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Home News Tribune Online 01/23/07

By Angela Bacque

My grandparents had diabetes, as did my mother and father. My sister and I watched as my father suffered the complications of diabetes: the vision loss, the kidney disease requiring dialysis, and finally the heart failure that claimed his life. Now, my sister is perilously close to becoming a type 2 diabetic.

Diabetes has become my calling. I am a certified diabetes educator and have made diabetes prevention and management my life's work. As manager of our hospital's Diabetes Self-Management Program, I help people with diabetes manage their disease. I also manage our hospital's Center for Healthy Lifestyles, where I show people with pre-diabetes that type 2 diabetes is not inevitable.

So when it comes to diabetes prevention, I have become my sister's keeper. I need to make her understand that despite our family history, diabetes does not have to be her destiny. Indeed, people with pre-diabetes who are at risk for developing diabetes can prevent it.

The health effects of uncontrolled diabetes are well known. It is a leading risk factor for heart disease and stroke. People with diabetes have a higher risk of kidney and vascular disease, blindness and circulatory problems. It is the leading cause of non-traumatic amputation.

Diabetes and Pre-Diabetes

As many as 40 percent of Americans between 40 and 74 years of age have pre-diabetes, according to the American Diabetes Association. Having pre-diabetes means a person is likely to develop type 2 diabetes and may already be experiencing its adverse health effects. Blood glucose is considered normal when it is below 100 milligrams per deciliter. A person with pre-diabetes has a fasting blood glucose level between 100 and 125 milligrams per deciliter, using the fasting plasma glucose test. Blood glucose over 125 milligrams per deciliter is considered diabetes.

Type 2 diabetes usually begins with insulin resistance, a condition in which fat, muscle, and liver cells do not use insulin properly. At first, the pancreas keeps up with the added demand by producing more insulin. Over time, however, it loses the ability to secrete enough insulin needed to convert food into the energy needed for daily life.

Besides our family history, my sister has other markers for diabetes. She is overweight and over 40. She had gestational diabetes when she was pregnant. While this type of diabetes usually goes away after the baby is born, a woman with gestational diabetes is more likely to develop diabetes. She gave birth to a baby over 9 pounds.

People with pre-diabetes can delay and even prevent the onset of type 2 diabetes by making lifestyle changes that include losing weight, eating a low-fat, low-calorie diet and getting regular exercise of 30 minutes a day, five days a week. While the treatment for pre-diabetes calls for reducing 5 to 10 percent of your weight, in many cases, even a loss of 10 to 15 pounds can make a difference in blood glucose levels. For some, intervening early can actually turn back the clock and return elevated blood glucose levels to the normal range.

My sister was a client at our center when she had gestational diabetes, but she's not a client now, despite my insistence. Like so many of us, she has a busy life. She works full time and has three children, the youngest a toddler. She is active in her community. Her dinners are eaten on the fly, usually on the way to a child's activity. My sister knows what she has to do to prevent diabetes — she knows about the importance of exercise, weight loss and reducing fat and calories. So how do I get her from knowing what to do to actually doing it?

I am a diabetes educator, so I teach. I am also a big sister, so I nag, scold, lecture and pester: I send articles about diabetes and lots of healthy recipes. I bought her a glucose monitor so she can test herself regularly. I clip and send her articles about weight loss and exercise. I buy her books. Together with her husband, we are scouting treadmills and exercise bikes she can use at home. In short, I have become a nudge.

I am using everything I know as a diabetes educator and activist. I do this because if my sister doesn't make these changes, diabetes will be her destiny, and I can't let that happen.

Angela Bacque, MPA, R.Ph, CDE is a pharmacy manager and certified diabetes educator. She is manager of the American Diabetes Association-certified Diabetes Self-Management Program and Center for Healthy Lifestyles at Robert Wood Johnson University Hospital at Rahway. The Center can be reached at (732) 499-6109.

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