by Richard Clark, Jr.

One day in October 1999, Lois Williams felt an extreme rush of anger, fear, and confusion. "Unexpectedly," she says, "within a few hours, I had lost my eyesight." First, Lois noticed things were looking gray, then foggy, and then everything was black. 

Yes, you read correctly. Lois did become blind in just a few hours. And it wasn’t the result of a freakish accident. Lois lost her vision as a result of diabetic retinopathy. She attributes the onset of her blindness to the fact that she did not understand the affects of diabetes, and failed to make needed lifestyle changes.

Type 2 diabetes often results from an unhealthy lifestyle. Overweight (and obesity—or extreme overweight) is another disease brought on by an unhealthy lifestyle. Both diabetes and overweight are worldwide problems and, complicating matters, overweight leads to type 2 diabetes.

With type 1 diabetes, the body is unable to produce insulin. With type 2 diabetes, the body resists processing available insulin properly. Insulin is required in order for glucose (sugar) to enter and fuel body cells.

Who has it?

As a diabetic, Lois has lots of company—more than 180 million worldwide, according to the estimate of the World Health Organization (WHO). Ninety percent of diabetics have type 2 diabetes. According to a 2005 study by the Centers of Disease Control (CDC), almost 21 million people in the US have diabetes.

While millions are diagnosed, millions more suffer from the disease but don’t realize it. In the US, it is estimated that more than six million are undiagnosed diabetics. Almost half of all people with type 2 diabetes don’t know they have it. Additionally, the CDC reports that some 54 million in the US have prediabetes, which is characterized by elevated blood glucose levels.

On the other hand . . .

Unlike easily ignored diabetes, overweight is, well—you get the picture. The CDC reports that in the US, more than one-third of adults were obese in 2005-2006. Worldwide, more than 1.5 billion people are overweight. Overweight and obesity are rising dramatically in low- and middle-income countries, particularly in urban settings. In fact, a recent article in Scientific American reports that obesity has emerged as a more serious threat than hunger for developing nations. Worldwide, more people are overweight (1.3 billion plus) than underweight (some 800 million).

Who Gets Diabetes?

Lois, as a woman and an African American, is especially at risk for diabetes. In the US, according to the CDC, African Americans, Hispanics, American Indians, Asian Americans, Native Hawaiians and other Pacific Islanders are at particularly high risk for type 2 diabetes and its complications.  Also, the disease is more devastating and more difficult to control among women. 

Overweight is primarily caused by consuming more calories than the body uses. Two major trends are causing the global increase in this disease:

1. People are eating more energy-dense foods high in fat and sugars (mostly lacking nutritional value),
2. People are getting less physical activity.

Debilitating and Fatal Results

As Lois knows first-hand, diabetes is no trivial matter. Because of her diabetes-caused blindness, she lost her job, and had to relearn such things as how to cook and use the telephone. Diabetic retinopathy is the cause of the most new cases of blindness in 20- to 74-year-olds. Between 12,000 and 24,000 new cases are reported each year. Diabetic retinopathy is the result of long-term damage to small blood vessels in the retina.
 
In addition to blindness, according to the CDC, diabetes is a leading cause of these diseases or complications:

• Heart disease and stroke (The WHO says half of all diabetics die from cardiovascular disease).
• High blood pressure.
• Complications of pregnancy, including major birth defects and spontaneous abortions.
• Kidney disease (diabetes is a leading cause of kidney failure).
• Amputations resulting from artery and nerve disease.

The diabetes epidemic is comparable with another, more familiar, world-wide problem. According to the WHO report, "The burden of premature death from diabetes is similar to that of HIV/AIDS."

The true cost of diabetes is inaccurately reported. Take, for instance, the WHO’s estimate of people who died from diabetes in 2005—1.1 million. Recall that diabetes can lead to heart disease and kidney disease. These two diseases may be recorded as the cause of death when diabetes was actually the culprit. Even in the US, where diabetes was the sixth leading cause of death in 2002, this under-calculation is probably true, according to the CDC.

Like diabetes, overweight and obesity cause serious health consequences, including:

• Cardiovascular disease (primarily heart disease and stroke)—it kills 17 million people each year.
• Cancers: breast, colon, and endometrial 
• Musculoskeletal disorders (osteoarthritis, particularly)

Because about 300,000 Americans die because of obesity annually, former Surgeon General C. Everett Koop has called obesity the second leading cause of preventable deaths in the United States.

What to Do?

Here are four steps you can take to prevent or delay the onset of type 2 diabetes. The first three can help prevent overweight and obesity, too:

• Increase physical activity. Get at least 30 minutes of moderate exercise per day, five days a week. Simple walking is one of the best.
• Eat a healthy diet. Start with 3-5 servings of fruit and vegetables daily. Cut way back on sugar and saturated fats.
• Achieve and maintain healthy body weight. It won’t happen overnight, but gradually work off those pounds. The American Diabetes Association says that, for treating prediabetes, losing 10 to 15 pounds can make a huge difference.
• Don’t Smoke. Smoking increases the already-elevated risk of diabetics of dying from cardiovascular disease. If you are addicted to nicotine, attend a nicotine cessation course, or take whatever steps are necessary to break the addiction. 

Lois Williams went from ignorance about diabetes to being the president of the Diabetes Action Network, a division of the National Federation of the Blind. Because she lost her eyesight out of ignorance, she now makes it her mission to arm others with knowledge about managing diabetes—or keeping it at bay.

"That’s why I talk to everyone I can about what I have learned," Lois says. "Had I known about the complications of out-of-control diabetes, I would have chosen healthful nutrition, and would have gotten into the habit of regular exercise. I am doing those things now."

Some of Lois’s vision has returned, and she believes her lifestyle change is the reason.      

Lois has a mnemonic device to help diabetics keep important points of diabetes control in mind: It is DIME—Diet, Information, Monitoring, and Exercise.

"Consistent attention to these four concepts,” says Lois, “enables one to take control and stay in control of diabetes, and to have a full, rewarding life."  

Richard Clark, Jr. is assistant editor of Connected.

Sources for more information:
ADA: www.diabetes.org 
CDC (has BMI calculator): www.cdc.gov
National Diabetes Education Program (also in Spanish): www.diabetes.niddk.nih.gov/dm/ez.asp
WHO: www.who.int/en