Monthly Archives: April 2017

Diabetes and Exercise

Almost twenty-one million people in the US are living with diabetes and an estimated 6.2 million of these people don’t know that they have diabetes because they are undiagnosed. People with diabetes, on average, have medical expenditures that are 2.3 times higher than non-diabetics, according to the American Diabetes Association. Another study in Population Health Diabetes Management estimates that diabetes is costing our nation $218 billion dollars in health care every year. Yet, most diabetes cases are preventable or reversible through exercise, weight loss, and healthy living.

I find myself wondering. What if the 6.2 million people who were undiagnosed knew they had diabetes? Or the estimated 57 million Americans with Pre-Diabetes were educated on how they could mange their health and avoid becoming a Type 2 Diabetic?

Being diagnosed as Pre-Diabetic does not mean that Type 2 diabetes is inevitable. If you lose weight and increase your physical activity, you can prevent or delay diabetes and even return your blood glucose levels to normal (ACSM 2006). (See sidebar for diabetes terms defined)

This is a very important point that many people do not understand – if you exercise and lose weight you can prevent or delay diabetes.

Do you know the signs of diabetes? Take a look around you. Do you see any signs of diabetes in your friends and family right now? (See sidebar for common signs of diabetes) It is very possible that there are people that are diabetic (or will become diabetic) around you every day. The Center for Disease Control and Prevention estimates that one in three Americans may develop diabetes in their lifetime. Those statistics are staggering and PREVENTABLE for most.

What about Type 2 diabetics that have been diagnosed? What if we educated them that through diet and exercise they could reduce their medication or eliminate it? What would this do for our health care crisis? I know that we’d first have to break through many myths, magic solutions, and limiting beliefs. The pharmaceutical companies won’t be happy with me letting this secret out either. But, what the heck, our health care system is in a crisis! Our Nation is sick! There, I said it. So let’s get down to the business of taking some personal responsibility for our health.

Many of you who are trying to understand diabetes and take responsibility for your health immediately have several questions:

o Should you cut out sugar?
o Is your weight putting you at risk?
o If you are skinny, you don’t have to worry, right?
o Can exercise and diet really help YOU?
o How do I control blood sugar levels?

And then there are the issues that you might not even know to ask about:

o Having diabetes for more than five years can increase your likelihood of developing cardiovascular disease
o Regular exercise can make you more sensitive to insulin, which can reduce medication dosages

First, let’s talk about insulin, the prime medication that keeps diabetics functioning and then you can see the answers clearly to your questions.

How does insulin work? Insulin is the main hormone that controls the entry of blood sugar from the blood stream into the cells of the body to be used as energy. How does exercise influence the insulin hormone? Exercise has an insulin-like effect on the body. When exercising, your muscles require a steady flow of sugar to keep contracting and keep you moving. Exercise increases the rate at which your muscles take up the sugar from your blood stream; so exercise acts the same as insulin by emptying the excess sugar in your blood stream into your muscles. This action, therefore, lowers your blood sugar. One twenty minute walk a day can lower glucose levels by twenty points.

Here is a great example to explain insulin’s function in your body. Think of insulin as a bus for a moment. Glucose (sugar) is the passenger. There are two types of diabetics. Type 1 diabetics manufacture no insulin (or have no bus), which, according to the Center for Disease Control, is 5% – 10% of all diagnosed cases. The second type (Type 2), have insulin resistance, which means the bus is there, but it is not picking up passengers and, there are less buses running the route. According to the Center for Disease Control, Type 2 diabetes accounts for 90%-95% of all diagnosed cases.

When you exercise, your muscles work harder than usual and require more fuel than usual; so your muscles send out their own buses to pick up the sugar in the bloodstream and carry it back to the muscles. Working muscles take over for insulin and (for Type 2 diabetics) they can even show the buses (insulin) how to work again (pick up passengers).

Exercising has many benefits for a diabetic. It increases glucose uptake by the cells, improves insulin sensitivity by improving glucose metabolism and reduces the risk of cardiovascular disease. Reduction of blood glucose levels improves insulin sensitivity by making it more effective. Exercise may reduce dosage requirements or need for medication and improve the ability to lose and/ or maintain body weight if combined with an intuitive diet. (See sidebar for Safe Exercise Check List)

There are many popular myths about diabetes. Here are a few that I hear often.

Myth #1 – Diabetics can’t eat sugar or sweets and the only reason they have diabetes is because they ate too much sugar. Yes, simple carbohydrates or sweets do raise your blood glucose levels but if you eat them in moderation and make them part of your meal plan, you can safely eat an occasional sweet

Myth #2 – If I’m skinny I’m fine. Diabetes is only a disease that obese people get.
Not completely true, 20% of people with Type 2 Diabetes are slim. Yes, being obese does put you at risk for Type 2 Diabetes, high blood pressure and high cholesterol. The key thing to remember is that there is not an atypical “diabetes” body type, genetic trait, race, age or gender. Type 2 diabetes is caused by lifestyle choices and diabetes is a disease to take seriously.

Myth #3 – There is no natural remedy for Diabetes. If I take insulin or insulin sensitivity drugs I can continue with my same lifestyle choices and be alright. Well there is a natural remedy, it is called exercise and balanced eating. You can keep a tight control on diabetes by monitoring your glucose levels, combining exercise with balanced eating, or use medication.

Myth #4 – Well I’m only borderline and 170 mg/dl blood sugar reading is normal for me. You may feel normal being a diabetic but high glucose levels are not safe. There is no such thing as borderline. You either are a diabetic or you are not a diabetic. This is a serious disease that requires you to take personal responsibility for your body. There is serious health complications associated with diabetes, especially when you are stressing your body with high blood sugar levels. You have to start to make lifestyle changes so that you can live a quality life over the long term.

Myth #5 – Exercise! What can that do for me? Blah! Blah! Healthy Lifestyle Blah! Yeah, Yeah, I know. The American Diabetic Association recommends 150 minutes of exercise a week. This is exercise of 20-60 minutes, in continuous sessions, 3-5 times a week. The Diabetes Prevention Study revealed that exercising for a total of two hours a week can reduce the risk of developing diabetes by 50%, that can be as little as 20 minutes, 6 days a week. Take a short, ten minute walk before and after work and you can prevent diabetes or lower your glucose levels.

The fact is, over 90% of diabetes cases are preventable and can be maintained with some natural remedies such as exercising, healthy eating, and/or combined with low doses of medication without tapping into our health care system to the tune of $218 billion. Start gradually and exercise a little everyday until you build up to the recommended guidelines. Eat a balanced, healthy diet and lose the all or nothing approach. Get educated about your disease, determine what your beliefs are about diabetes and make lifestyle changes starting today. (See sidebar Want to Learn More)

Diabetes is serious but you can do something about it!

Side Bars:

Diabetes Terms Defined
o Type 1 = Auto immune disease that destroys insulin producing cells in the pancreas. The body cannot manufacture its own insulin because the beta cells of the pancreas that are responsible for insulin production are destroyed. About 5-10% of all diagnosed cases (CDC 2005)

o Type 2 = body loses its sensitivity to insulin so the body’s cells are unable to utilize insulin properly (also knows as insulin resistance or adult onset diabetes). About 90% – 95% of all diagnosed cases (CDC 2005)

o Pre-Diabetes = If you have a fasting plasma glucose test (FPG) and your levels are 100 mg/dl to 125 mg/dl you are diagnosed as showing signs of becoming a diabetic unless you make some lifestyle changes

o Gestational Diabetes = When pregnancy hormones interfere with the mothers insulin, causing glucose levels to rise. This is a form of insulin resistance that in most cases ends with the birth of the child.

o Metabolic Syndrome = A combination of medical disorders that increases the risk factors of developing cardiovascular disease, obesity, hypertension, low high-density lipoprotein (HDL), high cholesterol levels and elevated plasma triglyceride levels.

o Hypoglycemic = abnormally low blood sugar levels which could be caused by excessive insulin, or your diet. Signs would be: trembling or shakiness, nervousness, rapid heart beat, increased sweating, headache, impaired concentration or attentiveness, unconsciousness and coma

o Hyperglycemic = abnormally high blood sugar levels. Signs would be: frequent urination, great thirst, nausea, abdominal pain, dry skin, disorientation, labored breathing, and drowsiness.

Do you know the signs of diabetes? Some very telltale signs include:
o frequent thirst, hunger and urination
o weight loss
o fatigue
o crankiness
o frequent infections
o blurred vision
o cuts/ bruises that are slow to heal
o tingling and numbness in hands and feet
o recurring skin, gum and bladder infections

Safe Exercise Check List
o Get physician clearance before starting any exercise program
o Test your blood glucose level before exercise, immediately after exercise, and again two hours after exercise
o Follow general guidelines for a safe exercise session; warm-up, cool-down, stretch, adhere to an intensity of Type 1 (3 to 5 RPE) and Type 2 (3 to 6/7 RPE), drink plenty of water
o Wear well-fitting, well cushioned, supportive shoes
o Wear polyester or cotton polyester socks so that your feet stay dry and minimize trauma to the foot
o Avoid strenuous, high-impact or static activity unless specifically approved by your doctor
o Carry a carbohydrate snack with you of 10-15 grams of carbohydrate

o Know and monitor signs of exercise induced hypoglycemia
o Do not exercise if 250 mg/ dl blood glucose levels or if you have ketones in your urine
o If you have autonomic neuropathy, peripheral neuropathy, neuropathy, retinopathy or any other related conditions to diabetes, you must get a doctors approval before starting an exercise program. These conditions require specific and strict guidelines.
o Exercise with a partner until you know your response to exercise
o Always check your feet before and after exercise for lesions
o Drink plenty of water. A good rule is to take a mouthful or two at least every fifteen minutes

A Disease Growing Fast to Epidemic Proportions

A summary and some stunning statistics
I am a diabetic, a person who suffers from the disease called diabetes, a disease that is growing at a fast rate in North America where in the United States and Canada there are now more that 25 million people diagnosed as being diabetic and where another 6 million are estimated to have the disease and do not yet know it, probably because they have not visited a doctor of late. And it gets worse, the forecast by health authorities is that one in three children born from this moment on will end up with diabetes. And a stunning number of 57 million people have the condition called pre-diabetes, referred to in the text below. And a major problem linked to diabetes is the similarly growing incidence of obesity.

So what is diabetes?
There are three main types of diabetes and a few others less common. There is also a condition referred to as pre-diabetes – and that is a something to be watched for because, as its name suggests, it can lead to the real thing, not a happy prospect for anyone.

No cure
It is generally accepted by the medical profession that there is no cure for diabetes and the condition must be contained and controlled within a specific tolerable range by the adoption of appropriate lifestyle changes. Those include more healthy dietary approaches that are even better if accompanied by exercise and perhaps weight loss and possibly medication to assist in controlling the levels of glucose that enter the bloodstream after eating.

But some say it IS curable
However, having said that there is no cure, I must add that there are a number of quite renowned and successful medical practitioners who insist that by adopting certain dietary approaches the disease can be brought under control until it does not manifest itself and the diabetes will, in effect, not exist for the individual who follows and adheres to that approach. The gestational form of diabetes, mentioned below and not very common, is a temporary diabetic condition suffered by a small percentage of pregnant women.

The three main types of diabetes are known as type-1 diabetes, type-2 diabetes, and gestational diabetes, of which type-2 is by far the most common, making up about 90 to 95 percent of all cases.

In the past, but less so nowadays, type-1 and type-2 were referred to respectively by the more descriptive names of juvenile diabetes and adult-onset diabetes.

Type-1 Diabetes
Sadly, type-1 diabetes is most often a disease that develops in childhood or in young adults, although it sometimes strikes adults. It is called an autoimmune disease that occurs when the individual’s immune system fails to function properly. The immune system is the collection of biological processes in the human body that normally protects us all against disease. But instead, in the case of type-1 diabetes, the immune system actually destroys cells in an organ of the body, called the pancreas, which make insulin. The result is that from that time on, the type-1 person must take insulin each day to stay alive.

Insulin and glucose
Without insulin, the glucose produced from the food we eat and that is needed to provide energy for all the body’s cells cannot be delivered into those cells and when that happens, life cannot survive for long. Without a source of insulin, a type-1 diabetic can fall into a life-threatening coma. A parent of a diabetic child lives with that constant fear and concern that such an event might occur.

Type-2 diabetes
The most common form of diabetes, is a condition in which an above normal level of glucose exists in the blood. That can occur for more than just one reason but most likely due either to insufficient insulin being produced by the body or resistance by the cells of the body to the insulin that is being produced. And it may be a combination of both of those factors.

The role of insulin
Insulin is needed to join with the glucose in the bloodstream and aid in the delivery of the glucose to the trillions of cells in the body where it is needed. It is the insulin’s ability to interact with the receptors that exist on the outer membrane of the cells, in a way acting like a mediator, that enable the process to take place to completion.

To illustrate, in the process, the insulin acts like a key that opens a door to a cell allowing the glucose to enter into the cell. Without that key, without insulin, the glucose cannot be absorbed. And that would lead to a dangerous life threatening situation if not remedied promptly.

Gestational diabetes
Is a usually temporary form of the disease developed by some women, usually late in their pregnancy, who may not even be aware of it because no symptoms are exhibited. It is not common, occurring in perhaps about 5 percent or more of pregnancies but one unfavorable outlook for the mother is that there is a 40 to 60 percent chance of them later becoming full type-2 diabetics by about 5 to 10 years later.

What is pre-diabetes?
According to the American Diabetes Association (ADA), there are 57 million people in the United States who have pre-diabetes. People with pre-diabetes have higher than normal blood glucose levels but levels not high enough for a confirmed diagnosis of diabetes. In pre-diabetes there is an increased risk of developing type-2 diabetes, and research indicates that damage to the body does occur especially in the cardiovascular system, meaning both the heart and the circulatory system, and that can lead to heart disease and stroke.

Important research relating to pre-diabetes
An important clinical research study called the Diabetes Prevention Program (DPP) showed that type-2 diabetes is preventable by adopting lifestyle changes that includes improved eating habits, adding or increasing physically active, and weight management. The weight target is to get down to a body mass index of 25 or less and to exercise for at least 30 minutes a day, 5 days a week. The Body Mass Index (BMI) is a chart of human body weights related to height and is used by doctors to aid in determining the degree of variance, if any, of a patient’s particular readings with known acceptable index values.

Diabetes is not contagious, it is not a disease that others can catch but in some cases it may have a heredity genetic component so that more than one member of the family may develop the disease. But the cause is really unknown although certain factors are known to increase the possibility of developing diabetes.

Type-2 diabetes is especially associated with obesity and is considered to be a lifestyle disease of the developed western world associated with our generally more sedentary life. The incidence of diabetes is increasing as we, as a population, consume more readily available foods that are rich in fats and contain more calories than we need to sustain our levels of energy output.

Incidence of diabetes
According to data from the Multinational Project for Childhood Diabetes by the World Health Organization, type 1 diabetes occurs equally among males and females but is more common in whites than in non-whites

Type-1 diabetes is uncommon in most African, American Indian, and Asian populations while some countries of northern Europe, including Finland and Sweden, have high rates of type 1 diabetes. The reasons for these differences are unknown. As mentioned above, type-1 diabetes develops most often in children but can occur at any age.

Type-2 diabetes is more common in older people, and overweight people and occurs more frequently in African Americans, indigenous native Americans, and some Americans of Asian origin, Hawaiians and other Americans of the Pacific Islands. Also it is more common among Latin Americans, a segment of the population that is growing faster than the rest.

Severe Diabetic Complications of Diabetes

The five main diabetic complications!

As with any other disease, you may want as much as possible to learn about diabetes and the complications of diabetes. The more knowledge you have, the easier it will be overcome and manage diabetes.

Acquiring the Knowledge of diabetes is also useful for those do not suffer from diabetes because this knowledge could be used to prevent the onset of adult diabetes and hopefully avoid this chronic disease altogether.

In addition to knowledge of diabetes such as the diabetes symptoms, diagnosis of diabetes, causes and treatment of diabetes, it is also important to know about all the related diabetic complications. All this knowledge will help you prepare – emotionally and physically – with the possibilities of coping with having not only with your diabetes, but also with other complications that are related to it as well and the lifestyle changes that is necessary to deal with it effectively.

Some factors such as heredity, age and ethnicity can have an influence on people who are prone to diabetes. But regardless of the risk factors associated with diabetes the complications of diabetes will be the same. Below are some of the diabetic complications that people need to be aware susceptible to diabetes are:

DIABETIC NEUROPATHY – If you suffer from diabetes then there is an increased risk of suffering from severe diabetic complications of the nerves. Damage of the nerves in the body will cause poor circulation in the body especially the extremities like the hands and legs, and fingers and toes. Smoking or drinking alcohol only exuberate the problem so limiting these would be a good idea.

HEART DISEASE and STROKE – According to experts, people with diabetes have a much greater risk of developing coronary heart disease, and angina compared to those without diabetes. In fact, these complications are the leading cause of death in diabetics around the world.

Diabetics are prone to heart diseases and stroke because of deposits of fat deposits in the arteries and hardness of the arteries caused by the extra glucose in the blood. This will cause high blood pressure or hypertension to develop.

DIABETIC EYE DISEASE – people who suffer from diabetes have a higher instance of suffering from diabetic eye problems as a result their diabetes. These problems of the diabetic eye may lead to diabetic retinopathy, cataract, glaucoma, and optic nerve damage. If not treated immediately they could lead to irreversible damage of the eyes or even blindness.

DIABETIC KIDNEY DISEASE – Kidney disease is also a very common complication of diabetes, because the parts of the kidneys that filter the blood damage because of high glucose levels. The kidneys will eventually be damaged as a result of being over worked and will be unable get rid of toxic by-product from the blood
This diabetic kidney disease can be avoided by keeping blood sugar levels under control by following your diabetic diets closely and do regular physical activity to keep the blood sugar in check. Other useful things that you could do include: stop smoking and drinking alcohol.

GASTROPARESIS – This is somewhat related to diabetic nerve damage. The nerves in the stomach help the stomach to contract and relax thus allowing the food to pass down into the intestine. When these nerves are damage the food remains in the stomach for long periods causing bacteria to develop. The improper functioning of the stomach also cause the diabetic to struggle in controlling his or her blood glucose level because the organ that convert the food we eat into carbs cannot be predicted. Approximately 20-30 percent of diabetics with type 1 diabetes are vulnerable to suffer gastroparesis because the vagus nerve, which keeps the food moving through the digestive tract are damaged. While people can get type 2 diabetes only suffer from gastroparesis less frequently and only in the advance stages of diabetes.

Early Symptoms of Diabetes

Diabetes mellitus is a common disease which affects many people worldwide. Chronic uncontrolled diabetes is a major source of death and disability because of the damage it causes to many different tissues and organ systems throughout the body. Over time it causes blood vessel disease which can lead to heart disease and heart attack, stroke and peripheral vascular disease. It also has negative effects on the kidneys, eyes and the immune system, to name just a few other long-term damaging effects of diabetes.

Because it is so common and so damaging, many people begin to wonder how to know if they have diabetes. What are the early symptoms of diabetes to look out for? This is actually a very important question because the earlier diabetes is caught, the better the chance of treating it effectively and preventing or minimizing the long-term complications that can occur.

The hallmark of diabetes is poorly controlled blood sugar (glucose). Normally, the blood glucose level hovers throughout the day in a fairly tightly controlled range. Insulin, a hormone secreted by the pancreas, helps to lower levels of glucose while other hormones (and eating carbohydrates) raise them. The balance between them helps keep glucose levels normal. In diabetes there is an imbalance because insulin is not working as it should to lower blood sugar levels. The glucose goes up and stays high at most times. This high level of glucose in the blood is termed hyperglycemia.

Diabetes Symptoms

When blood sugar levels are very high there are a number of acute symptoms which can occur. The most common are the three ‘P’s’, polyphagia (increased hunger), polydipsia (increased thirst) and polyuria (frequent urination). The high blood sugar causes the blood to become thickened, more concentrated, because of the sugar dissolved in it. Sugar also gets dumped in the urine by the kidney which pulls water with it, dehydrating the body and further concentrating body fluids. The net effect is that the body gets dehydrated and urination increases. The brain senses the dehydration and causes an increased sense of thirst and hunger. Other symptoms that can occur with hyperglycemia include blurred vision, fatigue, dry mouth, dry or itchy skin and recurrent infections (such as vaginal yeast infections, groin rashes and others), among others.

Early Diabetes Symptoms

However, these symptoms generally only occur with quite high levels of blood sugar when diabetes is quite severe. In early diabetes, symptoms can be less common. In fact, in very early diabetes patients may be completely asymptomatic, meaning they have no symptoms. Also, the early symptoms may be mild and may not be noticed or passed off as something less important. At this early stage, sometimes referred to as prediabetes, the blood glucose levels are elevated above normal, but not yet in the high range which could be diagnosed as diabetes. While it is not yet severe, it is still important because the increased sugar may already be doing damage to your organs and most people with prediabetes will go on to develop diabetes in time if they do not make changes in their life to prevent it.

So if early symptoms are absent or mild how do you know if you should be worried about diabetes? For one, simply educating yourself (as you are doing now) about the signs and symptoms of diabetes help to make you more aware so that if you do experience early symptoms you recognize them. Another thing to keep in mind is that if you have any concern or suspicion, seek the advice of your own doctor. They can counsel you about your risks for diabetes and perform simple tests which can help identify early diabetes.

Diabetes Risk Factors

One final suggestion is to learn more about your own risk for diabetes. Even if you do not yet have symptoms, knowing whether you are at high risk for developing diabetes can help you to be aware and get screened early. The most common form of diabetes is called Type II Diabetes, adult-onset diabetes or non-insulin dependent diabetes. While it generally occurs in adults it can affect younger individuals too, particularly if they are considerably overweight. Many of the risk factors for this type of diabetes are well understood. First and foremost, obesity and a sedentary lifestyle (lack of physical activity) both increase your risk for type II diabetes considerably. There is also a strong genetic link to diabetes which means that family history and ethnicity are important predictors. If you have close family members (parents and/or siblings especially) with Type II diabetes then your risk is greater. Also, individuals of African American, Native American, some Asian and Latino decent are at highest risk for diabetes. Age is also an important factor. As mentioned above, while diabetes can occur at almost any age, its risk increases as one gets older. Finally, in women, a history of gestational diabetes, high blood sugar during pregnancy, is another risk factor.

If you have one or more of these risk factors, your chances of developing diabetes are greater than the general public and you should be on the look out for it. Talk to your doctor about it and ask if getting screened for prediabetes or diabetes is advisable. Also, if you think you are at risk for diabetes or know you have early diabetes, there are changes you can make to help prevent it progressing and causing long-term complications. While some of the risk factors cannot be changed (age, family history, ethnicity, etc.), some are called modifiable risk factors which can be changed. If you improve them, your risk for diabetes will decrease. The best examples are obesity and sedentary lifestyle. Increasing physical activity and exercise both help to control blood glucose and help to control weight. Improving diet and losing weight can significantly improve your body’s ability to keep glucose in a normal range. Other factors, such as quitting smoking, and lowering blood pressure and cholesterol can be useful as well. While they do not directly impact diabetes, they are also risk factors for heart disease, stroke and other blood vessel diseases. Controlling diabetes as well as these other risk factors will greatly decrease your chances of developing these diseases as well.

A Note on Type I Diabetes

Type I Diabetes, also known as juvenile-onset diabetes and insulin dependent diabetes, is a less common form of diabetes. It most commonly presents in childhood although it can affect anyone. In a sense it is a more severe form of the disorder because the pancreas which secretes insulin is completely dysfunctional and there is little or no insulin secreted. Therefore, this form generally presents earlier with more severe symptoms. Patients can quickly develop severe hyperglycemia and the symptoms associated with it (increased thirst, hunger, frequent urination, etc.). In addition, if untreated by insulin injections, patients can develop diabetic ketoacidosis and diabetic coma, potentially life-threatening conditions which require emergent treatment. The risk factors for Type I diabetes are less well understood.

In Conclusion

In conclusion, stay aware of the early signs of diabetes as well as the risk factors which are associated with the disease. By being educated you can better judge your personal risk for the disease and better catch early signs of the disease. Again, if in doubt, ask your doctor. Making an early diagnosis of prediabetes or diabetes can help prevent the long-term damage that diabetes can do. It allows you to make changes in your life (improved diet, weight loss, exercise, etc.) which can help control diabetes and prevent the death and disability associated with poorly controlled diabetes.

A Focused Look at Native American Diabetes

The world is facing a new epidemic; type II diabetes. It is vital that smaller groups that have already faced an epidemic of type II diabetes be researched to learn what can be done to help reduce the treatment and to identify what is not worth repeating. Type II diabetes is also know as adult-onset diabetes and it often comes later in life. Native American populations have long faced a greatly increased percentage of type II diabetes. In fact the Pima natives of Arizona have the highest rate of type II diabetes in the world (Wheelwright). They know well that it is a deadly disease. By looking both at the history that has led up to the current diabetes epidemic in native populations and the preventative methods and their relative success rate, world health organizations could better prepare to help reduce the severity of the inevitable diabetes epidemic. National health care associations should begin a world wide prevention program for type II diabetes based on the experience of a population (Native Americans) that has already undergone such an epidemic like this before.

With estimates of the number of people worldwide with type II diabetes exceeding 300 million by 2025 it is vital that health organizations understand the devastating costs both monetarily and personally of this illness (Polikandrioti 217). Diabetes is a life changing and expensive illness. It is estimated that the treatment of diabetes in the United States now costs over $132 billion annually. Diabetes is the sixth leading cause of death in the United States (Type 2). The $132 billion is only the United States’ cost but proportionally higher costs hit other economies. China will lose “$558 billion in foregone national income due to heart disease, stroke and diabetes alone” over the period from 2006-2015 (Diabetes). It is not only the monetary cost that makes diabetes such a challenging illness. According to the World Health Organization, diabetes increases the risk of heart attack, stroke, limb amputation, blindness, kidney failure, nerve damage, and at least doubles the risk of death (Diabetes). This cost of diabetes was echoed by a study done by O’Connor, Crabtree and Nakamura that found that the mortality rate of Navajos increased from 17% to 39% with diabetes (216). The cost both monetarily in humanitarian loss that is caused by type II diabetes makes the illness one worth trying to prevent.

The good news about this impending epidemic is that type II diabetes is in many cases a preventable illness. This is important because illnesses that can be prevented are far easier and less expensive to prevent than to treat after onset has occurred. It is often referred to as an illness of lifestyle (Miller). Although there can be genetic factors at play, much can be done with a person’s lifestyle to prevent or delay the onset of the illness. The World Health Organization states that maintaining a healthy body weight, staying physically fit and eating a healthy diet can all help to reduce the risk of type II diabetes (Diabetes). Prevention for most cases of type II diabetes can be done through the seemingly simple act of getting people to live healthy lives, with regular frequent exercise and consistently a healthy diet. People who live healthier live are also less likely to get other chronic health problems like heart attack and stroke. A focus on prevention would not only help to reduce the prevalence of type II diabetes but also help in the overall wellbeing and general health of the people who were already being treated, thus world health organization should focus prevention on confronting this epidemic.

Prevention is possible. Treatment is very expensive and often cannot fix the problem. Therefore, prevention becomes the logical, practical and effective focus. If world health organizations are able to implement a successful prevention program that is able to convince its members to live a healthier life style then the overall health care need of that group will be reduced. The United States paying a staggering $132 billion annually makes it vital for the survival of aid organizations to do what they can to reduce the cost of treating major illnesses (Type II). A successful prevention program will not only reduce the number of people with type II diabetes within the community but it will also help to improve the general health of community thus reducing the cost of health care to the community further. Preventative medicine is almost always less expensive and often more effective than treatment, because it allows for the problem to be corrected before it becomes a full blown illness. This is not to say that treatment will not be important, but just that the money of health organizations can and will go further if they put their focus in to the prevention, while still preparing for treatments as necessary.

With the type II diabetes epidemic at the world’s door step, it is a challenge that all the world health organizations use that knowledge which has been gained by the group (Native Americans) that has already suffered from this epidemic. Native American tribes have had to face their own diabetic crises and have done a large amount of work to find what is most successful in the reduction of type II diabetes within their own tribes. Type II diabetes is a relatively new problem to the Native American populations, but the number of type II diabetes cases has risen very quickly (Edwards 33). With the quick rise of type II diabetes with in the Native community and the history of studies that have been done in the treatment and prevention of the illness for this community; Native Americans are a very good focus group for health organizations to consider. The studies that have been done on prevention programs for Native Americans could be very easily applied, and expanded on to help world organizations to reduce this epidemic before it comes.

Native Americans’ have the highest rate of type II diabetes in the world; the Pima in particular are the highest or any subgroup worldwide (Wheelwright). The reasons that type II diabetes is so high in this population are not known, but it is thought that here might be a genetic element. With such alarming numbers of type II diabetes it is important to understand how the Native American population got to this point and see if there are any trends in common with the world situation today. Prior to the 1940’s diabetes was virtually unheard of, but ever since the 1960’s the prevalence has been on the rise (Edwards 33-4). This rise is thought to be in part due to their food history and culture. Native Americans had a diverse food history prior to colonization, but after colonization the natives were forced to live on non-traditional lands and eat government hand-outs for food. Much of this food was of low quality, meaning that here is not much nutritional content for the caloric intake and led to many Natives being malnourished. Even as recently as the late 1990’s one in four Native household had elements of malnutrition (Edwards 32). Today most native diets more closely resemble the western diet than their traditional diet. The combination of the loss of their traditional diet with the replacement of that diet with low quality government food, especially highly processed grain like flour seems to have been a big part of, if not the cause of the increase of diabetes in the Native population. Let us hope that there is time before the world mimics the history of the Native American populations, but that will require action now.

The story around that world today looks much like that of the history books telling of the treatment on Native Americans in the 1940’s. There are many groups of people world-wide in developing nations who are starving to death or are severely malnourished. Many governments throughout the world are now providing food aid of a similar kind to world populations that are facing starvation or famine. Famine is a sociological issue, starvation is a physiological change within an individual. Both can result from unintended consequences of the political and economic patterns of western nations like the United States. Food aid tends to come in the form of inexpensive food products, mostly heavily processed grains. Heavily processed grains are very cheap because wheat, corn and rice are relativity easy to grow and subsidized by our government. Once processed such grains can last for a long time. The problem with such grains is that the human body breaks them down to sugar very easily, thus making its consumers more likely to get type II diabetes (Miller). This type of food aid sets up a structure similar to that which was created in the 1950’s and 1960’s with the Native Americans. The groups that are being given the aid become reliant on that food and lose their native food culture. As well as losing their native food culture, the groups are also staying malnourished, because they are not getting everything that they need from the food aid. Although this type of aid may be offered with the best of intentions, it also has hidden consequences, like type II diabetes. It is in places where aid like this is going that world health organizations need to focus on prevention.

There is another sleeping dragon in the room when it comes to the cause of the world epidemic of type II diabetes; westernization. Companies like McDonalds are now all over the world serving western fast food. This food is well known in America for causing chronic health problems like diabetes. Another western adaptation that is contributing to the diabetes epidemic is soda. Coke -A-Cola is sold in every country around the world and it is full of sugar. A diet that it very high is sugar will increase a person’s risk for getting type II diabetes (Miller). Government food aids along with the strong westernization of the rest of the world are placing the world at an enhanced risk of diabetes. The result of western aid programs and diet are being seen in the dramatic increase of type II diabetes world wide that is going on now. It is the role of western culture, in particular western food culture, that we are witnessing as the cause of the drastic spike in the number of type II diabetes cases world wide. It is western culture that has gotten us in to this mess, it should be the western health organizations that help to get us out.

For prevention programs of any kind to work it must instill the drive to change, and make those changes not only preferable but also achievable. Many people will want to change if they know that it will be better for them, but if that change is very hard or expensive they simply will not do it. For example, if you want a dietary change part of your program to work, you must not only tell people that their way of eating is bad for their health but also make them not desire to eat such foods. A study on the effectiveness of prevention programs in Native American populations found that:
“The major identifiable barriers were not lack of knowledge of healthy dietary practices and the value of exercise but preferences for high fat foods and large servings and less physically active lifestyles. Perhaps more important were a lack of personal confidence, a lack of skills and a lack of social support for bringing about desired changes” (Hood)

For a program to be successful it must not only present the information to the individual, but must also give that person the tools to make the desired changes, and make those changes more desirable. Cultural involvement, personal empowerment, social support and skills training, as well as a focus on preventative health measures all need to be involved in any successful prevention program.

In order to successfully create prevention programs worldwide it is vital that world health organizations look to see what makes programs that are now in use successful. Because of the Native Americans’ abnormally high level of diabetes and the large number of prevention programs in place within the community, they are particularly a good focal group. Successful diabetes prevention programs in Native American populations all have a combination of traditional methods and personal/community empowerment. In 2009 a group of researchers did a review of the literature on diabetes prevention in Native American communities, and found five programs that were exceptionally effective (Edwards 32). All the successful programs incorporated a large amount of personal and/or community support in addition to a focus on healthy living (Edwards 35). Having a strong support system, both individual and community, helps to make this prevention program far more effective. For world health organizations to make a program successful they should look at success of these five programs and mimic their value of a strong support structure. The individual culture of the target group must be taken into account in order to create a successful prevention program with an appropriate support network.