Nothing sweet about ‘the sugar’
A large part of Sharon Molden didn’t want to believe she had diabetes.
She had all of the risks.
It wasn’t until she turned 40 years old that she started to take seriously her doctor’s warnings. It wasn’t until four years later, when her diabetes grew from borderline status to the full-blown package, that Molden’s sense of denial surrendered to a stronger sense of staying alive.
The final straw came one night when she was driving southbound on Interstate 93 from Boston to her home in East Taunton. All of a sudden, her vision became fuzzy.
The only thing she could see, and that was barely, were the red taillights of vehicles ahead, and those red spots were shaped in a pattern that resembled a Christmas tree.
“Everything was blurry,” Molden recalled. “I was alone and driving a car and I couldn’t see. I couldn’t even see the license tags in front of me. I could have killed someone.”
Or herself.
In a sense, her denial in having one of the industrialized world’s most deadly diseases underscores a silent reality — of all the diseases, diabetes is the least understood and respected.
Dr. David Nathan, director of the Diabetes Center at Massachusetts General Hospital, doesn’t sugarcoat what he considers an “enormous epidemic.”
“Type 2 diabetes is arguably the single greatest epidemic that we will face this century,” he said.
He is not exaggerating.
According to the American Diabetes Association, almost 21 million people in this country have diabetes. Roughly 6 million of them are unaware that they have it. Type 2 diabetes is the most common.
What’s worse is that many experts maintain that the death rate from diabetes is vastly under-counted. It is the sixth leading cause of death in the United States. Yet, diabetes is a significant risk factor in cardiovascular disease, the nation’s number one killer.
Unlike heart disease, cancer and other life-threatening illnesses, which are decreasing in number, the incidence of diabetes is rising. Dr. Nathan estimates 1.5 million new cases a year.
“Diabetes is a growth industry,” Dr. Nathan said. “Even without considering how many people the disease kills every year, it causes misery for those still alive.”
Fortunately for Molden that night on the highway, she was able to pull over to the side of the road. She made it home, but it marked the last time that she would ignore her blood sugar level.
It was a long time in coming.
Molden’s mother died six months ago.
“I watched,” Molden said, “what had been a seemingly very healthy black woman have five strokes, lose vision in one eye and hearing in one ear. She was often very disoriented. She lost toes on both feet.”
Her kidneys failed four years ago. From then on, it was a dialysis machine three times a week. Because of her age and medical complications, she was not a candidate for a kidney transplant. Nor was the rest of her body able to cope.
“We would find her unconscious at the dialysis center,” Molden said. “Her veins had become very weak and she was unable to support all the treatments. She eventually just gave up.”
Bolden was back and forth to her hometown in Dallas, Texas. While there, her family agreed to sign an order that instructed doctors not to resuscitate their mother if she fell unconscious again.
The official cause of death was listed as complications due to diabetes and hypertension.
Molden has vowed to take control of her own diabetes.
“I’m going to keep going,” she said. “I have to make myself get up and fight this.”
In type 2 diabetes, the body either does not make enough insulin, or does not effectively use the insulin it produces. Insulin is a hormone secreted by the pancreas, a small thin gland situated beneath the stomach. Insulin plays a major role in the absorption of glucose into the cells of the body.
Glucose, or sugar, is produced when we digest certain foods, especially carbohydrates, and provides fuel for the body. Just as cars run on gas, our bodies run on glucose. There’s a small hitch — glucose cannot enter the cells without help from insulin. The cells are “locked” but insulin is the key, allowing the glucose to enter. Without the assistance of insulin, sugar builds up in the blood.
For reasons not fully understood, a high concentration of sugar in the blood can cause long-term complications. Nerve damage can result in tingling, numbness, or pain in the hands and feet. Eye damage, or retinopathy, is common. Diabetes is the leading cause of blindness in adults, and is a contributing factor to cardiovascular diseases, including heart attack, stroke, and hypertension. Infections, especially of the gums, feet, kidneys, and bladder, are possible. More than 60 percent of non-traumatic amputations of the lower limb occur in people with diabetes.
Diabetes is also a precursor to kidney damage, or nephropathy. Severe damage can lead to kidney failure or end-stage kidney disease, requiring dialysis or a kidney transplant.
Diabetes is also the leading cause of erectile dysfunction.
Also on the rise is the incidence of pre-diabetes, a condition in which the blood glucose is higher than normal, but not high enough to be diagnosed as diabetes. It is estimated that more than 50 million people in this country have pre-diabetes. Having pre-diabetes does not make you immune to the complications of diabetes. People with pre-diabetes are already at increased risk for heart disease and stroke.
The risk factors of type 2 diabetes are many — obesity, especially excess weight around the waist, inactivity, age, race, and family history. Diabetes occurs more frequently in people over the age of 45; however, it is becoming more common in children, partly fuelled by obesity and lack of activity. Race is a significant factor. Although diabetes is increasing in all races, the incidence in non-whites, including blacks, Hispanics and Asian Americans, is roughly twice that in whites.
Genetics plays a role as well. An international team of scientists recently identified several genes that are linked to type 2 diabetes, according to a recent online article in the journal Nature. Locally, several institutions, including Massachusetts General Hospital, are performing research on the genes controlling diabetes.
The good news is that type 2 diabetes is largely preventable, a significant finding of the Diabetes Prevention Program, sponsored by the National Institutes of Health.
The trial determined that the illness can be delayed or prevented by implementing three strategies — losing five to seven percent of body weight if overweight; being physically active for 30 minutes a day, five days a week; and eating healthier foods and in smaller portions. Those with pre-diabetes in particular can avoid the disease by implementing this lifestyle change.
Molden considers herself blessed that she agreed to be involved with Look AHEAD (Action for Health in Diabetes), a study at Massachusetts General Hospital designed to examine the impact of lifestyle changes on diabetes. The study is sponsored by the National Institute of Diabetes and Digestive and Kidney Diseases.
There were nights when she couldn’t sleep. She was so thirsty. She was back and forth to the bathroom, and her mouth was so dry that when she would finally get to sleep, she would awake with her tongue practically glued to the roof her mouth.
Her blood sugar level was at 300. The safe zone is 110.
Oral medications were out four years ago, and she started insulin injections.
Throughout her struggle, Molden has maintained her strong sense of Southern humor.
At 5’2” and 220 pounds, she has had little choice.
“When people would tell my parents that they had a big, healthy baby, they weren’t lying,” she said.
For her height, she should weigh about 120 pounds.
Molden knows she must lose weight and watch her diet.
She has a great motivation.
“I have to stay on top of my diabetes,” she said. “I check my feet every day. I have 400 pairs of shoes and I don’t want to lose a single toe.”
Dr. Nathan had another motivation.
“If I were African American,” he said, “I would treat diabetes like a bigot and try to fight back twice as hard.” |
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Sharon Molden’s love for shoes keeps her focused on minimizing the impact of type 2 diabetes.
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| David M. Nathan, M.D., Director of the Diabetes Center at Massachusetts General Hospital |
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