April-June, 2003

Cover story

Diabetes: The new American epidemic

Three years ago, 39-year-old Jim Smotherman of Springfield lived life his way.
He rarely cooked, preferring to eat out most every meal. He smoked two packs of cigarettes a day. He also rarely exercised.

Because Smotherman wasn’t overweight, he didn’t see a reason to change his ways – until a heart attack and diagnosis of type 2 diabetes at age 36 forced him to recognize just how unhealthy his lifestyle really was.

“Looking back, I was experiencing signs of diabetes (fatigue and extreme thirst) for probably a year before I was diagnosed,” Smotherman says. “Diabetes and my heart attack really meant a lifestyle change for me. I quit everything cold turkey.”

Diabetes has been on the rise in the United States for the past 10 years due to the increase of obesity in our society, says St. John’s endocrinologist Greg Ledger, M.D. Diabetes is the fourth-leading cause of death in the United States. Seventeen million Americans are suffering from it and approximately 6 million Americans don’t even know they have it. Ninety to 95 percent of people with diabetes suffer from type 2 diabetes.
The disease impairs the body's ability to use food. The hormone insulin, which is made in the pancreas, helps the body to change food into energy. In people with diabetes, either the pancreas doesn't make insulin or the body cannot use insulin properly. Without insulin, sugar – the body's main energy source – builds up in the blood.

“Type 2 diabetes is the most common form of diabetes and is a result of insulin resistance. The body doesn’t know how to properly use insulin. With our nation continually becoming more overweight, diabetes is rapidly becoming more prominent,” Ledger says
As the U.S. population becomes more overweight, researchers expect type 2 diabetes to appear more frequently in pre-pubescent children.
Diabetes can be a debilitating disease if it is not maintained properly. Ledger says diabetes complications include heart disease, stroke, high blood pressure, blindness, kidney disease, nervous system disease, dental problems and problems with pregnancy as well as decreased immune system functioning.
Ledger adds lifestyle changes can prevent or delay the onset of type 2 diabetes among high-risk adults. Those at high risk for the disease are people with a family history of diabetes, the obese and African Americans, Latinos, Native Americans, Asian-Americans and Pacific Islanders.

“Women who have experienced gestational diabetes when they were pregnant are also at a higher risk for type 2 diabetes,” Ledger says.
While going through cardiac rehabilitation at St. John’s Hammons Heart Institute after his heart attack, Smotherman worked with dietitians and fitness instructors to learn how to prepare healthy meals and snacks, adopt an exercise program and maintain his diabetes.
“I went from taking three shots of insulin and checking my blood sugars three times a day to taking a pill twice a day and checking my blood sugar twice a week,” Jim says.
Convinced that watching his diet and exercising is important for a long life, Smotherman is now training for a half-marathon – a far cry from his former couch-potato lifestyle. He also gets regular check-ups twice a year.
“My way didn’t work anymore. I thought I would give eating the way you’re supposed to and exercising a try and I’m healthier for it,” Smotherman says, as he laces up his tennis shoes for an evening run.

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Types of diabetes

Type 1: Usually diagnosed in children and young adults, and was previously known as juvenile diabetes. In type 1 diabetes, the body does not produce insulin. Insulin is necessary for the body to be able to use sugar. Sugar is the basic fuel for the cells in the body, and insulin takes the sugar from the blood into the cells.
Type 2: Most common form of diabetes and is a result of insulin resistance. The body doesn’t know how to properly use insulin.
Pre-diabetes: Occurs when glucose levels are higher than normal but not high enough for a diagnosis of type 2
Gestational: Affects about 4 percent of all pregnant women. Pregnant women who have never had diabetes before but who have high blood sugar (glucose) levels during pregnancy are said to have gestational diabetes.
Eat Healthy: Eat a healthy diet consisting of more fruits and vegetables, skim milk products and leaner meats such as poultry.


Prevention

Eat Healthy: Eat a healthy diet consisting of more fruits and vegetables, skim milk products and leaner meats such as poultry.
Exercise: Get cardiovascular exercise at least three or four times a week. Cardiovascular means exercising for at least 30 minutes in your target heart rate.

Healthy fast-food choices

• Taco Bell Bean Burrito 380 calories, 10 grams fat
Water/low-fat milk/diet soda
• Schlotzsky’s small light turkey sandwich 357 calories, 8 grams fat
Water/low-fat milk/diet soda
• Subway roast beef sandwich, 6-inch 303 calories, 5 grams fat
(no cheese, oil or mayonnaise)
Water/low-fat milk/diet soda


Diabetes Education

In 1990, the American Diabetes Association first recognized St. John's Health System's diabetes education program as a quality diabetes self-management education program. St. John's meets national standards for diabetes self-management education, which is an essential component of effective diabetes treatment. Diabetes self-management through education may prevent unnecessary hospital admissions and some of the acute or chronic complications of diabetes. The St. John's program has offices at St. John's Smith-Glynn-Callaway Medical Building in Springfield, where diabetes educators empower patients to take control of their diabetes through comprehensive individualized education programs.

The services are offered on both an inpatient and an outpatient basis.
"Our diabetes education curriculum is given to diabetic patients who are referred to the program by their physician. We provide training, individual and group, for patients with either type 1, type 2 or gestational diabetes, as well as a support group for patients and family members. The program serves adults and children and its goal is to improve a patient's or parent's ability to manage the disease," says Debra Barnhart, St. John's Medical Management Services director.
For more information about St. John's diabetes education program, please call 417-890-4100.

Have you or a family member been recently been diagnosed with type 2 diabetes?
If so, a St. John’s diabetes support group meets at 4:30 p.m. the first Thursday of each month in room 210 of St. John’s Mid-America Cancer Center, 2055 S. Fremont, in Springfield. Call 888-8888 or 1-800-909-TEAM for more information.