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The Sour on Sweet: The Coming Diabetes Epidemic

Tuesday, July 21, 2009 at 6:50 AM

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If asked to name the greatest threat to American health, it's unlikely that diabetes would be toward the very top of most peoples list. And yet…if untreated…it can lead to debilitating or even fatal complications - kidney failure, blindness, amputation, heart attack or stroke. 24 million Americans have diabetes - that's roughly 8 percent of the population. The number has nearly doubled in the last ten years. It shows no signs of slowing and now children are getting diabetes at a faster rate than ever before. As part of ideastream's week-long multi-media focus on diabetes, health reporter Gretchen Cuda tells us what's behind the sharp rise in diabetes, and what can be done to reverse the trend.

CUDA:  I studied engineering in College.  And I remember, on the first day of one class, the professor used a familiar intimidation tactic .  “Look at the person to your left,” he asked us.  “Now look at the person to your right.” We complied.  Then he spoke again.  “One of you won’t make it to graduation.  It’s up to you to decide which one.”

Fourth grade teachers all across America listen up – Give the same warning to with your students next year.  But change the last line to “One of you will develop diabetes in your lifetime.”

That is, if a few of them don’t have diabetes already.  A small percentage of children get a genetic form of diabetes called type 1.  But type 2 diabetes – the much more common type— is closely associated with obesity – and until now, has mainly affected adults.

CUTTLER: As an endocrinologist I did not see Type 2 diabetes in children until about 10, perhaps 15 years ago.  Now we are seeing a lot of it.”

CUDA: That’s Leona Cuttler.  She’s a pediatric endocrinologist at University Hospitals Case Medical Center in Cleveland, and her area of expertise is obesity in children and adolescents.  Cuttler introduces me to one of her patients – Taylor Smith —she’s 13 years old, and she has been a type 2 diabetic since she was 10.  She seems like a happy and well-adjusted teenager – talks about school and her friends.  But there is little doubt about the origin of her diabetes – she’s just over 5 feet tall, and she weighs in at over 260 pounds. Cuttler says obesity and diabetes in children are serious problems and a trend she thinks is only getting worse.

CUTTLER: Obesity is clearly an epidemic in children, in the state of Ohio as well as in the country.  We see a surge in the complications of obesity, particularly diabetes, happening in children and adolescents now, and we expect that this will be a further surge in the future.

CUDA: Cuttler and other endocrinologists say obese children are 4 to 5 times more likely to develop diabetes, and obesity is growing among children of progressively younger ages. According to the Ohio Family Health Survey, 1 in 5 children, and 1 in 7 toddlers in Ohio are considered obese.  And that’s not all.  Research shows that even newborn babies are fatter than they were a generation ago.

Nationwide, obesity has been on the rise for the last several decades –in children and adults - and the trend parallels the rise in type 2 diabetes.  Compare that to Cancer which has been steady or dropping over the same time period. 

SEEHOLZER:  Basically in America and in the western world the diabetes epidemic really the obesity epidemic, there’s no difference.

Eileen Seeholzer is a doctor of internal medicine at Metro Health Medical Center and the director of the hospital’s weight management program. She says study after study has shown that a person’s risk for developing type 2 diabetes increases as their body mass index – a ratio of height to weight – and their waist circumference goes up.

SEEHOLZER: Gentleman who have a waist of larger than 40 inches-- or ladies who have a waist of more than 35 inches have a higher risk for diabetes than those who are below those numbers.

CUDA: Exactly HOW packing a few extra pounds causes diabetes is a subject of intense research – but it all starts with a special kind of belly fat – something doctors call visceral fat.  Seeholzer says that for years doctors believed that fat cells didn’t do much but grow and shrink.  But now, there is evidence that visceral fat actually secretes substances that interfere with the action of insulin – one of the critical hormones in metabolism, and the key hormone in diabetes.

Dr. Patrick Sheehan of the North Coast Diabetes Institute in Westlake explains that insulin’s job is to help the muscles and tissue absorb glucose from the blood and use it for fuel. In fact, he says insulin literally unlocks the body’s metabolism—

-- Sound of key turning in lock and door opening--

SHEEHAN: It’s like a lock and key situation. It literally turns the key and allows glucose into the cell

CUDA: Sheehan says that in a normal person, the pancreas is like an extraordinarily sensitive thermostat – constantly sensing blood sugar levels and adjusting the level of insulin to keep them in a normal range.  But in type 2 diabetes, insulin stops working and the glucose is effectively locked out of the cells.  In response, the pancreas keeps churning out more and more insulin until it wears out.  Think of it sort of like revving a car motor at higher and higher RPM with the breaks on—

--Motor revving---

No matter how much gas you give it, you’re not going anywhere. And, Sheehan says, eventually the motor burns out.

--Engine turning over---

CUDA: But if type 2 diabetes is caused by being fat, how come some thin people are diabetics? And why are many obese people not diabetic? Armand Krikorian is a diabetes specialist at University hospitals Case Medical Center - he says that the answer still isn’t well understood, but probably lies in an individual’s genetic makeup.

KRIKORIAN: The best way to put is probably that we are all born with a certain amount of insulin producing cells, and depending on how much of those we have, we might be more or less at risk of developing type 2 diabetes.  For example, if we are born with a huge pool of insulin producing cells, we still have plenty of cells around to be able to make insulin for the longest of times.  However if we are born with a limited pool, then even if our body weight is not frankly obese we might still get type 2 diabetes because we don’t have that many insulin producing cells. 

CUDA:  If there’s a silver lining to the obesity and type 2 diabetes story it’s this: diet and exercise can greatly reduce your risk of getting the disease, and dramatically improve your outcome if you already have it. Patrick Sheehan says that makes diabetes unique.

SHEEHAN: It’s probably the only disease whereby an individual’s behavior is going to so greatly influence the outcome

--Sound of feet running on treadmill--

CUDA: And even small changes in behavior have a big impact.  In a 200 pound person, losing a mere 15 pounds and getting moderate exercise 2-3 times a week can reduce the risk for diabetes by more than HALF.  And studies have shown that for people with diabetes – diet and exercise can be even more effective than medications.  For Dr. Seeholzer at Metro Health, that’s the message she hopes to get across: 

SEEHOLZER: Your most important medicine to take every day is how you eat and how much you move.

--Sounds of running---

CUDA: Reporting from my treadmill.  Gretchen Cuda, 90.3.

HOST BACK-ANNOUNCE:  You can hear more about diabetes this morning at 9 on The Sound of Ideas and all week here on WCPN and on WVIZ-PBS; to see the full schedule go to WCPN-DOT-ORG

Additional Information

Worried about your risk for developing diabetes? Research shows that if your Body Mass Index (BMI) is in the overweight (greater then 25) or obese (greater than 30) category, you may be at increased risk. You can calculate your BMI easily using this online tool on the American Diabetes Association website.

Another criteria is your waist measurement. For women, your waist should be under 35 inches, and under 40 inches for men.

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Health, Diabetes: The Constant Shadow

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