Interview with Dr. Noel Maclaren, winner of the Mary Jane Kugel Award for Diabetes Research:

Diabetes

What is diabetes? A disease that leads to abnormally high blood sugar (glucose) and sometimes high fat (lipid) levels too.

Which kinds of people get diabetes? Persons of certain ethnic groups like Asians or Native Americans are very prone to diabetes. People of Hispanic, Arab or African descent worldwide also have high rates of diabetes.

Why does having diabetes matter? When blood glucose levels rise, it causes chemical changes in the proteins of the body, a process named glycation or glycosylation. Glycation of the smallest arteries leads to their damage making them leaky, and prone to blockage. When this process becomes widespread and advanced, complications develop which can shorten one’s lifespan significantly. Also, when blood levels of lipids rise, (typical of type-2 diabetes), then damage to large arteries with blockage (atheroma) may also occur.

What are the complications of diabetes? Diabetes is the leading cause of blindness and kidney failure. When blood lipid levels rise over time, blood vessel blockage (atheroma) may lead to heart disease and stroke. This condition is a common cause of male impotence and infertility. Further, a woman with diabetes may be at risk for having a child who has spinal or heart defects.

Can these complications be stopped? Once complications have developed throughout the body, there is no way to go back. Even at this late stage, careful management can slow progression of the disease. The best way to avoid these problems however, is through early diagnosis and treatment, and prevention of the complications.

What are the signs of diabetes? There are few signs of the disease and the diagnosis is often made only when complications appear. Women with diabetes often develop an itchy vaginal discharge due to a yeast infection or thrush while others can develop skin infections. Most times however, diabetes remains silent, causing widespread damage that may only be diagnosed at the time of a heart attack.

Am I at risk for diabetes? You are if you have family members with diabetes. The disease is inherited genetically – as many as half of the family members of a patient with type-2 diabetes, are at risk – especially if they are overweight. With advancing age and obesity, the risk of diabetes goes up. This genetic problem makes the body unable to respond properly to the insulin it makes. Insulin is a hormone that is secreted into the blood when we eat, signaling the body to store the food for later usage. Insulin resistance itself may be marked by a velvety, dark-colored skin lesion commonly found around the neck and under the arms. The medical name for this is acanthosis nigricans. If you have this, you are at risk to develop diabetes.

OBESITY

What can you tell us about obesity?

Today, 1 of 3 adults is overweight. Many have defective signaling to the appetite centers in their brains, causing a condition known as metabolic syndrome.

There is a good reason why some people, despite their best efforts, do not achieve the results they wish for through exercise and diet control alone. Grizzly bears have genetic markers which allow them to gain up to 30 lbs. per week as they prepare for hibernation. Similarly, one in three Americans have defective signaling from their fat cells to the appetite center in their brains to tell them to eat less. This leads to insulin resistance, polycystic ovarian syndrome, type-2 diabetes and high blood pressure.

Beginning a fitness program without knowing one’s metabolic profile is a bit like wearing eye glasses without getting an eye exam. For the best results, precise data is crucial.

For a person with metabolic syndrome, it is likely that as many as half of the close family members are also affected. This indicates the underlying genetic nature of the problem resulting in an eating disorder and an exaggerated tendency to gain bodily fat.

The consequences of this condition are serious, and interfere with the ability to enjoy life as well as, sadly, to shorten it, through damage to the blood vessels by high blood pressure, lipid disorders, inflammation and diabetes.

While an understanding about the nature of this problem in adults is growing, fewer people know that insulin resistance syndrome begins in childhood.

As puberty proceeds, consequences of insulin resistance begin to appear, with falls in “good” cholesterol levels, rising levels of blood triglyceride and glucose levels especially after food.

Somewhat later, constant elevations of blood glucose lead to diabetes, while rises in blood pressure become persistent.

Affected teenager girls may have excessive levels of male hormones leading to loss of scalp hair, appearance of unsightly facial hair and acne and missed menstrual periods – all of these are features of the disordered hormonal balance of polycystic ovarian syndrome (PCOS) or insulin resistance syndrome in childhood.

Adults often go undiagnosed until a heart attack and stroke lead to recognition of the metabolic syndrome that preceded it.

The Foundation offers a brief examination by medical assistant, as well as finger prick blood screenings to assess presence of the metabolic syndrome and early presence of dyslipidemia, hypertension and diabetes. EKGs are also done for adults and thyroid testing if indicated all on site. Those found to be at risk are referred for medical preventative or treatment care, or taken care of by the Foundation’s clinical staff.