Diabetes in Men

Why should I care about diabetes?

After years of warning about an epidemic of diabetes, researchers are beginning to see clear signs that it's underway. The incidence of this devastating disease has doubled in the past 30 years, according to a 2006 report in the journal Circulation. And the biggest jump in diabetes diagnoses was among men.

The risk for type 2 diabetes typically climbs after the age of 45, although the disease is now showing up in younger and younger people. In fact, type 2 diabetes used to be called adult onset diabetes because it usually didn't occur until middle age. No longer. "We're beginning to see type 2 diabetes showing up in people in their 20s now," says David Ludwig, MD, PhD, an endocrinology expert at Children's Hospital in Boston.

The risk factors for type 2 diabetes include:

• being overweight or obese
• a sedentary lifestyle
• a diet high in sugar and refined carbohydrates and low in fiber and whole grains
• a history of type 2 diabetes in your immediate family (mother, father, sister, or brother)

African-Americans, Hispanics, American Indians, Native Alaskans, Asian Americans, and Pacific Islanders also have an increased risk.
Having diabetes, in turn, increases the danger of heart disease, as well as a range of problems associated with impaired circulation, such as eye disease and nerve damage.

What is diabetes?

Diabetes is a disease that occurs when the body can't control blood glucose levels properly. Normally, the digestive tract breaks down food into glucose, a form of sugar, which is released into the circulating blood. The hormone insulin, produced by the pancreas, stimulates cells to absorb glucose from the bloodstream and use it for energy.

Type 1 diabetes, which typically shows up in childhood, is caused when the immune system mistakenly attacks insulin-producing cells in the pancreas. Type 2 diabetes occurs when tissues in the body gradually become resistant to the effect of insulin. The pancreas responds by churning out more of the hormone. But eventually it can't keep up, and blood sugar levels begin to climb.

That's bad for many reasons. High glucose levels damage nerve and blood vessels, leading to heart disease, stroke, blindness, kidney disease, and gum infections. Advanced type 2 diabetes can result in blindness and the need to amputate limbs that no longer get adequate circulation.

One of the main causes of the current epidemic of type 2 diabetes, researchers believe, is the rise in obesity. Over time, excess weight makes cells in the muscles, liver, and fat tissue less responsive to insulin -- a condition called insulin resistance.

Another contributing cause -- to both obesity and the rise in type 2 diabetes -- is likely to be increasing consumption of sugar and highly refined carbohydrates such as white flour.

A third cause of type 2 diabetes, also linked to the others, is inactivity. Lack of activity increases the risk of obesity, of course. But a sedentary lifestyle may contribute directly to type 2 diabetes risk as well. Studies show that overweight or obese people who become active improve their blood sugar control, even if they don't lose weight.

An estimated 6 million people in the U.S. have this serious disease and don't know it. It's easy for doctors to check for diabetes using a simple blood test that measures blood sugar levels. Unfortunately, many people aren't tested because they either don't have symptoms or the symptoms are so mild that they don't notice them. If you are 45 and overweight, you should be tested for diabetes, regardless of symptoms. If you have other risk factors for type 2 diabetes, no matter how old you are, talk to your doctor about being tested, especially if you're experiencing any of the following symptoms:

• increased thirst
• increased hunger
• fatigue
• frequent urination, especially at night
• unexplained weight loss
• blurred vision
• sores that don't heal

What can I do to prevent diabetes?

Plenty. Studies show that 90% of cases of type 2 diabetes could be prevented -- or significantly delayed -- simply through a healthier diet and plenty of physical activity. The big proof of that came in a study of 3,234 people who were overweight and had elevated blood glucose levels, putting them in the crosshairs of diabetes risk. Those who followed a lifestyle change program of exercise and diet geared to losing weight -- in this case, an average of 15 pounds -- lowered their risk of diabetes by 58%. Those in the 60-and-older set cut their risk by 71%. And these were people who already had a high risk of diabetes. Keep your weight in the normal range and stay active, experts say, and you stand an excellent chance of never getting diabetes.

How is diabetes treated?

A diabetes diagnosis isn't the end of the world. In some cases, lifestyle changes can keep the disease entirely under control. Still, many people with diabetes need to take oral medications that lower blood sugar levels. When these aren't enough to do the job, insulin injections may be necessary, sometimes in combination with oral drugs. Several new drugs that work in combination with insulin to improve blood sugar management have been approved by the FDA.
While treatment has improved, however, controlling diabetes remains a challenge, which is why experts emphasize prevention.

What else do I need to know about diabetes?

Experts agree that a healthy diet designed to prevent type 2 diabetes should emphasize whole grains, fruits and vegetables, and small amounts of sugar and refined carbohydrates. One controversial area is alcohol. Traditional advice for people with diabetes or at risk for it was to avoid alcohol. But recent studies suggest that alcohol may actually protect against diabetes. Combining data from 15 studies, researchers writing in the journal Diabetes Care found that moderate alcohol consumption reduced the risk of type 2 diabetes by almost 30%. Excessive drinking, however, increased the risk. Here, as always, the word is moderation. For men, that would be a glass or two of wine or beer with a meal.

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