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      ✔ The large number of screens watched passively all day, from TVs to smartphones

      ✔ The larger, higher-calorie meals that tend to be eaten, both at home and at restaurants

      ✔ The dependence on vehicles for much movement

      ✔ The huge increase in mass-produced, high-calorie convenience foods

      What steps can people take to reverse this trend? Some of the ideas developed to reverse the high rate of cigarette smoking can be recycled, but the process takes years for the whole population. What you can do immediately is contained in Part III. Some of the population-wide measures include the following strategies:

      Putting Faces to the Numbers: Sharing Some Real Patient Stories

      The numbers that are used to diagnose diabetes don’t begin to reflect the human dimensions of the disease. People end up with test results after days, months, or even years of minor discomforts that reach the point where they can no longer be tolerated. The next few stories of real (though renamed) patients can help you understand that diabetes is a disease that happens to real people – people who are working, relaxing, traveling, sleeping, and doing many other things that make life so complex.

      

Sal Renolo was a 46-year-old black-belt judo instructor. Despite his very active lifestyle, he was not careful about his diet and had gained 16 pounds in the last few years. He was more fatigued than he had been in the past but blamed this fatigue on his increasing age. His mother had diabetes, but he assumed that his physical fitness would protect him from this condition. However, he could barely get through a one-hour class without excusing himself for a bathroom break. One of his new students had diabetes, and he suggested to Sal that he ought to have the problem checked, but Sal insisted that he could not possibly have diabetes with all his activity. The symptoms of fatigue and frequent urination got worse, and Sal finally made an appointment with the doctor. Blood tests revealed a random blood glucose level of 264 mg/dl (14.7 mmol/L). The following week, another random blood glucose was 289 (16.0 mmol/L). The doctor told Sal he had diabetes, but Sal refused to believe it. He left the doctor’s office angry but vowed to lose weight and did so successfully. On a repeat visit to the doctor, a random glucose was 167 mg/dl (9.3 mmol/L). Sal told the doctor that he knew he didn’t have diabetes, but his resolve to eat carefully didn’t last, and he was back six weeks later with a glucose of 302 mg/dl (16.8 mmol/L). Finally, Sal accepted the diagnosis and started treatment. He rapidly returned to his usual state of health, and the fatigue disappeared.

      Debby O’Leary’s active sex life with her husband was continually being interrupted by vaginal yeast infections, which resulted in an unpleasant odor, redness, and itching. Over-the-counter preparations promptly cured the condition, but it always rapidly returned. Finally, after three of these infections in two months, she decided to see her gynecologist. The gynecologist told her she needed a prescription drug. The cure lasted a little longer this time, but the infection promptly returned. On a return visit, the gynecologist did a urinalysis and found glucose in her urine. A random blood test showed a glucose of 243 mg/dl (13.5 mmol/L). He sent her to an internist, who ordered a variety of tests including a fasting blood glucose, which was 149 mg/dl (8.3 mmol/L). The doctor told her she had diabetes and recommended exercise and diet change to start with. She followed his advice, and as a result she not only lowered her blood glucose to the point that she no longer developed yeast infections but also lost weight and increased her energy, making her sex life with her husband even more satisfying.

Chapter 3

      Recognizing the Various Types of Diabetes

       In This Chapter

      Ladies and gentlemen, I’d like to introduce you to your pancreas. This shy little organ – to which you’ve probably never given any attention – can rear its lovely head at entirely unexpected moments. (You probably didn’t even know that your pancreas has a head and a tail, but it does. Now you’ve broken the ice!) Most of the time, your pancreas hides behind your stomach, quietly doing its work by assisting with digestion first and then helping to make use of the digested food. The information in this chapter should put you on closer terms with your pancreas, which is good, because you need your pancreas as much as it needs you. In one way or another, the pancreas plays a role in all of the various types of diabetes.

      Here’s the good news: You can prevent diabetes. Here’s the bad news: You can’t do so quite as easily as you may like. Your best method for preventing diabetes is to pick your parents carefully, but that method is slightly impractical, even with modern technology.

      In general, you can prevent a disease if it meets two requirements. First, you have to be able to identify if you are at high risk for getting the disease. Second, some treatments or actions must exist that can definitely reduce the occurrence of the disease. This chapter shows you how to identify whether you’re at risk for type 1 or type 2 diabetes, and it covers definite actions that you can take to prevent both of these types of diabetes.

      This chapter helps you get a clear understanding of your type of diabetes, how it relates to the other types of diabetes, and how the failure of your friendly pancreas to do its assigned job can lead to a host of unfortunate consequences. (I cover these consequences in detail in Part II.)

      Getting to Know Your Pancreas and Its Role in Diabetes

      You don’t see your pancreas very often, but you hear from it all the time. It has two major functions. One is to produce digestive enzymes, which are the chemicals in your small intestine that help to break down food. The digestive enzymes don’t have much relation to diabetes. Your pancreas’s other function is to produce a hormone of major importance, insulin, and to secrete it directly into the blood. The following sections explore the ins and outs of your pancreas and insulin so that you’re well acquainted with both.

Figure 3-1 shows the microscopic appearance of the pancreas. The following list explains the different cells found in the pancreas as well as their functions:

      Illustration by Kathryn Born

       Figure 3-1: The pancreas and its parts.

Understanding insulin

      

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