Davidson Mayer B. - Complete idiots guide to diabetes

Table of Contents

Happenstance does not account for the enormous amount of press given to diabetes in the past few years. A compelling body of evidence makes it clear that the decade of the 90s witnessed an explosion of diabetes, elevating this disease to true epidemic status. It is the epidemic of our time, and its excess morbidity, health-care costs, and mortality are well-documented. It is fair to say, however, that physicians and scientists have not been idle in the face of this growing problem. On the contrary, extraordinary advances have been made in our understanding of virtually every aspect of this disease. We understand a great deal about the underlying causes for all the major types of diabetes, including type 1, type 2, and gestational diabetes. We have gained important insights on the complex genetics of this disease and on the metabolic defects that occur in liver, muscle, and fat which drive the hyperglycemia and abnormal lipids of diabetes. Insulin resistance is now understood to be a systemic condition accompanied by changes that make an affected person more prone to high blood pressure, blood clot formation, inflammation, and higher levels of blood sugar and blood fats. It is this collection of risk factors in the setting of insulin resistance that result in the higher rates of cardiovascular disease like heart attacks and strokes in diabetes. In many ways, that we understand so much of the cellular, genetic, and molecular events that lead to many of the outcomes we experience in diabetes is good news. That we can design treatment strategies that will actually prevent the onset or delay the progression of many of these serious complications is even better news for the over 18 million persons with diabetes. We can say with certainty what the goals are for blood sugar, blood pressure, and blood fats, both cholesterol and triglycerides, in order to prevent these outcomes. The lessons we have learned about lifestyle changes, the powerful new medications, the new delivery systems and convenient monitoring devices can be used to good advantage in people with diabetes. Thus, it is nothing short of disappointing that so few people are achieving the required treatment goals and preventing the outcomes in diabetes. Why have we accomplished such poor translation of this abundant fundamental knowledge about diabetes into clinical results in our patients?

While we have no simple answer to this question, it is clear that diabetes must be managed primarily by patients themselves, who must be capable of making the daily choices regarding nutrition, physical activity, medication adjustment, and stress management that affect the status of their diabetes. They must be prepared to regularly interact with the other members of the diabetes team, including the diabetes educator, the physician, the nutritionist, and the pharmacist, among others. They must have a strong foundation of basic understanding about the many aspects of this disease, including the physiology, the signs and symptoms, the meaning of high and low levels of glucose, the meaning of glycated hemoglobin, or HGA1C, the significance of trace amounts of protein in the urine, and the difference between the calories per gram of carbohydrate versus fat. These same persons must understand how metformin is different from a sulfonylurea, what an insulin sensitizer is, and what the various types of insulin do to blood sugar levels over short and over long periods of time. Since virtually no aspect of a persons physical or psychological being is unaffected by diabetes, there is a great deal to understand. As challenging as it seems, it is unavoidable that the patient must become an expert in the management of her disease. This requires not just a familiarity but some mastery of the basics of diabetes and the most effective strategies of self-care. But it does not stop there. A person needs to understand the policies, practices and procedures of insurance companies who cover the costs of goods and services used by people with diabetes. People with diabetes must understand the implications of major health legislation like the Medicare Modernization Act and how it will affect their individual access to various types of coverage and care or those of loved ones.

It is a real challenge to assemble and express this vast and complex mix of issues in a way that takes the mystery and confusion out of the various discussions about diabetes. This book takes on precisely this challenge and scores a major achievement. The authors combine their different experience and perspectives on this disease to produce information that the average person can relate to and understand. They have reduced complicated scientific and biologic concepts to a practical conversation that can occur with relative ease between patients and any members of the diabetes health-care team. What is more, the book is organized in ways that allow a person to go directly to the sections that are most applicable and pressing for his individual circumstance. With comprehensive, cutting-edge discussions of all of the major clinically-relevant areas of diabetes, whether cause or consequence, this is truly a complete guide. It is an excellent general reference source about the broad range of topics encountered in diabetes care, including a much-needed segment on what clinical trials are and how they have contributed to improvements in patient care. The authors have included intermittent short segments called Bet You Didnt Know to introduce special items of interest to all persons with diabetes. Just reading these alone makes this book a valuable guide. This is a book that will stimulate conversations about diabetes between friends and family and between the patient and health-care providers. While it does an admirable job of answering a lot of questions, my expectation is that it will prompt the asking of a great deal more. That is a good thing, actually. Otherwise, I do not know how the idiot for whom this book is intended will ever rise to the level of an informed, empowered, and activated patient advocate so essential in stemming the tide of this epidemic among us. This is a must read for all persons ready to assume greater control and assure better outcomes in diabetes. Surely any idiot would want that.

James R. Gavin III, M.D., Ph.D.
Chair, National Diabetes Education Program
Past President, American Diabetes Association
Professor of Medicine
Emory University School of Medicine
Atlanta, Georgia

Our country, indeed, the entire developed world, is facing a health epidemic of frightening proportions. Its not caused by a virus, a bacteria, or anything we can catch. Instead, this burgeoning epidemic is the result of our modern lifestyles, lives in which high-fat, sugar-filled food is everywhere we turn, in which we can go days without doing anything more strenuous than turning the key in a car or flipping channels with a remote.

Were talking, of course, about type 2 diabetes, which affects more than 16 million Americans. How serious is the epidemic? Just consider that one in three Americans born in 2000 will develop diabetes during her lifetime. Left unchecked, this will lead to a crisis in our health-care system and the health of our population that has never before been seen.