Posted on: Saturday, September 20, 2003
PRESCRIPTIONS
Pills, diet, exercise can lessen complication risks of diabetes
By Landis Lum
Q. Johnny Cash died recently from complications of diabetes. How can I prevent that from happening to me?
A. Jerry Garcia and Ella Fitzgerald had diabetes. Halle Berry collapsed into a diabetic coma while taping a sitcom, and is now a Juvenile Diabetes Association volunteer. You can reduce the risk of complications and feel good about yourself by taking charge of the following: Improve your blood sugars, take your pills daily, and get more fit.
Hate pills? Unnatural? The average person died at age 47 in 1900. Part of longer life in 2003 is from better sanitation, but part is from new drugs, too.
I tell my diabetics that taking pills will help them live longer as well as better (reduced misery from diabetes-caused stroke paralysis, kidney dialysis, blindness, and heart failure). Diabetes triples heart attack risk. If you smoke, quit.
High blood sugars damage the eyes, nerves, and kidneys. Nerve damage causes burning pain or numbness in the legs — you can't feel pain from infections, so they spread, leading to amputations.
To reduce these complications, learn to check your feet and home blood sugars daily; get blood sugar level to between 80 and 130 before meals. The hemoglobin A1c test averages your blood sugars over the past three months — get it less than 7.
See a nurse case manager or certified diabetic educator regularly. Get eye and foot exams annually, and see a dietician.
Get diabetes information at www.diabetes.org or www.medlineplus.gov. Regular exercise such as walking an extra 10 minutes three times a day and losing weight (even only 5 percent) if overweight are twice as powerful as drugs in reducing blood sugars.
Getting less than an hour of extra exercise a week doubles your chance of dying from heart attacks or strokes. Consider weight-loss surgery if you're over 90 pounds overweight.
If diet and exercise don't get blood sugars to goal within three months, start pills. Metformin causes less weight gain and reduces heart attacks 39 percent over diet alone. If pills don't work, start insulin shots.
Keep blood pressure less than 130 over 80. Diuretics and ACE-inhibitors such as Lisinopril or Accupril reduce strokes and heart disease better than calcium channel blockers such as Diltiazem or Amlodipine. Diabetics over 50 should be on an ACE-inhibitor, even with normal pressures. And those over 40 should be on a statin pill like Lovastatin, Pravastatin or Simvastatin to further reduce heart attacks, strokes, and bypass surgeries of the heart or legs, even with normal cholesterols. And at a high enough dose (40 mg a day for Lova or Simva). They're safe for your liver and kidneys, and don't cause tiredness or cancers.
And ask your doctor about starting aspirin. Take your 6 to 8 pills a day — so you can sing your song for many more years beyond 47.
Dr. Landis Lum is a family-practice physician for Kaiser Permanente and an associate clinical professor at the University of Hawai'i's John A. Burns School of Medicine. Send questions to Prescriptions, Island Life, The Advertiser, P.O. Box 3110, Honolulu, HI 96802; fax 535-8170; or email islandlife@honolulu advertiser.com.
