diabetes, a disease that is marked by the body’s inability to use or metabolize food. the age of 40, but the face of type II diabetes is changing. …
About Health TV with Jeanne Blake Type II Diabetes
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JEANNE BLAKE:
Welcome to About Health TV Im Jeanne Blake Millions of Americans live with
diabetes, a disease that is marked by the bodys inability to use or metabolize food On this program we turn our attention to type II diabetes Historically, this is a disease thats been seen in people over the age of 40, but the face of type II diabetes is changing To talk with us about type II diabetes, were joined by Dr Lori Laffel, who is the chief of the pediatric and adolescent unit at Joslin Diabetes Center Thanks, Dr Laffel, for coming back to talk with us again about diabetes The reason that were seeing type II diabetes now in younger people, in children, is a reflection of the obesity epidemic in this country What is the correlation? DR LAFFEL: Type II diabetes occurs when the body isnt making enough insulin for that
individuals needs to use the food for energy You need more insulin in the setting of obesity and inactivity because those conditions lead to a condition called insulin resistance If youre developing resistance and your body cant make enough insulin, you can come down with type II diabetes Were now
living in an era where theres a lot of fast food, theres less indications to be physically active when you could be on the Internet or playing video games JEANNE BLAKE: DR LAFFEL: Or watching television Or watching television And thats just a setup for children to be gaining weight
and falling into this epidemic of being overweight or obese as a child JEANNE BLAKE: To differentiate, when someone has type I diabetes, they have to take an insulin
shot Type II diabetes, what happens? DR LAFFEL: Type II diabetes probably develops in two major stages One is this condition
called insulin resistance, where the body is making plenty of insulin but its as if you think about insulin as a key that has to open a lock on a cell to let the sugar molecules in to provide energy from the food that we eat If insulin resistance develops, its as if somebody took that key and bent it so it no longer opens the lock on that cell to allow the sugar in So insulin resistance develops, or that lock and key dont fit anymore, in the setting of conditions like obesity, inactivity, pregnancy, just going through normal puberty, what all boys and girls have to do as they go from being children into adolescents
and
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young adults The state of puberty induces insulin resistance, and aging induces insulin resistance So some of the natural phenomena of life bring insulin resistance to all of our bodies, but environmental exposures, outside factors such as less activity and extra calories from high-fat calorically dense fast foods, that also brings extra insulin resistance In that setting, the body is asked to make more insulin to overcome the insulin resistance, so youre trying to straighten out that bent key to fit into the lock again JEANNE BLAKE: So someone comes to you thats a young person with type II diabetes Are they
always overweight? Is there always a presence of obesity thats causing that? DR LAFFEL: JEANNE BLAKE: DR LAFFEL: Almost all children with type II diabetes are overweight or obese Okay So do they all have to start taking insulin? Children who are overweight or obese because of this epidemic, we know we
need to screen them for type II diabetes Not all overweight and obese children have diabetes, but JEANNE BLAKE: Right, but once it has been determined that a child does have type II diabetes, is
an immediate treatment that they begin
taking insulin? DR LAFFEL: Thats a great question Often when theyre diagnosed with type II diabetes,
children may start on insulin It doesnt mean they need to stay on insulin, because their body is still making some insulin That imprint is just not working effectively or efficiently So what they have to make that body accept insulin better is, its great to begin healthy eating and a physical activity program, so lifestyle modification, so that you reduce some of that insulin resistance Then the body may work effectively again Sometimes you do give insulin at the beginning to get over that period of high blood sugars As you know, adults with diabetes can use a constellation of many, many oral drugs that can lower your blood sugar Children with diabetes havent had the opportunity to use all these drugs, because they havent been tested in children yet JEANNE BLAKE: Thats right I was going to ask that question That really presents a potential
serious complication for you as a physician trying to treat I guess not necessarily a complication, but a challenge, as youre trying to give your patients the best care that you can, and if they need a medicine, you certainly look at who its
been tested on and who its supposed to be given to
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DR LAFFEL:
Right Well, we learn a lot from our adult colleagues and the adult patients who
have used these medications, so we can often follow that example But were also fortunate because physicians and pharmaceutical companies and research institutes are trying to study all these medications in kids So almost all the medications approved in adults are also being evaluated for safety and efficacy in children So right now we have one oral mediation that is approved for use in children as well as the ability to use insulin to treat children with type II diabetes JEANNE BLAKE: Okay Well, were going to learn something about the practical application of
everything that youve been talking about by meeting one of your patients, and were going to do that in one minute When we come back well talk with Andrea Levine Well be right back We continue our discussion now about type II diabetes, and were joined by Andrea who at 12 years old was diagnosed with type II diabetes ANDREA: Yeah I was 12 and I was taken to the doctors because I had boils and I had a lot of
health problems, sleeping a lot, a lot of
lethargic behaviors, things like that My mom did some research and she found out that could be a sign of diabetes JEANNE BLAKE: You have a pretty astute mom to dig into that But there was a reason that she
was suspicious, right, Andrea? ANDREA: Yeah We have a large family history of diabetes in my family My grandmother, great-
grandmother, my aunt all have diabetes JEANNE BLAKE: ANDREA: Yeah So you went to the doctor and you learned you had diabetes? So she was on the lookout
JEANNE BLAKE: ANDREA:
Yes, I did And at first they put me on Glucophage, metformin Which is?
JEANNE BLAKE: ANDREA:
Its a pill Its an oral medication that you take Its supposed to help the insulin get to
where it needs to go
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JEANNE BLAKE: ANDREA:
Okay
And after about three months I was put on insulin in small dosage, and then I worked my
way up to a much higher dosage JEANNE BLAKE: ANDREA: Andrea, what was your reaction to finding out that you had this disease?
It was pretty scary at first What was scary about it?
JEANNE BLAKE: ANDREA:
Knowing that most likely for the rest of my life I was going to have to give myself shots
and watch my health very carefully
JEANNE BLAKE: ANDREA: Because you grew up knowing other family members that had it?
Yes I was around my grandmother all the time, and she would do shots around me, she
would do finger sticks, everything, so I was very used to the idea, but not for myself DR LAFFEL: And you told me that you were playing softball and you really felt fine, and
suddenly your mom had got you ANDREA: Yeah I was in the middle of a softball game and I was pulled out and I was taken to the
hospital and I stayed there for three days JEANNE BLAKE: ANDREA: Yes Let me ask you this Im wondering if other young people that found out that you And that was your introduction to finding out you had diabetes
JEANNE BLAKE:
had diabetes picked on you Did you ever get teased about it?
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ANDREA:
No Most kids didnt really know a lot about it and had tiptoed around the topic People
would come up to me and ask me if I was okay because I was in the hospital for a couple of days But there was no teasing or anything; it was mostly concern, actually JEANNE BLAKE: Dr Laffel, Andrea had a family history, so her mother knew to be on the lookout,
and yet there are other indicators that
would suggest that a child who is overweight should be screened for diabetes, because oftentimes they dont have symptoms or at least they cant verbalize what they are DR LAFFEL: Thats right The example that Andrea was playing softball and she didnt even
realize that she had an undiagnosed condition called diabetes and had to be whipped off to the hospital to control her high blood sugars So the things that pediatricians and physicians are asked to look for now and families are asked to look for is if a child is overweight, you should be thinking about diabetes, and then they should be screened for diabetes if they have one of the three other following risk factors The first one is a family history, like Andreas family history of diabetes The second is if the person comes from a racial or ethnic minority group, because Native Americans, African-Americans, Pacific islanders, Latinos, and Caucasians all groups get diabetes, but the first four that I mentioned, those ethnic and racial minorities, are more prone to get type II diabetes And then the third other risk factor is if you have other findings that sometimes march along with insulin resistance, and thats high blood pressure or
high cholesterol And sometimes people see like a darkening ring around the neck JEANNE BLAKE: DR LAFFEL: JEANNE BLAKE: DR LAFFEL: In a child, though, you would see that? Sometimes youll see that, and thats a sign of insulin resistance Really? Hmm And parents may think that a child is just not washing, but it actually has a very
large medical name, and thats another sign JEANNE BLAKE: Andrea, once you learned that you had diabetes, Dr Laffel spoke earlier about
lifestyle changes Have you made those adjustments? Have you tried to make those adjustments?
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ANDREA:
Lifestyle changes are extremely difficult, obviously I have had a constant battle for the
past three years in trying to change my eating habits, my exercise habits, making sure I get all my medications when I need to get them You have to rearrange your life around it JEANNE BLAKE: yourself on? ANDREA: I dont have one currently We never really focused on it The biggest focus at first was As weve learned in earlier programs about diabetes, it really does become the
focal point of ones life So how have you changed? What kind of an exercise program do you have
my eating habits JEANNE
BLAKE: ANDREA: And how did they change?
I was put on a 2,200 calorie diet, which is probably about 2,000 calories now It was
more foods I would make, vegetables, not grabbing something off the snack cart at school or whatever I started bringing my own lunch to school and things like that JEANNE BLAKE: ANDREA: And the exercise that you get in your life?
Exercise isnt really a planned thing for me currently Were trying to work on that, but
its hard to control everything all at once JEANNE BLAKE: ANDREA: Does your mom try to get you to exercise more?
Yes, she does She offers to do it with me, she tries to help me out Why do you think you resist that?
JEANNE BLAKE: ANDREA:
I just think its something I mean, for a while I was doing it I just think its something
you have to get used to doing all the time Its not something that, like, you know, you can say youre going to start its just a really hard change to make JEANNE BLAKE: You know about some of the complications, the potential complications of living
with diabetes long term
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ANDREA:
Yes, Ive been made aware of kidney failure, everything, all the problems that I can
have You know, if
you dont take care of your body, if you dont take care of cuts you can lose limbs, youve got to watch your feet, circulation, everything Its definitely made me pay much more attention to every little cut or scrape that I get on my body JEANNE BLAKE: Dr Laffel, Andrea is your patient What kinds of things do you talk with her about
in terms of living an overall healthy lifestyle? DR LAFFEL: I give Andrea a lot of credit, because its always important to look forward and
always at your next meal try to do better, and even next season try to add some more physical activity to your lifestyle and not look back and say what you didnt do right And Andrea does have periods in her life when shes able to incorporate physical activity and its just natural and its fun and thats really the way it is for kids JEANNE BLAKE: Well, thats right We know that if its not going to be fun for any of us were not
going to want to do it And there are times in our lives when we have other priorities DR LAFFEL: Right Well, I think that Andrea for a while had this group of friends that would all
go out dancing, and wasnt that wonderful physical activity and that was fun And weve talked about it There are
some times when its just easier to pay attention to these lifestyle issues and other times that its just a greater challenge But we need to look forward, and each time you sit down to a meal its another time to try to do your best because, you know, diabetes didnt happen in a day We can control it in a number of weeks or months, but Andrea is doing a great job and she just isnt giving up And thats whats important JEANNE BLAKE: Dr Laffel, youve written that we need a community-wide approach to diabetes
and youre calling on communities and schools and families to be more proactive Talk with us about how families can play a role in helping to manage diabetes DR LAFFEL: Well, when a child has diabetes the family has diabetes And when a child is at
risk for diabetes, then the whole family will have those problems associated with the diagnosis So healthy eating is were not talking about a diet, thats a four-letter word we dont use Even meal planning, you dont even have to use that word anymore, but just healthy eating for the entire family And physical activity, just incorporating, taking a walk If you like sports, doing sports I mean, I loved when you were talking about playing
softball when you were in middle school I mean, you dont
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always have those opportunities in high school, because its much more at a competitive level, but if there can be community-based intramural programs, after-school programs for kids It doesnt need to be at a highly competitive level, but programs that encourage the physical activity and the self-esteem building So not necessarily the competitive approach Back to the healthy eating The vending machines in schools is a big problem, because theres fruit juices, which are high-calorie, the regular sodas, which are very high in calories, and not to mention the candies and the chips Do we need vending machines in schools today? JEANNE BLAKE: healthfully ANDREA: The whole cafeteria lunch food, they give us actually in my high school we have quite Andrea, lets talk with you about the choices that you have in school to eat
a few options Theres a salad bar, theres diet drinks in some of those machines, you know We have options, actually, and you can also bring your own lunch if you want to, so its not really a big problem for me, actually JEANNE BLAKE: DR LAFFEL: ANDREA: Thats good And youve said
it was easiest for you when you brought your own lunch Yeah, and another thing that I think is important is for my peers to be aware, because I
feel like a lot of them dont understand or know what its like I dont think theres a lot of knowledge given to kids about diabetes and about other kids who have diabetes, and I think it would make it easier on my friends to understand whats going on with me than not having a clue JEANNE BLAKE: ANDREA: What would you want them to know?
I would like for people to know just about it, just know what it is, that its chronic, that its
not going away, its something I have to deal with, and so it would kind of make people be a little more considerate with me Because I have times where Im not in the mood to do certain things and whatnot because, you know, my diabetes is acting up or whatever, and people dont tend to understand that as much JEANNE BLAKE: What does that mean? You have an opportunity now, if someone were listening
and you wanted them to understand what that mean So when you say, My diabetes is acting up,
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what does that mean? ANDREA: High blood sugars, low blood sugars Sometimes when your blood
sugar is high you
become more irritable, and sometimes I dont want to be around certain people and they dont seem to understand that its because of certain things that are going on with my body and not because of me Im not always myself when I have high or low blood sugars DR LAFFEL: And if youre running high blood sugars for quite a long time, and we dont want
that to happen, but if you are you can almost feel like you have the flu all the time, and you know what its like when you have the flu I mean, you really dont feel like you want to do anything JEANNE BLAKE: Dr Laffel, at Joslin you are on the cutting edge of research What kinds of hope
have you been able to give patients like Andrea about how their lives might change in the future based on research thats going on? DR LAFFEL: Well, there are new medications to help manage type II diabetes coming out all
the time, and a lot of medications in adults are now being evaluated in children We are part of a large national trial which is trying to identify the best way to treat type II diabetes in youth This is an NIHfunded trial, and we will be a center along with the Mass General Hospital trying to help figure out how lifestyle
modification can be incorporated into a childs life and into a familys life What are the best oral medications to help combat the insulin resistance that I mentioned, the insulin resistance that leads to type II diabetes, and how we can manage type II diabetes, possibly without insulin As Andrea shared with us, I mean, Andrea does need insulin now She takes an oral agent as well as insulin because she really needs both of them to try to bring her sugars down Taking insulin, I think, for you was one of the big challenges ANDREA: Yeah, at first when I had to take insulin I didnt ever think Id be able to do it myself, and
now I take two shots a day, you know I think that people dont understand that a lot of people say that they could never do that if they were me, and its not a choice really Its something you have to do if you want to live, you know, be healthy JEANNE BLAKE: ANDREA: myself
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Live and have some independence, too, so your mom doesnt always have to
Exactly I cant take out the car unless I do my insulin, you know, and I take care of
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DR LAFFEL: ANDREA: DR LAFFEL: ANDREA:
Well, I thank your mom because shes helping to keep you healthy,
isnt she? Yes, she is By a routine? Yes, she is Dr Laffel, Andrea spoke very clearly about what some of the potential
JEANNE BLAKE:
complications are long term of diabetes type II, and if her disease is not managed well she could experience some of those down the road Every person who lives with diabetes knows that that threat is there, and yet generally diabetes type II was being diagnosed historically in older patients What concerns do you have now as a physician and as a researcher that children are going to be living with those complications and the challenge of diabetes for so many more years now? I mean, Andrea was diagnosed at 12, not at 42 DR LAFFEL: I think as a community, as a nation, were very concerned about this epidemic of
obesity and this epidemic of type II diabetes in children, because getting diabetes as a younger age means that by the time youre in your early 20s or 30s and barely 40, youve already been living with diabetes for decades And there is a preliminary study that has shown in a very small subset of individuals, children developing type II diabetes in their teenage years, look like they were getting complications in their third and fourth decade of
life, which is frightening Now I can look at Andrea and I can tell her that she can prevent complications, we can prevent complications together, because I know she can remain healthy, and I think the important thing by what her mother did was that she found the diabetes Diabetes is often silent, and it may not even be diagnosed, so children may be living with these high sugars, living with the abnormal metabolism, for many, many years Getting treatment and treatment that may be very difficult to implement, because someones been so used to living with high sugars theres not an interest to try to improve them, that there is a risk for complications But Im optimistic that these are preventable complications JEANNE BLAKE: When you spoke I dont want to stay so focused on the potential
complications, but the last time we spoke about diabetes you gave a very articulate, clear description of whats going on inside the body when its not being managed and why it can lead to higher levels of heart disease and other complications Can you, just for the purposes of this program also, just review some of those? Whats going on inside the body when its not being taken care of?
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DR LAFFEL:
Well, again, the body needs sugar Sugar is not a bad thing Sugar provides us
energy so that all of our cells can have the nutrition to do the cellular work and go on with our daily living To get that sugar in the cells you need insulin Even if insulin is there, like it is in type II diabetes, but it isnt able to work efficiently, the sugar levels back up in the bloodstream With the backup of the sugar levels, the body is trying to recruit other fuels, other fuels such as fats and lipids, and thats why often in type II diabetes you also, besides seeing high sugars, you also see high cholesterol level, high triglyceride level And also you will see rising blood pressures You see high blood pressure as part of the syndrome of insulin resistance So its that combination in type II diabetes of high blood sugars, high blood pressure, high lipid levels that really in combination are potentially affecting the blood vessels in our body, the blood vessels that feed our heart and our limbs This isnt a problem for Andrea I mean, shes healthy; she has a long life ahead of her But the potential is there for future problems if someone with diabetes continues to have
high blood sugars and has these high lipid levels and high blood pressure levels JEANNE BLAKE: Yeah, because its obvious when you spell it out like that you can see that
anybody thats being challenged like that is going to age more rapidly Go ahead, Andrea ANDREA: If your blood sugar is controlled, I think its the easiest time in your life to take care of
other things When I feel good, my body feels good It makes it a lot easier for me to go out and do exercise, for me to, you know, hang out with friends, to do anything, school work I think I excel more I think the most important thing for people with type II diabetes to know is, if you keep your body, your blood sugars, in control, the rest will fall into place JEANNE BLAKE: And to other young people who are feeling the challenge as youve described,
sometimes you just dont feel like doing it, what would you say, Andrea? ANDREA: I think that everyone goes through hard times with diabetes Its not an easy chronic
illness to control, but you cant give up Like, its your life; theres no choice JEANNE BLAKE: ANDREA: No I have a funny feeling that your mom, Wendy, wouldnt let you, right?
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JEANNE
BLAKE:
Which weve all said before Dr Laffel, youve said it many times before, and you
said it earlier in this program, diabetes is a family disease, and certainly having support like you have from your mom is a big help ANDREA: Yes Andrea, thank you for coming in to talk and to share what its like for you to live
JEANNE BLAKE:
with diabetes as a young person And Dr Laffel, thank you DR LAFFEL: JEANNE BLAKE: Thank you And we want to thank you for joining us on About Health TV Im Jeanne Blake
and Ill see you next time
About Health TV is sponsored in part by Harvard Pilgrim Health Care Foundation Improving health through medical education, clinical research and community service
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Source:abouthealth.com
