Managing Diabetes

Karen Chambers, the director of product development for IMAN Cosmetics in New York City–and an ordained interfaith minister–had just finished her seminary thesis in May 2009, when her primary doctor called to tell her that she had diabetes. She was in disbelief. Chambers, then 41, had visited her physician for a routine checkup and believed feeling tired and over-extended was a natural result of managing both work and school. “I felt a bit lethargic but it’s kind of hard to tell whether that’s just life or something more serious,” says Chambers. “It absolutely shocked me. I was like, ‘Am I going to have to test my blood every day or stick my finger?’ ”

The South Orange, New Jersey, resident began treatment on Metformin, an oral diabetes medicine that helps control blood sugar levels, and uses a medical meter to monitor her daily concentration of sugar (glucose) in the blood. She was diagnosed with the most common form of the disease——type 2 diabetes, in which the body is insulin resistant or fails to use insulin properly. Although diabetes runs in both sides of her family, Chambers knew very little about the disease when she was diagnosed. And worse, her primary doctor was not much help. Her physician scheduled an appointment two days after the call, but had double-booked patients which allotted only 10 minutes to discuss the  diagnosis. During the short meeting, her doctor wrote her a prescription for medication, recommended a nutritionist, and suggested online research. Feeling angry and confused, Chambers stopped seeing her primary care physician for her diabetes and sought the advice of an endocrinologist, a nutritionist, and a friend who is also a chiropractor to learn how to cope with her disease. “I told her it’s not a death sentence, but a wake-up call,” says New Jersey-based chiropractor Paula Parker. “It’s a chance to do something different in your life.”

What Chambers learned is that diabetes is manageable for those who are proactive and disciplined about diet, physical activity, and overall health. “I asked myself, ‘How much do I love my body and how well am I going to treat it?’ ” says Chambers. Vanessa Jones Briscoe, a veteran diabetes educator and research assistant professor of medicine at the division of diabetes, endocrinology, and metabolism at Vanderbilt University Medical Center, concurs. “Whatever [people] do affects their blood sugar,” says Briscoe. “It’s a hard disease to live with, but through education people learn to manage and hopefully learn to avoid complications.”

A Critical Situation
Chambers is one of 3.7 million, or 15% of blacks aged 20 years or older who have been diagnosed with diabetes, according to the American Diabetes Association (www.diabetes.org). Most experts believe the cause of diabetes is both genetic and environmental. Once known as juvenile diabetes or insulin-dependent diabetes, type 1 is usually diagnosed in children and young adults. Type 1 is a chronic condition in which the pancreas, a gland behind the stomach, produces little or no insulin, a hormone that helps convert sugar into energy the body needs. The cause of type 1 is unknown, but experts know that in most cases a person’s immune system–which normally fights bacteria and viruses–destroys the insulin-producing (islet) cells in the pancreas. Normally, once a person eats, the pancreas secretes insulin into the bloodstream which helps to lower the amount of sugar in the blood flow. But with type 1 diabetes, there is no insulin to release sugar into the cells. Instead, sugar builds up in the bloodstream and can cause major complications. Type 1 has no cure, but with proper treatment can be manageable. Experts believe that genetics and exposure to certain viruses may be factors.

Type 2 diabetes, a far more common disease, occurs when the body has trouble metabolizing sugar–either the body does not produce enough insulin or the cells ignore the insulin. With type 2 diabetes, the islet cells function, but the pancreas doesn’t produce enough insulin so sugar builds up in the bloodstream, which can also cause major complications. The cause of type 2 is also unknown, but excess weight and inactivity are believed to play major factors. Similar to type 1, there is no cure for type 2; however, the disease can be managed or prevented with medication and a healthy lifestyle.

In total, there are nearly 24 million Americans, including children and adults, or 8% of the population diagnosed with diabetes. The ADA also estimates that of the 12 million or 11.2% of all men aged 20 years or older who have diabetes, nearly one-third of them don’t know they have the disease. In comparison, 11.5 million or 10.2% of all women aged 20 years or older have diabetes. Approximately one-quarter of them are unaware. Furthermore, the disease is two to four times higher among black, Latina, American Indian, and Asian/Pacific Islander women than white women. Even more staggering is that there are an estimated 57 million Americans who have pre-diabetes, a condition that occurs when a person’s blood glucose levels are higher than normal, but not high enough for a diagnosis of diabetes. If unchecked or untreated, pre-diabetes can eventually result in a diagnosis of the disease and increase a person’s risk of having heart disease and stroke. In fact, a person with diabetes is twice as likely to develop heart disease or suffer a stroke.

Briscoe often explains to patients that type 1 and type 2 diabetes can have devastating effects on the body. Both types present similar and severe complications that aside from heart disease and stroke include blindness, nerve damage, sexual dysfunction, and kidney disease. “People don’t take diabetes seriously. When you get complications, you can’t reverse them,” she explains. “People must make that connection in order to control the disease.”

Chambers refuses to call herself a diabetic. Instead, she says she is managing diabetes——and with great success. Within three months of her diagnosis, Chambers’ blood sugar dropped to a normal rate. Using the A1C test, which gauges glucose levels over two to three months by measuring what percentage of a person’s hemoglobin——a protein in red blood cells that carries oxygen——is coated with sugar, Chambers was able to see the results of changes in her diet and increased physical activity. Her A1C level went down from 8% to 6.3%. According to the ADA, a person who does not have diabetes has an A1C level of roughly 5%. Someone with a result between 6% and 6.5% is considered pre-diabetic. Anything above 7% is considered high and unhealthy. Levels can go as high as 25% if diabetes goes unmanaged for an extended period.

The Obesity Factor
Eating foods that are high in sugar and carbohydrates along with physical inactivity does not cause diabetes, but will contribute to obesity. Being overweight, particularly central obesity (fat around the abdomen and waist), is believed to be a major contributing factor to the disease. According to the U.S. Department of Health & Human Services, in 2007, African Americans, who are genetically predisposed to diabetes, were 1.4 times as likely to be obese as whites. In addition, African American women have the highest rates of being overweight or obese compared with other groups, with four out of five black females being overweight or obese. Unhealthy weight gain due to poor diet and lack of exercise is responsible for more than 300,000 deaths each year.

Obesity is increasingly becoming a problem, even for children. According to the American Academy of Child and Adolescent Psychiatry, between 16% and 33% of children and adolescents are obese and are more likely to become overweight adults unless they adopt and maintain healthier patterns of eating and exercise. According to the ADA, 186,300 children under the age of 20 have diabetes; 2 million, or one in six, overweight adolescents aged 12 to 19 have pre-diabetes.

Chambers admits weight control has been a challenge since her adolescence. She remembers kids calling her fat in school which made her retreat and become less physically active. Despite her parents’ efforts to help her lose weight with Weight Watchers and diet camps in her youth, as an adult, Chambers used food as a sedative to cope with life’s adversities, such as stress and the emotional pain of relationship breakups. Prior to her diagnosis, she admits to primarily eating foods that offered little or no nutritional value. Her nutritionist explained the importance of a balanced diet including more whole foods——foods with little or no refinement and processing, such as vegetables, fruits, and certain meats and poultry. “Moderation is key. If people control their serving size and eat in moderation, we wouldn’t have the obesity problems we have now,” asserts Briscoe. “But we’re just a super-sized generation that promotes overeating.”

Chambers also uses dance and yoga to help her keep the weight off. “I hate the gym,” she groans. “The whole, ‘no pain, no gain’ is not me. But I love dancing.” So she takes classes, including Zumba, a popular Latin aerobics dance, four times a week.  She even organizes group outings with her friends to various dance aerobics classes such as belly dancing. “It’s about making a have-to-do thing enjoyable,”  says Chambers.

The Everyday Battle
Chambers, now 42, believes when crisis strikes, it’s an invitation for people to step up. “I realize now that my body is not indestructible,” she says. “Life is shifting and I’m becoming more authentic, more open as a person.” Her spiritual practices of prayer and Reiki, a form of Japanese meditation, help her manage mood swings and emotional stresses that had previously driven her to comfort foods. Parker asserts that Chambers, like many professional women, is on the bottom of her very own to-do list. But since her diagnosis, Chambers says she has made her health a No. 1 priority. “It took me a long time to become overweight. If it’s a process to lose weight, I’m willing to do that [and] I don’t want to get discouraged,” says Chambers. “[Today] I feel different; I feel better physically.”

This article originally appeared in the November 2009 issue of Black Enterprise magazine.