The Specialist:
As the director of the Mount Sinai Clinical Diabetes Institute, Dr.
Ronald Tamler is an endocrinologist who specializes in diabetes care and
prevention of complications. November is National Diabetes Awareness
Month.
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| Dr. Ronald Tamler |
Who’s at risk:
An estimated 30 million Americans are living with diabetes, but a full of quarter of them do not know it.
“Diabetes is a condition that makes the concentration of glucose or
sugar in the blood stream higher than normal,” according to Tamler.
“This high glucose level is caused by one of two things: either your
body isn’t making enough insulin to move glucose into the cells or you
need more insulin than usual because your cells have formed a resistance
to insulin.” More than 700,000 New Yorkers have diabetes.
Over time, having increased glucose levels leads to a cascade of health
problems. “The effect on the body is serious,” Tamler says. “Diabetes
damages the blood vessels, the nerves, the eyes, it multiplies the risk
of heart attack and it is a leading cause of death.”
There are two main categories of diabetes: type 1 and type 2.
“Type 1 diabetes, which we used to call juvenile diabetes, is when the
cells in the pancreas that are supposed to make insulin stop making it,
often when the patient is still relatively young. These patients must be
on insulin replacement,” Tamler says. “Far more common is type 2
diabetes, when some cells stop making insulin but also the body develops
insulin resistance — so what insulin you have doesn’t work as well.
These patients have many treatment options.”
Doctors have also identified a condition called prediabetes.
“This is when an individual’s blood sugar starts rising into a range
where it’s not normal, but it’s not yet high enough to count as
diabetes,” says Tamler. “One-third of adults in this country have
prediabetes. Which means they have a 10% risk per year of getting
diabetes. But they also have a chance to prevent the disease by getting
more physical activity and eating a more healthful diet.”
Some groups are considered particularly prone to diabetes. “We consider
people at high risk of developing diabetes if they have relatives with
type 2 diabetes, if they are mothers who had diabetes during pregnancy
and if they are obese,” Tamler says. “Some ethnic groups are also at
higher risk than others, especially Native Americans, but also people of
African, Asian and Hispanic descent.”
More and more groups are working to bring diabetes prevention to
high-risk communities. “Lifestyle changes, in particular getting more
exercise and eating a healthier diet, can actually decrease one’s
likelihood of getting diabetes more than medication,” Tamler says. “Lots
of groups in the community are offering classes on diabetes prevention.
And you can always ask about resources at your local YMCA.”
Signs and symptoms:
One of the difficulties of fighting diabetes is that it can be invisible.
“Most of the time it’s a silent disease without any symptoms until you
develop complications,” says Tamler. “Uncontrolled diabetes may present
with great thirst, frequent urination and frequent infections.”
How can people gauge their diabetes risk if the disease doesn’t have
symptoms? “There is a great risk calculator you can use at diabetes.org,”
Tamler says. “Don’t hesitate to ask your doctor if you should be
screened for diabetes — there’s a simple hemoglobin A1c blood stick
test, which can assess your average blood sugar over the past year.”
Traditional treatment:
Most patients with diabetes can be taken care of by their preferred
doctor, usually their primary care physician. “If you’re diagnosed with
diabetes, look for a Diabetes Center of Excellence near you and meet
with a certified diabetes educator to help you set your goals,” Tamler
says. “After that, your doctor can help manage your care or refer you to
a specialist as needed.” There are many Diabetes Centers of Excellence
in the New York area, so there should be one near you.
Your treatment options will depend on what type of diabetes you have.
“People with type 1 diabetes have to be on insulin because their bodies
don’t make it any more,” Tamler says. “There are various options for
how this insulin is delivered, including pumps and injection pens.” Work
is also underway to create an artificial pancreas.
Patients with type 2 diabetes have more choices. “The first treatment
is often the medication Metformin, which is very safe, frequently
prescribed and very affordable,” Tamler says. “There are also relatively
new medications that can be injected once a day or once a week, and can
help with weight loss, and even newer medications that allow the body
to excrete sugar in the urine.”
Living a healthy lifestyle is vital for controlling diabetes. “The more
you adhere to a sensible lifestyle, including physical activity for at
least half an hour a day, the less medication you will need to control
your diabetes,” Tamler says. “You can also use new technology like apps
to keep track of what you’re eating. Some patients even take photos of
what they’re eating and drinking as a food log.”
Most people think of sugar as the big problem for people with diabetes,
but actually starch is the problem because it is broken down to
glucose.
“My message is that you can keep the spoon of sugar in your coffee.
What you need to watch out for is eating too much bread, rice, pasta and
potatoes.” Foods labeled a
s “diabetic friendly” can also be deceptive,
because while they may not include sugar, they still have flour or other
starch that is just as bad.
Research breakthroughs:
A group of Mount Sinai scientists just released a study based on data gathered from thousands of patients.
“We think we have identified at least three subtypes of type 2
diabetes,” Tamler says. “These different subtypes need to be assessed
differently and medicated differently. What this means is that we’re
moving forward into a more personalized era of diabetes treatment.”
Questions for your doctor:
Everyone can benefit from asking, “Am I at risk for diabetes?”
If the answer is yes, ask “What can I do to reduce my risk of
developing diabetes?” And, “should I be screened for diabetes with an
A1c blood test?” If you’re diagnosed with diabetes, then ask, “What
should I tell my relatives?” They may also be at higher risk and may
want to be screened. A counterintuitive question is, “What other than
blood sugar should I be watching out for?” It turns out that diabetes
patients need to be extra careful about cholesterol and blood pressure.
Since diabetes places great stress on their blood vessels, they need to
be even more sure to keep their cholesterol and blood pressure under
control.
“There’s a lot of work being done to help people with diabetes live
longer and healthier lives with fewer complications,” Tamler says. “This
work is already paying off, and both prevention and treatment options
are only getting better with time.”
What you can do:
Get informed. There is excellent information available on the web, thanks to the American Diabetes Association (diabetes.org), the Juvenile Diabetes Research Foundation (jrdf.com), and Mount Sinai (mountsinaihealth.org/patient-care/diabetes).
Make healthy lifestyle choices. Exercising 30 minutes a day and eating a
healthy diet can help manage diabetes — or even prevent it in the first
place. It’s also important to take a cholesterol medication and have a
urine check once a year.
Get an annual eye check.
Diabetes can damage the nerves in the eye, so it’s especially important
for people diabetes to get their eyes checked every year.
Have a foot check as part of your physical. Every time you go to the
doctor’s office, ask for someone to examine the bottom of your feet to
check for diabetes damage. “Diabetes can damage the nerves that travel
to the feet, so people with diabetes have a higher risk of developing
infections that can lead to hospitalization and even limb loss,” Tamler
says. “That’s what a foot check helps prevent.”
By the numbers:
- An estimated 30 million Americans have diabetes.
- One out of every four people with diabetes remains undiagnosed.
- About 5% of patients have type 1 diabetes.
- 700,000 New Yorkers have diabetes, and 1 in 3 are at risk of developing the condition.
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