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This document discusses the challenges and progress in diabetes treatment and research. Some key points:
- Diabetes rates are increasing worldwide, with 1 in 3 babies born in 2000 projected to develop it.
- While type 2 diabetes prevention is possible, there is no prevention or cure for type 1 diabetes currently.
- Improved care and understanding of diabetes science has reduced complications, but better translation of research into practice is still needed.
- Recent decades have seen significant progress, including ways to delay or prevent type 2 diabetes through lifestyle changes. Medication and care approaches are also more effective at controlling blood sugar and reducing health risks.
- However, diabetes management remains complex and further improvements are still needed to make progress accessible to
This document discusses the challenges and progress in diabetes treatment and research. Some key points:
- Diabetes rates are increasing worldwide, with 1 in 3 babies born in 2000 projected to develop it.
- While type 2 diabetes prevention is possible, there is no prevention or cure for type 1 diabetes currently.
- Improved care and understanding of diabetes science has reduced complications, but better translation of research into practice is still needed.
- Recent decades have seen significant progress, including ways to delay or prevent type 2 diabetes through lifestyle changes. Medication and care approaches are also more effective at controlling blood sugar and reducing health risks.
- However, diabetes management remains complex and further improvements are still needed to make progress accessible to
This document discusses the challenges and progress in diabetes treatment and research. Some key points:
- Diabetes rates are increasing worldwide, with 1 in 3 babies born in 2000 projected to develop it.
- While type 2 diabetes prevention is possible, there is no prevention or cure for type 1 diabetes currently.
- Improved care and understanding of diabetes science has reduced complications, but better translation of research into practice is still needed.
- Recent decades have seen significant progress, including ways to delay or prevent type 2 diabetes through lifestyle changes. Medication and care approaches are also more effective at controlling blood sugar and reducing health risks.
- However, diabetes management remains complex and further improvements are still needed to make progress accessible to
We are learning a lot about diabetes especially during
the past five to ten years. This accumulation of new
knowledge is both encouraging and at the same time very challenging. On the "challenging'' side: Diabetes seems to be everywhere and steadily increasing in its presence. Think about it 1 in 3 babies born in 2000 will develop diabetes in their lifetimes. Every day, about 1,400 people are diagnosed with diabetes in the United States. And now no country in the world is free from diabetes, and its growth. We now do know how to prevent type 2 diabetes, but today for type 1 diabetes, neither prevention nor a long- lasting cure is available. Once diabetes is present, good care based on solid science now can prevent much of the devastation formerly caused by elevated blood sugars. But there remains a sizable gap between what we know to do and how well and widely we are doing it. In other words, the "translation" of diabetes science into daily practice still has a way to go. Nonetheless, in spite of these and other important challenges, we are all better prepared to deal with diabetes in 2007 than we were even a few years earlier, let alone decades ago. Remarkable progress has occurred. For example, many people at high risk for type 2 diabetes do not develop it. Modest weight loss and increased physical activity have been shown to eliminate or at least delay the development of this type of diabetes by 60-70 percent regardless ofrace, ethnicity, or age. In addition, for both types 1 and 2 diabetes, we now have many more effective medications which, when taken appropriately and in combination with proper nutrition and activity, will result in controlled plasma glucose, blood pressure, andblood fats with definite reduction in the likelihood of eye, kidney, nerve, and heart problems. In other words,while the goals of diabetes research still in large part should be prevention or cure, even now the devastation formerly caused by this condition does not have tohappen! Nowadays, too, we have better ways to follow and keep track of diabetes with improved health care systems, better educational programs, less painful self-monitoring of blood sugars, more quickly available and accurate glycosylated hemoglobin levels, ways to identify kidney problems early, and so forth. We can know what is going on! So, in fact, we are actually seeing an improvement in diabetes care in the United States, although not with all people and not yet to an ad equate level or fast enough. What does all this have to do with Dr. Bernstein and this edition of Diabetes Solution 7. As mentioned earlier, the rate of accumulation of new diabetes knowledge is quite remarkable and daunting. Yet Dr. Bernstein stays on top of it all. The care pattern for diabetes has be come much more complex and demanding, and Dr. Bernstein and his approach have proved equal to the challenge. In essence, diabetes is in many ways "less easy" than in the past for the patient or for his/her health care professional. There are lots of nutritional approaches to consider, lots of medications to be used in varying combination, and often less time within a busy office practice to make all these wonderful advances real and meaningful for people facing diabetes. This newly revised edition presents the advances in diabetes thinking and management with passion, compassion, caring, and conviction. Certainly, for some people, his approaches are not easy! But they do reflect evolving medical science as well as his personal experiences in managing his own diabetes. He does not ask anyone to do anything that he himself would not do, and for this I have respect and admiration. He is offering to persons challenged by the presence or risk of diabetes a way to be in charge of the disease. And he is ensuring that important advances in diabetes science get out there now to make a difference in people's lives. Take a look! Think about the ideas and suggestions they can further our mutual and ongoing effort to prevent, capture, and control this disease called diabetes. Estamos aprendendo muito sobre o diabetes - especialmente durante os ltimos cinco a dez anos. Essa acumulao de novos conhecimentos ao mesmo tempo encorajadora e ao mesmo tempo muito desafiadora. No lado "desafiador": A diabetes parece estar em toda parte e cresce constantemente em sua presena. Pense nisso - 1 em cada 3 bebs nascidos em 2000 desenvolvero diabetes em suas vidas. Todos os dias, cerca de 1.400 pessoas so diagnosticadas com diabetes nos Estados Unidos. E agora nenhum pas do mundo est livre de diabetes e seu crescimento. Sabemos agora como prevenir a diabetes tipo 2, mas hoje, para a diabetes tipo 1, nem a preveno nem uma cura duradoura esto disponveis. Uma vez que o diabetes est presente, o bom atendimento baseado em cincia slida agora pode prevenir grande parte da devastao causada anteriormente por acares elevados no sangue. Mas permanece uma grande diferena entre o que sabemos fazer e quo bem e amplamente estamos fazendo isso. Em outras palavras, a "traduo" da cincia do diabetes na prtica diria ainda tem um caminho a percorrer. No entanto, apesar destes e de outros desafios importantes, estamos todos melhor preparados para lidar com a diabetes em 2007 do que ramos at alguns anos antes, muito menos dcadas atrs. Registaram-se progressos notveis. Por exemplo, muitas pessoas em alto risco de diabetes tipo 2 no desenvolv-lo. Perda de peso modesta e aumento da atividade fsica foram mostrados para eliminar ou pelo menos atrasar o desenvolvimento deste tipo de diabetes em 60-70 por cento - independentemente da raa, etnia ou idade. Alm disso, para ambos os tipos 1 e 2 de diabetes, agora temos muitos mais medicamentos eficazes que, quando tomado adequadamente e em combinao com uma nutrio adequada e atividade, resultar em glicose plasmtica controlada, presso arterial e gordura sangunea - com reduo definitiva na Probabilidade de problemas nos olhos, rins, nervos e corao. Em outras palavras, enquanto os objetivos da pesquisa de diabetes ainda em grande parte deve ser preveno ou cura, mesmo agora a devastao causada anteriormente por esta condio no tem que acontecer! Hoje em dia, tambm, temos melhores maneiras de acompanhar e acompanhar o diabetes - com melhores sistemas de sade, melhores programas educacionais, menos auto-monitoramento doloroso de acares de sangue, mais rapidamente disponveis e precisos nveis de hemoglobina glicosilada, formas de identificar problemas renais precoces , e assim por diante. Podemos saber o que est acontecendo! Assim, na verdade, estamos realmente vendo uma melhora no cuidado do diabetes nos Estados Unidos, embora no com todas as pessoas e ainda no a um nvel ad equate ou rpido o suficiente. O que tudo isso tem a ver com Dr. Bernstein e esta edio de Diabetes Solution 7. Como mencionado anteriormente, a taxa de acumulao de novos conhecimentos de diabetes bastante notvel e assustador. No entanto, o Dr. Bernstein permanece no topo de tudo. O padro de cuidados para a diabetes tem sido muito mais complexo e exigente, eo Dr. Bernstein e sua abordagem tm se mostrado iguais ao desafio. Em essncia, o diabetes , em muitos aspectos, "menos fcil" do que no passado - para o paciente ou para o seu profissional de sade. H muitas abordagens nutricionais a considerar, muitos medicamentos a serem usados em diferentes combinaes, e muitas vezes menos tempo dentro de uma prtica de escritrio ocupado para fazer todos esses avanos maravilhosos reais e significativos para as pessoas que enfrentam diabetes. Esta edio recm-revista apresenta os avanos no pensamento e gesto do diabetes com paixo, compaixo, carinho e convico. Certamente, para algumas pessoas, suas abordagens no so fceis! Mas eles refletem a evoluo da cincia mdica, bem como suas experincias pessoais no controle de sua prpria diabetes. Ele no pede a ningum para fazer qualquer coisa que ele prprio no faria, e por isso tenho respeito e admirao. Ele est oferecendo a pessoas desafiadas pela presena ou risco de diabetes uma maneira de ser responsvel pela doena. E ele est garantindo que os avanos importantes na cincia do diabetes sair l agora para fazer a diferena na vida das pessoas. D uma olhada! Pense sobre as idias e sugestes - eles podem continuar o nosso esforo mtuo e contnuo para prevenir, capturar e controlar esta doena chamada diabetes.
I do not know of many diabeticswho developed the
illnessaround the time I did, in 1946, who are still alive. I know of none who do not suffer from active complications. The reality is, had I not taken charge of my diabetes, it's very unlikelythat I'd be aliveand ac tivetoday.Many myths surround diet and diabetes,and much of what is still considered by the average physician to be sensible nutritional advicefor diabeticscan, overthe long run, be fatal. I know, because conventional "wisdom" about diabetes almost killed me. I developed diabetesin 1946 at the ageof twelve, and for more than two decades I was an "ordinary" diabetic, dutifully followingdoctor's orders and leading the most normal life I could, giventhe limitations of my disease. Over the years, the complications from my diabetesbecame worse and worse, and like many diabeticsin similar circumstances, I faced a veryearlydeath.I was still alive, but the qualityof mylifewasn'tpar ticularly good. I have what is known as type 1, or insulin- dependent, diabetes, which usually begins in childhood (it's also called juvenile-onset diabetes). Type 1diabetics must take daily insulin injections just to stay alive. Backin the 1940s, whichwerevery much still the "dark ages"of di abetes treatment, I had to sterilize my needles and glass syringes by boiling them every day, and sharpen my needles with an abrasive stone. I used a test tube and an alcohol lamp (flame) to test my urine for sugar. Many of the tools the diabetic can take for granted today were scarcely dreamed of back then there was no such thing as a rapid, finger- stick blood sugar-measuring device, nor disposable in sulinsyringes. Still, eventoday, parents of type 1diabetics have to five with the same fear my parents lived with that something could go disastrously wrong and they couldtry to wakeup their childand discover him comatose, or worse. For any parent of a type 1diabetic, this hs been a real and constant possibility. Because of my chronically elevated blood sugar levels, and the inability to control them, my growth was stunted, as it is for many juvenile-onset diabetics evento this day. Back then, the medical community hadjustlearned aboutthe rela tionship between high blood cholesterol and vascular (blood vessel and heart) disease. It was thenwidely believed thatthe cause of high blood cholesterol was consumption of large amounts of fat. Since many diabetics, even children, have high cholesterol levels, physi cians were beginning to assume that the vascular complications of diabetes heart disease, kidney failure, blindness, et cetera were caused by the fat thatdiabetics were eating. Asaresult, I was put on a low-fat, high-carbohydrate diet (45 percent of calories were to be carbohydrates) before such diets were advocated by the American Diabetes Association or the American Heart Association. Because car bohydrate raises blood sugar, I had to compensate with very large doses of insulin, which I injected with a 10 cc"horse" syringe. These injections were slowand painful, andeventually they destroyed all the fatty tissue undertheskinof my thighs. Inspite of thelow-fat diet, my blood cholesterol became veryhigh. I developed visible signs of this state fatty growths on my eyelids andgray deposits around the iris ofeach eye. During my twenties andthirties, the primeof life for most people, manyof my body's systems began to deteriorate. I had excruciatingly painfulkidney stones,a stone in a salivary duct,"frozen"shoulders, a progressive deformity ofmy feet with impaired sensation, and more. I would point theseout to my diabetologist (whowas then president of the American Diabetes Association), but I was inevitably told,"Don't worry, it hasnothingto do with yourdiabetes. You're doing fine." But I wasn't doing fine. I now know thatmost of these problems are com monplace among those whose diabetes is poorlycontrolled, but then I was forcedto acceptmy condition as"normal." By this time I wasmarried. I had gone to college and trainedasan engineer. I had smallchildren, and eventhough I wasnot much more than akid myself, I feltlike an old man. I hadlost the hairon the lower parts of my legs, a sign that I had developed peripheral arterial dis-
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