the Juvenile Diabetes Research
Foundation’s efforts to find a cure and to
show others, especially children, that there
is no reason diabetes should keep them on
the sidelines.
Role model: Will Cross’ trek to the North Pole last year and his preparations for the South Pole in November are
“I hope to inspire younger kids and their twofold: to raise money for the Juvenile Diabetes Research Foundation to find a cure and to let youth know they
families who are wondering whether their can have fulfilling lives.
kid can participate in school activities and
sports,” Cross says. “I played sports all
through school, but people are very
hesitant to include the diabetic, because what if your blood sugar well if you’re going to live long,” he says. “It becomes a lesson in
suddenly goes low? What if you need medication? I was always how to manage what you eat, to test your blood, exercise for at
striving for independence. If you don’t, you don’t get to least an hour, four or five days a week.” How well that is
accomplished, especially early on, is critical, he says. “Research
participate.”
shows the better you manage during your first year of diagnosis,
Type 1 diabetes, which affects 5% to 10% of the 17 million the better off you are, long range.”
diabetics in the USA, results from destruction of insulin-producing
On his treks, he works with the University of Pittsburgh on
cells in the body. It usually is diagnosed by early adulthood and
requires daily insulin and careful monitoring of levels of blood studies of diabetic metabolism and how a diabetic might react to
a 7,000-calorie-a-day diet and 12 hours of exercise pulling a 200glucose, or sugar.
pound sled. “That’s exercise and eating in the extreme, but it’s
Cross, who wears an insulin pump that delivers a constant relevant to the newly diagnosed diabetic, because it gives a brutal
supply of the hormone to his body, says he has never let his understanding of how the body will manage under those
illness stand in the way of his explorations. Now 34 and the father conditions,” he says.
of four, his life is a series of adventures, from his day job as
“If you can manage under this environment, you certainly can
principal of the Alternative School in Pittsburgh, where he works
with students with behavior problems, to his expeditions in in high school or at work.”
hostile climates.
For details on the Ultimate Walk to Cure Diabetes, check
Diabetes is a disease that requires patients to “be fit and eat www.curewalk.com
Reprinted with permission. All rights reserved.
Page 4
AS SEEN IN USA TODAY LIFE SECTION- TUESDAY - June 18, 2002 - 9D
Blood-vessel inflammation
may signal diabetes, stroke
Other highlights from the diabetes meeting:
By Anita Manning
SAN FRANCISCO — Diabetes researchers studying the
mechanisms that lead to chronic illnesses are zeroing in on
inflammation as a major factor in both diabetes and heart disease.
Scientists have recently noted that substances which signal
inflammation, called inflammation markers, can be found in the
blood of patients who have diabetes, as well as of those who have
atherosclerosis, or hardening of the arteries, in which chronic
inflammation of blood-vessel walls creates lesions that rupture,
form clots and lead to stroke.
Now, data presented here at the American Diabetes Association
suggest that inflammation is part of the disease process in both
conditions, and that these inflammation markers can be useful in
predicting who will develop diabetes and which diabetics may
suffer from heart disease.
Treating inflammation may be a way to prevent both diseases,
says endocrinologist Paresh Dandona of the State University of
New York-Buffalo. Dandona reported on research that shows a
drug called rosiglitizone, one commonly taken by adults with
diabetes to boost insulin sensitivity, appears to have antiinflammatory properties.
That means treating diabetes with these drugs may produce two
benefits: increasing insulin response and decreasing the risk of
atherosclerosis. Rosiglitizone, and probably other drugs in the
same class, Dandona says, “can not only treat high glucose (sugar)
levels in diabetes, they may actually prevent the major cause of
death in diabetes.”
• The GlucoWatch Biographer, a wristwatch-like device that tests
blood sugar levels through the skin, appears to work in children as
well as in adults, research suggests. A study in 40 children ages 7
to 17 who have type 1, or juvenile, diabetes found that automatic
glucose monitoring significantly improved control of blood sugar.
The device is licensed only for adults, but the developer, Cygnus, is
seeking Food and Drug Administration approval for its use by
children.
• An international survey of 2,702 people with diabetes finds
that 60% say they’re not worried about such long-term
complications as blindness or limb amputation, although studies
show that if untreated, 74% of people with diabetes will develop a
complication that could lead to blindness, kidney failure or lowerlimb amputation. The study by the International Diabetes
Foundation and Lions Clubs International Foundation also found a
fatalism that researchers found especially disturbing. “Over 40%
think nothing they do will change the course of their disease,” says
James Gavin, senior scientific officer at the Howard Hughes
Medical Institute. “That’s wrong. We can prevent or delay all these
complications. The fact that they don’t know that shows we have
enormous work to do.”
The study points to the need for better education, says Croatian
endocrinologist Zeljko Metelko, vice president of the International
Diabetes Federation-Europe. “Enormous amounts of money are
spent on research, and enormous amounts are spent on
treatment,” he says, “but the transfer of knowledge to physicians
and patients is lacking.”
Reprinted with permission. All rights reserved.
Page 5
AS SEEN IN USA TODAY LIFE SECTION - MONDAY - June 17, 2002 - 7D
Young type 2 diabetics face
severe problems
with type 2 diabetes before the age of 17. She reported:
By Anita Manning
SAN FRANCISCO — The first long-term study of children
diagnosed with type 2, or “adult-onset” diabetes, shows that as
young adults, many suffer from severe complications, including
kidney disease, miscarriages and death.
The study, though small, is ringing alarm bells for researchers
here at a meeting of the American Diabetes Association, giving
weight to predictions that a growing incidence of type 2 diabetes
in children could have catastrophic health consequences in years to
come.
Type 2 diabetes is the most common form of the disease,
affecting at least 90% of the more than 17 million Americans with
diabetes. It is associated with obesity, lack of exercise and genetics,
and, until about 20 years ago, almost never occurred in teens or
children.
Unlike type 1, or juvenile, diabetes, type 2 is most often detected
in middle age or older, but it is increasingly being found in children,
especially among ethnic minorities, and has become a “dramatic
and very alarming fact of our lives,” says Eugene Barrett of the
University of Virginia, vice president of the diabetes association.
Because it is new in children and many doctors don’t look for it,
many cases may be overlooked, experts say. In communities
where there is a large Hispanic, Native American or black
population, as many as 50% of newly diagnosed children have type
2, Barrett says.
Heather Dean, professor of pediatrics at the University of
Manitoba in Winnipeg, Canada, who presented her study on
Saturday, found a high rate of diabetic complications in a group of
51 Native Americans, now ages 18 to 33, who had been diagnosed
• Three are on dialysis because of kidney failure.
• One became blind at 26.
• One had a toe amputated.
• Of 56 pregnancies, only 35 resulted in live births.
• Two died of heart attacks during dialysis. Another five died of
causes unrelated to diabetes.
Because her study was small and involved a genetically distinct
group, Dean says, the findings can’t be applied to all children with
type 2 diabetes. And, she says, the outlook may improve, thanks to
advances in the treatment of diabetes in the past 15 years.
“We’ve become much more aggressive in our treatment
strategies,” she says. “My sense is the future is more optimistic, but
this is the first group, and this helps us to realize this is a very
aggressive disease with very serious long-term complications.”
The reasons for the increase in children are not entirely known,
but many experts believe inactivity, overeating and genetics are
coming together to create a public health time bomb set to go off
over the next two decades.
“Obesity is pulling the trigger,” says pediatrician Silva Arslanian
of the University of Pittsburgh School of Medicine. “Rates of
obesity in children are escalating like a rocket. Two of five children
are overweight, and some races are even more prone to be
overweight.”
Reprinted with permission. All rights reserved.
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AS SEEN IN USA TODAY LIFE SECTION - MONDAY - June 17, 2002 - 7D
Companies
seek
alternatives
to injected
insulin
This is an AERx insulin delivery system, an alternative method of insulin
administration.
By Anita Manning
SAN FRANCISCO — Drug companies are making progress in
efforts to bring needle-free insulin to people with diabetes, but
they’re still years from the finish line.
degraded. “We’re able to control blood glucose, probably for the
first time, with an oral insulin preparation that is ingested,” says
researcher Stephen Clement of Georgetown University, who
presented results of studies on the Nobex drug. The product is
early in development, he says, but is “very feasible.”
Several studies reported here Sunday at a meeting of the
American Diabetes Association show that research in alternatives
to insulin injections is advancing rapidly, says Christopher Saudek
of Johns Hopkins School of Medicine, president of the association.
But he cautions that “each is at a different stage in development,
and people are well advised to take advantage of what is available
today” to manage diabetes.
* Insulin patch. A two-step system that uses a batterypowered sticky patch to open skin pores, then deliver insulin
through a second patch, is being made by Altea Development
Corp. In a small study, it provided a steady supply of insulin over
12 hours.
Of the estimated 17 million Americans with diabetes, about 3.7
million need daily insulin shots to keep levels of blood sugar on an
even keel and to prevent such long-term complications as heart
disease, blindness, kidney disease and amputations.
* Insulin mouth spray. Generex Biotechnology Corp.’s
RapidMist allows insulin to be absorbed through cells lining the
mouth. Generex researcher Pankaj Modi says the insulin spray was
as effective in tests as fast-acting injected insulin.
Among developments:
* Insulin pills. Nobex Corp. and Emisphere Technologies are
taking slightly different approaches in developing insulin pills that
can be absorbed through the digestive system without being
* Inhaled insulin. Five companies are racing to develop a fastacting form of insulin that can be inhaled into the lungs in liquid or
powder form, but questions remain about its safety for long-term
use.
Reprinted with permission. All rights reserved.
Page 7
AS SEEN IN USA TODAY LIFE SECTION - WEDNESDAY - June 12, 2002 - 6D
Cooking up a balance
New approaches help
diabetics make tasty food
By Anita Manning
Last year, in the middle of a teenage whirl of high school,
friends and sports, Emma Lowenstein’s life changed. The Chevy
Chase, Md., teenager, now 15, was diagnosed with type 1, or
juvenile, diabetes.
Her mother says she never saw it coming. Emma had
symptoms, she says, including weight loss and constant thirst,
but diabetes “was so off my radar screen.” No one in the family
had the disease. The Juvenile Diabetes Research Foundation says
that’s common in about 90% of cases.
“I knew one kid my daughter’s age with diabetes, but I knew
nothing about it,” says Emma’s mother, Shelley Lowenstein. “We
were so ignorant.”
Not anymore. The diagnosis has meant changes, not only for
Emma — who has learned to test her blood several times a day,
inject insulin and balance diet and exercise — but also for her
family.
By Steve Barrett for USA TODAY
“We didn’t know if Emma could ever eat cookies again,” her
mother says. She and Emma pored over nutrition labels in the
grocery store, combed through cookbooks and went online
looking for information. “We were always a family that loved to
cook,” she says. “My husband clips recipes. We eat out all the
time.”
Now the family’s dining choices are influenced by Emma’s need
to eat a balanced diet on a daily schedule. As a diabetic, “you learn
to live by the clock, which we’ve never done,” Lowenstein says.
“That means you have to get up at a certain time, eat at a certain
time, have a mid-morning snack at a certain time . . . “
People with diabetes need to eat frequently, generally three
meals and at least a couple of snacks, to keep blood sugars on an
even keel. That means keeping portion sizes small and eating a
variety of foods in moderation, says Carol Guber, whose book,
Type 2 Diabetes Life Plan (Broadway Books, $25) is being
published this week.
While most dieters obsess over fats and calories, diabetics need
to limit carbohydrates, which greatly affect blood sugar. Guber
says most adults can consume 45-75 grams of carbohydrates per
meal, depending on age, weight and activity level. (There are
around 15 grams of carbohydrates in a slice of bread or half a
banana, and about 41 per cup of pasta. A 2-ounce package of
strawberry Twizzlers has 54 grams.)
Carbohydrates are nutrients that are released into the
Big adjustments: Shelly Lowenstein and daughter Emma, 15, adapt their favorite
recipes to suit Emma’s diabetic needs. She often needs a bedtime snack to get her
through the night, when sugar levels tend to drop.
bloodstream in the form of glucose, a simple sugar that fuels cells.
Insulin is a hormone that allows cells to use this sugar fuel, but in
juvenile diabetes the body’s insulin-producing mechanism is
destroyed. Patients have to take insulin shots every day.
In type 2 diabetes, insulin is produced, but it’s not used
efficiently by the body, resulting in high blood sugars. Type 2
diabetes often can be managed with drugs and diet. In either
form of the disease, diet plays a crucial role in balancing blood
sugars.
Food and family eating habits have as much to do with culture
and social interaction as with nutrition, Guber says. When she
was diagnosed with diabetes nearly five years ago at age 50, she
says, “I thought it was going to separate me from everyone.”
Food was “part of the community I lived in,” says Guber, who
taught nutrition and food preparation at New York University for
many years. She feared the need to watch every morsel would
separate her from her peers.
It hasn’t, she says. In fact, she says she’s able to incorporate new
dining habits seamlessly into everyday life — whether eating at
home or in restaurants — by corralling her cravings, losing weight
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Diabetes
AS SEEN IN USA TODAY LIFE SECTION - WEDNESDAY - June 12, 2002 - 6D
and developing eating patterns that would be good for all
Americans.
cater to them,” Lowenstein says. “She said those people should get
special cookbooks.”
“Everybody should be eating as if they have diabetes,” Guber
says. “It’s a healthy way of eating.”
There are plenty of “special cookbooks” for diabetics, including
dozens published by the American Diabetes Association (ADA),
(www.diabetes.org). “People with diabetes are starving for
information,” says Chris Smith, author of Cooking with the Diabetic
Chef ($19.95), one of the ADA’s publications.
When Emma Lowenstein was diagnosed with diabetes, her
mother set out to find recipes that would be good for Emma and
that the whole family would enjoy. That soon proved frustrating,
she says, because newspapers, magazines, cooking shows and
even cookbooks often fail to provide complete nutritional
information.
Lowenstein set out to change that, launching an advocacy group
called Per Serving (www.per-serving.org) to try to persuade
newspaper food editors, through a letter-writing campaign, to
include per-serving food facts for all recipes. The effort has won
the support of the American Association of Diabetes Educators,
the American Cancer Society, American Heart Association and
other groups.
“I’m a very practical person, and I want to do anything I can to
make her day-to-day life easier,” Lowenstein says.
A Culinary Institute of America-trained chef and a type 1
diabetic, Smith has developed cooking methods that he
demonstrates across the country for audiences made up of
diabetics, heart patients and others interested in healthy eating. At
a recent event at the East Texas Medical Center in Tyler, where
about 70 audience members were expected, a crowd of 800
showed up, most of them non-diabetic, he says.
Smith will attend the upcoming ADA annual meeting, starting
Friday in San Francisco. While most of the hundreds of
presentations will focus on the latest medical advances in diabetes,
Smith will hold cooking seminars on such topics as summer
salads, vegetarian cuisine and grilling.
There’s nothing magic about a diabetes-friendly diet, he says.
“When reputable newspapers run headlines all the time about
diabetes, obesity, heart disease and cancer and don’t give us this
information on their food pages, they’re only giving us half the
story.”
So far, she says, the reaction from editors has been mixed. Many
big-city papers, including The Washington Post, The Philadelphia
Inquirer, Chicago Tribune and San Francisco Chronicle do print
complete nutrition information with recipes, but “there is still a lot
of resistance,” she says. One editor wrote to say her paper
provides information on calories and fat in recipes; anything more
is important only to “people with special needs, and she can’t
“What I teach is actually cooking lessons, from pan searing to
roasting to wok cooking to poaching,” he says. “People are
compromised nutritionally. I’m fighting a tidal wave. I want to
teach people to eat healthy.”
By exercising portion control and making simple changes in
cooking methods — roasting instead of deep-fat frying, for
instance, or using marinades and spices to flavor foods instead of
heavy sauces — people with diabetes or other health problems can
eat just about anything, he says.
Reprinted with permission. All rights reserved
Page 9
AS SEEN IN USA TODAY LIFE SECTION - THURSDAY - May 30, 2002 - 8D
In trial, drug curtails diabetes
By Anita Manning
A two-week treatment with an experimental immunesuppressing drug halted progression of diabetes in newly
diagnosed patients for at least a year, scientists report today.
If results are confirmed in larger studies, the drug could be a
“major contribution” to diabetes prevention, says Jay Skyler of the
University of Miami.
Skyler, director of a large diabetes prevention study, reports in a
second journal article that in a study of 339
people at high risk of developing type 1 diabetes,
In a study in today’s New England Journal of
insulin injections did not prevent the disease.
Medicine, researchers at Columbia University say
Type 1 diabetes:
they followed the course of illness in 24 patients,
The data, initially reported last year at a meeting
ages 7 to 27, who recently were diagnosed with
of the American Diabetes Association, failed to
About 5% to 10% of
type 1 diabetes, a form of the disease that occurs
confirm smaller studies that indicated insulin
the nation’s estimated
when the insulin-producing cells in the pancreas
injections might preserve the ability of pancreas
17 million diabetics
are destroyed by the body’s own immune
cells to produce insulin by giving the cells periods
have type 1, or juvenile,
system.
of inactivity and making them less likely to be
diabetes, caused by the
targeted for destruction by the immune system.
body’s inability to
They found that the drug halted destruction of
produce insulin.
insulin-producing cells in nine of the 12 treated
“We’d hoped we’d find something that would
patients, while 10 of the 12 untreated patients
have been a help to the people at risk for
had significant decline in insulin production.
diabetes,” Skyler says. Because so much is known about insulin
and its safety, he says, “if we had hit with this, we would have
The experimental drug is safer than other immunebeen thrilled.”
suppressants because it targets only specific cells, eliminating
dangerous side effects on other organs or tissues, says its
The study shows the value of clinical trials, Skyler says. “Small
developer, Jeffrey Bluestone of the University of California-San
studies might give us hints of what might be right,” but their
Francisco. Its beneficial effects continue beyond treatment, he
results need to be confirmed in larger studies.
says.
“It seems to re-educate the immune system, for a while at
least,” he says.
A two-year trial involving 80 patients is scheduled to begin
within a few weeks, Bluestone says.
The second part of the Diabetes Prevention Trial, a study to
determine the effect on diabetes prevention of oral insulin, which
works through a different mechanism than injected insulin, should
be completed next year, Skyler says.
Reprinted with permission. All rights reserved.
Page 10
AS SEEN IN USA TODAY LIFE SECTION - WEDNESDAY - May 15 2002 - 5D
Researchers weigh in on
soaring diabetes rates
By Anita Manning
WASHINGTON — More than 17 million Americans have
diabetes, and if rates continue to soar, there could be 30 million
suffering from the chronic, sometimes fatal, disease by 2050.
Diabetes is “a side effect of prosperity” that is growing
alarmingly around the world, says Christopher Saudek, director of
the diabetes center at Johns Hopkins University.
“Any nation that increases its body weight is going to increase
its diabetes.”
In the USA, he says, diabetes rates have risen 6% a year for the
past decade.
Saudek, president of the American Diabetes Association, spoke
Tuesday at a briefing by the Journal of the American Medical
Association on its theme issue on diabetes, published today.
Among reports:
• Differences in the long-term diabetes complications among
ethnic groups may have more to do with genetic susceptibility
than access to good medical care, say researchers at Kaiser
Permanente in Oakland.
An analysis of data on 62,432 diabetic patients enrolled in the
Kaiser Permanente HMO in Northern California found that whites
have higher rates of heart attack than blacks, Asians and Latinos,
while minorities experience more kidney failure than whites.
Rates of congestive heart failure and stroke were similar for blacks
and whites but were lower for Asians and Latinos.
The incidence of limb amputations was similar among blacks,
whites and Latinos, but in Asians, the rate was a startling 60%
lower than that of whites.
The disparities suggest the complications have “genetic
underpinnings,” Kaiser researcher Joe Selby says.
• Children with diabetes are more likely to suffer dangerous
highs and lows in blood sugar levels if they are underinsured,
have had erratic blood sugar level swings in the past three
months or have psychiatric problems that could cause them to
skip insulin injections.
A study by researchers at the University of Colorado-Denver
looked at 1,243 diabetics under age 20 and their incidence of
severe high blood sugar, called ketoacidosis, and very low blood
sugar levels, or hypoglycemia. Either condition can cause coma
and death.
The researchers found that 80% of the episodes occurred in 20%
of the children, suggesting that children at greatest risk can be
identified and targeted for extra help. Researchers estimate the
cost of treating ketoacidosis and hypoglycemia in diabetic children
in the USA at more than $100 million per year during the late
1990s.
• One or two drinks of alcohol a day improve insulin sensitivity
in older women, who are at increased risk of diabetes after
menopause. In a study of 63 postmenopausal, non-diabetic
women, researchers at the Human Nutrition Research Center, part
of the U.S. Department of Agriculture in Beltsville, Md., found that
those who had one or two drinks before bed — they were given
grain alcohol mixed with orange juice — each night for eight
weeks had better insulin sensitivity and lower levels of
triglycerides, a type of fat, than non-drinkers. Earlier studies have
found that moderate drinking reduces heart disease risk,
researchers say. The new data show a similar effect on diabetes
risk.
• Women who are born small may be at higher risk of
developing gestational diabetes, a transient form of the disease,
during their first pregnancy, says a report from the University of
Colorado and the University of Virginia. Gestational diabetes often
disappears after pregnancy, but it is a risk factor for later
development of diabetes in the mother. The finding suggests that
susceptibility to diabetes may be “preprogrammed in uteruo,”
researchers say.
Reprinted with permission. All rights reserved.
Page 11
AS SEEN IN USA TODAY LIFE SECTION - THURSDAY - May 16, 2002 - 8D
Cell infusion is a ‘miracle’
for diabetic
Before the procedure, Schwendinger had been unable to
stabilize her blood-sugar level, no matter what she did. Now, it’s
always on target. She no longer needs insulin shots because her
body is producing the hormone. She eats what she wants, when
she wants, and even has a glass of wine now and then.
She has some side effects from the immune-suppressing drugs
she takes daily to keep her body from rejecting the transplanted
cells, such as edema, high blood pressure and a low white-bloodcell count. She says the trade-off is worth it.
“I’m one of the first pioneers,” says Schwendinger, diagnosed
when she was 7. The procedure has “a long way to go and quite a
bit of research has to be done, but I think it’s fantastic. All those
years, that was my one prayer: ‘Please, God, take this disease away
from me.’ “
Schwendinger and other pioneers who have undergone isletcell transplantation are in Washington, D.C., today to kick off the
annual meeting of the Juvenile Diabetes Research Foundation and
lobby Congress for funding to help find a cure for diabetes.
Juvenile diabetes, also called type 1, affects about 1 million
Americans. Usually diagnosed by early adulthood, it results from
the loss of insulin-producing islet cells in the pancreas. Because
their bodies produce little or no insulin, type 1 diabetics require
daily injections to stay alive.
By H. Darr Belser, USA TODAY
Sigrun Schwendinger is a diabetic but is off insulin injections after
undergoing an experimental procedure. She works in the admissions office of the Landon School in Bethesda.
Robert Goldstein, chief scientific officer of the Juvenile Diabetes
Research Foundation, says fewer than 80 people have undergone
the process, in which doctors remove islet cells from cadavers and
infuse them through a thin tube into recipients.
By Anita Manning
Usually two pancreases are needed to harvest enough islet cells,
and a lack of the donated organs is one reason more islet-cell
transplantations have not occurred.
For 50 years, Sigrun Schwendinger of Potomac, Md., coped with
diabetes. She gave herself multiple insulin injections every day,
tested her blood-sugar levels frequently and paid constant
attention to her diet and exercise.
For people whose diabetes has caused complications, such as
vision or hearing loss, or who can’t control wide swings in bloodsugar levels, “to be able to change the course of their disease is
akin to a miracle,” Goldstein says.
That changed in February 2001, when Schwendinger got the
second of two infusions of insulin-producing pancreatic cells in an
experimental procedure at the National Institutes of Health.
But because transplant patients have to take drugs every day,
the procedure isn’t for everyone
The process, developed by Canadian scientists and reported
two years ago, is being duplicated in medical centers around
the world.
“This is not the ultimate answer,” Goldstein says..
Reprinted with permission. All rights reserved.
Page 12
AS SEEN IN USA TODAY LIFE SECTION - WEDNESDAY - April 17, 2002 - 8D
Damage often precedes
diabetes detection
By Anita Manning
The complications of diabetes come on slowly and stealthily, say
experts from the American Association of Clinical
Endocrinologists, who on Tuesday staffed the first USA TODAY
online chat on the illness.
“It may take as long as 10 or 15 years for complications to
develop,” says AACE president Rhoda Cobin of Mount Sinai School
of Medicine in New York, in response to a reader’s question.
“Often people who have type 2 diabetes (the form usually
diagnosed in midlife) have actually had it for many years before it
is detected, so as many as 50% already have complications at the
time of detection. Neuropathy (nerve damage), eye, kidney and
heart disease may all occur.”
The diabetes hotline drew questions from 708 readers around
the world. Cobin — and endocrinologists Paul Jellinger of the
University of Miami School of Medicine, and Om Ganda of
Harvard Medical School and the Joslin Diabetes Center in Boston,
fielded questions on diagnosis, medications, diet and
complications of diabetes, which affects 17 million Americans. A
sampling:
Q: Does heavy drinking of liquor affect the blood sugar? Is one
type better than others? — Lake Worth, Fla.
A: Too much alcohol poisons the liver and predisposes the body
to hypoglycemia (low blood sugar). But it also contains calories, so
it can make the sugar go up and put on weight. Alcohol is alcohol,
but some drinks, like sweet wines, beer, etc., have more calories
and sugar in them. — Cobin
Q: My daughter who is 20, has had adult-onset diabetes since
the age of 16. She is at present on insulin. How long a life can I
expect for her? Will she be able to marry and have children
normally? — Dubai, United Arab Emirates
A: It depends on how well controlled her sugar is. If it is under
good control and she has no complications, she should be able to
live a long life. Pregnancy likewise, but (it) requires very frequent
testing to tightly control the blood sugar to make sure the baby
has no problems. Please consult a specialist who is familiar with
pregnancy in a diabetic before conception, if possible. — Cobin
Q: If you have a strong family history for diabetes, is it
recommended to start on medications before you have (it)? —
Orlando
A: Research is looking at that question, but the final word is not
yet in. No recommendation for medication is at this time
appropriate, but that recommendation may be with us in the near
future. Stick with diet, exercise and weight loss (if obese) for now.
— Jellinger
Q: What is the status of a cure in the next five years? —
Blairsville, Ga.
A: The cure is not yet in sight, unfortunately. A number of
studies are in progress. Islet-cell transplant looks more promising
than before. Efforts are also underway in the development of a
vaccine. — Ganda
Reprinted with permission. All rights reserved.
Page 13
Behind the Story: A Reporter’s Notebook
As the prevalence of diabetes increases
around the world, the need for broader
understanding of this disease and its
impact on nearly every facet of society has
grown.
Anita Manning
Diabetes affects the individual, the
family, employers, insurance companies,
the food industry, schools and
government. Studies show changes in
lifestyle may be as effective as medication
in some cases, and promising new
research is being done with islet cell
transplantation and stem cells.
In order to bring together the diverse parts of this story, I rely on
those who have diabetes to describe how it affects their own lives,
supplementing that with information from scientists and
physicians. I call on diabetes experts for practical lifestyle advice for
patients and families, and national health leaders for statistical and
policy information.
Underlying all this coverage is a belief that the more our readers
understand about diabetes, the better prepared they will be to
conduct their own lives and to influence public health policy.
Anita Manning is a medical reporter at USA TODAY. She began
working for Gannett in 1979 at the News Journal in Wilmington,
Del., and has been with USA TODAY since 1983. She specializes in
coverage of infectious diseases, vaccines, food safety and diabetes.
Anita was awarded the C. Everett Koop Medal for Health
Promotion and Awareness in 2001 by the American Diabetes
Association. She received a degree in English, with a minor in
journalism, from the University of Rhode Island in 1968, and now
lives and works in Wilmington, Del.
Reprinted with permission. All rights reserved.
Page 14
Future
implications:
For discussion
1. Why is the prevalence of type 2 diabetes increasing in
the U.S.?
2. What are the most effective prevention strategies for
type 2 diabetes?
3. How do particular types of inflammatory signals
increase risk for diabetes cardiovascular disease?
4. For many people with diabetes, self-administering
insulin is a daily, painful chore. What are the new
insulin delivery technologies on the horizon?
5. Is there hope of developing a cure for type 1 diabetes?
1. There are now scientifically proven strategies to
prevent or delay type 2
diabetes. How can health
care providers better recognize those at risk for
the disease and incorporate these proven strategies into clinical care?
2. What impact could new
glucose monitoring
devices, such as continuous monitors, have on the
future of diabetes care?
About Francine Ratner Kaufman, M.D.
President, American Diabetes Association
Dr. Kaufman is currently a Professor of Pediatrics at the Keck School of Medicine at the University of
Southern California; Director, Comprehensive Childhood Diabetes Center; and Head of the Division of
Endocrinology, Diabetes & Metabolism, at Childrens Hospital of Los Angeles.
Dr. Kaufman earned her undergraduate degree from Northwestern University and her medical degree
from Chicago Medical School, where she was Valedictorian of her medical school class and won the Medical
School Pediatric Award.
Dr. Kaufman has received continual funding from the National Institutes of Health (NIH) since 1980, and
has focused her work on many aspects of diabetes, including type 1 and type 2 diabetes prevention, the
endocrinology of HIV infection, and galactosemia, a rare inborn metabolic error.
Dr. Kaufman has been actively involved with the American Diabetes Association since 1978. The
Association gave her the award for Outstanding Contribution to Children and Youth with Diabetes in 1996.
Additional resources
Organizations:
American Diabetes Association
(www.diabetes.org)
Juvenile Diabetes Research Foundation
(www.jdf.org)
American Association of Diabetes Educators
(www.aadenet.org)
American Association of Clinical
Endocrinologists (www.aace.com)
International Diabetes Foundation (www.idf.org)
Books:
The First Year: Type 2 Diabetes
(Gretchen Becker, Marlowe & Co)
Type 2 Diabetes Life Plan
(Carol Guber , Broadway Books)
Cooking with the Diabetic Chef
(Chris Smith)
Referenced Web Site:
Per Serving (www.per-serving.org)
http://www.usatodaycollege.com
Page 15