Did you know that your body shape is a good indicator of whether or not you’re at risk for diabetes? Or that the disease is largely preventable? Or that more than 23 million Americans have diabetes … and 6 million of them don’t know it yet?
Disaboom talked to Linda Haas, PhC, RN, CDE, to get the latest information and explore the link between diabetes and disability. Haas chairs the Older Adult Workgroup at the National Diabetes Education Program (NDEP), a partnership of the National Institutes of Health, the Centers for Disease Control and Prevention, and more than 200 public and private organizations.
Apples and Pears
DB: Why are Americans getting diabetes more frequently as they age?
LH: People are becoming overweight and less active. That happens as we get older, too. We’re just not as active at 70 as we were at 30 or 40, and our fat redistributes and changes. People who get diabetes gain their weight in their tummies. It’s the apples vs. the pears: people who gain their weight in their thighs tend not to get diabetes.
DB: Can you predict from a person’s body type early on how likely they are to get diabetes?
LH: Yes, particularly if they have diabetes in their family. Type 2 diabetes is very strongly inherited. But losing even a small amount of weight can make a big difference.
DB: We all know how difficult it is to lose weight. What do you advise people who are trying to lose a couple pounds?
LH: The desire has to come from inside, it really does. You can tell people all kinds of things, but something has to click. With some people, it’s the diagnosis of diabetes itself. They have horror stories about diabetes in their family, because it’s only recently – in the past 10 or 15 years – that we’ve been able to prevent the complications of the disease. They’ve seen foot amputations and loss of eyesight, and they don’t want those things to happen to them.
DB: So those are completely preventable now?
LH: Yes, amputations certainly, and the blindness (retinopathy) is too. If you’re over 65 you can call 1-800-222-EYES for a free dilated eye exam if you have diabetes.
DB: What does someone in a wheelchair need to be aware of if they get a diagnosis of diabetes?
LH: People in wheelchairs can be fairly active. We just had the Veterans Wheelchair Games in Spokane this week! There are exercises you can do in a wheelchair (even if you’re not an athlete). A lot of the people I see in wheelchairs have multiple other problems, and it’s harder for them to do much of anything. They have depression, heart disease, they’re grossly overweight.
Depression and Diabetes
DB: Depression is rampant with diabetes. A study by Bruce et al. found more than 50% of elders with diabetes had depressive symptoms. What’s your take on this?)
LH: We encourage people with diabetes to at least get tested for depression. At the VA where I work, we ask these two questions. In the past two weeks:
1. Have you had little interest or pleasure in doing things?
2. Have you felt down, depressed or hopeless?
Each person is scored according to how often the feelings occurred, from not at all to nearly every day. People with high scores are referred to a mental health clinic.
Top Three Things to Know About Diabetes
DB: What are the three most important things we should all know about diabetes?
LH: 1. It’s increasing in prevalence.
2. It’s treatable.
3. Type 2 (about 93% of all diabetes) is preventable.
DB: It’s still preventable, even if you have it in your family?
LH: Yes. This is what the diabetes prevention study showed regarding people who were at high risk for diabetes, whose blood sugars weren’t quite normal but they weren’t yet in the diabetes range.
“I always like the government-funded ones instead of ones funded by a drug company!” she says of the randomized control trial of all different age groups and ethnicities. She gives the statistics: 11% of the people in the placebo group developed Type 2 diabetes. In the group that got Metformin, that risk was cut by 38%. But the lifestyle change group cut their risk of getting the disease by a whopping 58%, which increased to 70% in people over 60. And what was the lifestyle change?
Walking. The lifestyle group walked a little more than 20 minutes per day, which caused them to lose an average of four pounds over a four-year period.
“That’s really doable,” Haas notes.
Ask Your Doctor About Metformin for Prevention
DB: What role does Metformin play in prevention?
LH: It was more effective in the 30-39 age group and in people who are overweight. It’s the first-line drug we use to treat diabetes. The FDA hasn’t approved Metformin for the prevention of diabetes, but some providers are using it for that, and there have been no reports of any harm.
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