Stayin’ alive

A kidney dialysis/transplant diary

Diabetes awareness

It’s November 1

Why the special note? It’s the first day in Diabetes Awareness month.  I’m not too big on special days and months, but this is an important one and it fits one of the things I want to accomplish by blogging: Making people more aware of the desvastation diabetes can cause.

I’ve been aware of some of the severe complications of diabetes for more than 40 of my 60 years.  A favorite great aunt lost both her legs to diabetes before she died. The amputations, besides being physically debilitating, demoralized her. She simply was not the same and simply, I believe, lost the will to live.

I’d also heard stories about a cousin, Jack, who was what used to be called a brittle diabetic who was 4 years old when his Type I diabetes was diagnosed.  He was in his late 20s or early 30s and had just received his first guide dog when he died.

When I first went to college, I worked as a nurse’s aide on a major medical/surgical floor in a large Duluth, Minn., hospital. A male patient on the floor — a diabetic — had been there for months recovering from frostbite (he’d been mugged and lay unconcious in a Superior, Wisc., alley for hours during a bitterly cold night) that had caused surgeons to remove all his fingers and toes. Diabetes had accelerated the damage to his appendages probably because of neuropathy and the poor circulation that accompanies diabetes for many patients.

So, knowing how terrible some of the complications of diabetes can be, why did I not worry about diabetes? I’ve been overweight all my life.  A doctor first put me on a diet when I was 8 years old. I am reasonably intelligent. Why could I not control my appetite, literally? If you know something’s bad for you, you’re supposed to stop doing it, right?

Trying to control my weight is the hardest thing I’ve ever NOT done. That’s the way I think about it.  I can’t say it’s the hardest thing I’ve ever done because I’ve never been able to do it successfully.

But I didn’t worry about diabetes very much. I thought about it occasionally beginning in my 30s but when the thought would cross my mind I’d  think: “Well, you know, if you get diabetes you just change the way to eat. That’s all. You know you have to do it, so you do it.”


Diabetes is insidious. It attacks everything. Everything. And it feeds upon itself in a repeating cycle that makes you feel like a hampster on a wheel: Diabetes is caused in part by overeating…diabetes elevates your blood sugar which makes you crave more food.  That’s the simplest example of the treacherous cyclical downward spiral.

Diabetes — high blood sugar — makes your blood thick (think of pancake syrup whre the higher the sugar content the thicker the syrup) which makes your heart pump much harder which elevates your blood pressure which does crazy things throughout your body. And so it goes, an every spiraling downward path. Sometimes you can halt it, hold it at bay.  Sometimes you can’t.

I remember when I was first diagnosed with diabetes, I told a coworker who was typically a Mr. Cool type of guy. Never seemed to get too upset about things, always kept his well-groomed cool.

His eyes fired. His posture became tense. “Fight it,” he said, “fight it with everything you’ve got.” He explained his dad had diabetes and he was — at that time — watching him slowly die from the complications.

That was about 10 years ago.  I attended his dad’s funeral about 9 years ago.

Here’s what a couple of regional experts say about diabetes’ effect on our society today — if you read the story on GazetteOnline, you may want to skip this, but even if you did, it’s worth a second read.

Diabetes ‘scourge on society’

The Center for Disease Control chronicles a 153 percent increase in diabetes diagnoses from 1994 to 2005.

Dr. Fadi Yacoub, a nephrologist with Internists Associates of Iowa, has been practicing 13 years in Iowa, eight in Cedar Rapids.

The incidence of Type I Diabetes has remained fairly stable, Yacoub says, but there is “no question about it” that Type II Diabetes has “skyrocketed for one single reason – weight.   The more weight the more diabetes the more kidney disease.”

Dr. Alan Reed, chief of the division of transplantation at University Hospitals and director of its organ transplant center, says “Type II Diabetes is a real scourge on our society.”

 Reed, who has performed “several hundreds” of kidney transplants says “we tend to be a victim of our own success.”

 People are living longer in large part because of medical advances and Type II Diabetes and the many complications it spawns, including kidney failure, is mostly seen in aging patients. “All you have to do,” Reed says, “is look at the number of people on dialysis and waiting for transplants.”

 Yacoub has experienced those growing numbers in his own practice. In the last “two to five years,” the number of kidney patients Yacoub sees has “increased dramatically” and many of those patients are “a lot older, more frail.”

There are 20.8 million children and adults in the United States, or 7 percent of the population, who have diabetes,  according to the American Diabetes Association, including   6.2 million people (or nearly one-third) who are unaware that they have the disease.

Add to that the 54 million people in the United States who have pre-diabetes. Recent research has shown that some long-term damage to the body, especially the heart and circulatory system, may already be occurring during pre-diabetes.

Is there a need for more nephrologists and support staff to deal with the increasing numbers? There may be, Yacoub says, but beefing up medical professional numbers is not the answer. 

“The bigger question,” he says, “is how are we going to make diabetes go away? If you remove diabetes in the future, 50 percent – if not more” of the number of kidney patients alone would disappear.

In the 1970s when statistics on kidney failure patients were first being gathered only a “very few were from diabetes,” Yacoub says, and so when projections of patient numbers were made “we grossly underestimated the impact of diabetes.” 

The predictions were off by about 400 percent: the 40 patients then predicted compared to the actual 200 seen today.  “Today half to 60 percent” of kidney failure cases are caused by Type II Diabetes, Yacoub says. 

Those numbers are “very different from most European countries and Japan.”

Diabetes – especially Type II – is “not glamorous,” Yacoub says, so there are “not enough dollars spent” on researching how to make Type II Diabetes go away or how to control obesity.

The long term answer, Yacoub says, is “to start in childhood.  Keep kids healthy, active, thin and trim. Type II is totally controllable if you prevent it” and prevention starts early.

Reed agrees that prevention is the answer and says “we need to do things that reward prevention.” Another problem, Reed says, “one that hit me squarely between the eyes,” is “there is no money to be made in prevention only in treatment.”

Society sees obesity “not as a disease but as a lifestyle,” Yacoub says, and so instead of spending money to find ways to combat obesity and Type II Diabetes “we tend to spend on treating the complications” of diabetes, Yacoub  says. Those complications can include hypertension, heart problems, neuropathy, blindness and kidney failure.

None of the above addresses the personal impact of diabetes. The ripples have “tremendous effect on those surrounding, the whole family and friends,” Yacoub says.  “They are very dramatic, expensive and often debilitating and affect family, friends and social life.”


November 1, 2007 - Posted by | diabetes, dialysis, health, kidney, renal diet, transplant

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