African Americans Living with Diabetes - Essay Example

African Americans and Diabetes Table of Contents Introduction Diabetes, a disease which alters the body’s capability to utilize glucose effectively, plays a significant role in the deaths of more than 200,000 Americans each year, six times the number in 1950. Diabetes is the fifth deadliest disease in the United States, and it has no cure. The total annual economic cost of diabetes in 2002 was estimated to be $132 billion, or one out of every 10 health care dollars spent in the United States. Increased risks of stroke and heart disease are associated with diabetes. “These life-threatening consequences strike people with diabetes more than twice as often as they do others” (American Diabetes Association, 2006). Further complications associated with diabetes include kidney disease, blindness, and the threat of amputations. This health concern currently affects about 16 million people in the United States with an estimated five million of those unaware of their condition and a disproportionate number being of African-American descent. The odds of African Americans contracting diabetes are estimated to be at least double the national average. This disparity is increasing every year and has become the most significant health concern for the African American community. Approximately one in eight African Americans has diabetes. More disturbingly, of those with diabetes, African Americans are more likely to develop associated complications and become disabled than are the white community, possibly as a result of escalating health care costs associated with diabetes treatment supplies. Further, “death rates for people with diabetes are 27 percent higher for African Americans compared with whites” (National Diabetes Information Clearinghouse, 2002). This paper first explains the cause of diabetes through an overview of its symptoms and who’s at risk, then delves deeply into diabetes from an African American perspective including the reasons for this racial imbalance, female-specific issues and the amplified ancillary effect that diabetes has on African Americans. It will also speak to how physical activity, calorie intake and obesity factor into the equation. Finally, a brief section is included that covers diagnosis and treatment of diabetes and will discuss preventative measures as well as proper diet and care for those afflicted with the disease. What causes diabetes? A primary factor in diabetes is the level of insulin present in the body. Insulin is a chemical the body produces naturally to manage the induction of glucose into the system. When the body produces too little amounts of insulin, greater amounts of glucose are allowed to enter the bloodstream thereby causing the symptoms of the disease called diabetes. Glucose, a simple sugar, enters the body by way of ingested food and into every red blood cell via the bloodstream; the cells then break down the glucose which acts to supply energy throughout the body. Brain cells, as well as other organs, are fueled by glucose alone. In diabetics, the body does not keep a stable amount of glucose in the cells. This means the body has more than the necessary glucose levels immediately after a meal but too little otherwise. To maintain a constant blood-glucose level, the healthy body produces glucagon and insulin, two hormones originating from the pancreas. Typically, there is balance of these hormones in the bloodstream with the insulin acting to prevent the concentration of blood-glucose from increasing disproportionately. Types and Risk Factors There are generally two types of diabetes that have been identified, differing primarily in the onset and cause and referred to as Type One and Type Two diabetes. Type One diabetes, or juvenile diabetes, is caused by the body’s inability to produce insulin. Occurring primarily in children, this type afflicts less than 10 percent of all diabetics. Type Two refers to ‘non-insulin-dependent’ or ‘adult-onset diabetes’ and describes the condition in which the body manufactures insulin but cannot process it. More than 90 percent of diabetics suffer this type which normally afflicts those over 40 years of age. “Type Two diabetics have an abnormal glucose-tolerance test and higher than normal levels of insulin in their blood” (Freudenrich, 2002). The immune system, the environment and genetics are factors that influence Type One diabetes but the risk factors are more clearly defined for Type Two diabetes. These include obesity, physical inactivity, elderly people, family history of diabetes, a past history of gestational diabetes and those with a weakened tolerance for glucose. Ethnicity is another risk factor. “African Americans, Hispanic/Latino Americans, American Indians, and some Asian Americans and Pacific Islanders are at particularly high risk for Type Two diabetes” (American Diabetes Association, 2006). Symptoms Diabetics display numerous symptoms including “excessive thirst (polydipsia), frequent urination (polyuria), extreme hunger or constant eating (polyphagia), unexplained weight loss, presence of glucose in the urine (glycosuria), tiredness or fatigue, changes in vision, numbness or tingling in the extremities (hands, feet), slow-healing wounds or sores and abnormally high frequency of infection” (Freudenrich, 2002). These various symptoms are common to both forms of diabetes. However, patients are not necessarily subject to all of the signs mentioned. African Americans and Diabetes Racial imbalance of Diabetes Although about 33 percent of people with the illness are unaware of their condition, nearly three million or almost 12 percent of the African American population over 20 years of age suffer with symptoms of diabetes.  Because of this, African Americans have been identified as being at greater risk than those of Anglo descent to suffer macro-vascular problems such as strokes and heart disease. “African Americans are 1.6 times more likely to have diabetes than non-Latino whites. Twenty-five percent of African Americans between the ages of 65 and 74 have diabetes” (American Diabetes Association, 2006) The disproportionate gap that exists between the African American population and others regarding diabetes continues to widen. “National health surveys during the past 35 years show that the percentage of the African American population that has been diagnosed with diabetes is increasing dramatically” (Tull & Roseman, 1995). In a thorough investigative study conducted from 1976 to 1980, the total prevalence of diabetes was less than nine percent in African Americans aged 40 to 75. Another similar study conducted between 1988 and 1994 showed that this number had increased two-fold to more than 18 percent while in the white community the rate rose only slightly to just over ten percent. “Prevalence in African Americans is much higher than in white Americans” (Harris et al, 1998). Reasons for Imbalance Research has suggested that African immigrants and African Americans have an inherited ‘thrifty gene’ derived from an evolutionary adaptation of their common ancestors. For many thousands of years, this ‘thrifty’ gene permitted Africans to use energy derived from food with greater efficiency in times of famine when food sources were sparse. This gene that facilitated survival for generations of Africans is unneeded in the developed world and is causing an imbalance in glucose levels causing diabetes and interferes with proper weight regulation which exacerbates the disease and leads to other complications. “This genetic predisposition, along with impaired glucose tolerance (IGT), often occurs together with the genetic tendency toward high blood pressure” (“Diabetes?”, 2000). African American Women and Diabetes Women in general and African American women in particular who have contracted this form of diabetes find themselves at a higher risk for developing Type Two diabetes later in life. African Americans and those with a family history of diabetes also experience a greater chance of contracting gestational diabetes than do those of other life classifications. “One in four African American women over 55 years of age has diabetes” (American Diabetes Association, 2006). Gestational diabetes is similar to Type Two diabetes and can arise in all categories of women who are pregnant. Studies have confirmed that nearly all women with a history of gestational diabetes have about a 40 percent chance of developing diabetes in the future. “Other specific types of diabetes, which may account for one to two percent of all diagnosed cases, result from specific genetic syndromes, surgery, drugs, malnutrition, infections, and other illnesses” (National Center for Chronic Disease Prevention and Health Promotion, 2005). Women with gestational diabetes experience an abnormal tolerance to glucose and have somewhat elevated insulin levels. While pregnant, the effects of insulin are blocked by various hormones which act to desensitize the patient to the insulin her body produces. This form of diabetes can be effectively treated by supplemental insulin injections and by submitting to specialized diets. Normally, the symptoms of gestational diabetes do not continue in the woman following the birth of the baby. Obesity Factors African Americans have been proven to have a high obesity rate but researchers don’t think that being overweight necessarily heightens the chance of contracting diabetes. However, the ancillary effects of the disease tend to be more pronounced in those that are considered obese. Unfortunately for African Americans, the ‘thrifty’ gene causes both weight gains and diabetes. Despite the biological impediments that cannot be altered, African Americans can take measures to combat this genetic predisposition. Those African American diabetics who are overweight when they begin the nutritional program may require more initial calories until their weight drops to a more normal level. The reasoning is that too rapid of a weight loss can be very unhealthy and it takes additional calorie intake to sustain a larger body frame. Gender also plays a role in determining a proper program as males generally possess a greater muscle mass than females and consequently may require a higher intake of calories. Because muscle uses up more calories per hour than does fat, people who are not physically active will have less need for caloric intake, a good reason for everyone, and especially those with diabetes, to exercise regularly and build-up muscle mass. In other words, if you like to eat, supplement it with proportional amounts of exercise. There are different theories regarding the most effective diet but the fact that diet is very important in controlling the symptoms of diabetes is indisputable (American Diabetes Association, 2006). Physical Activity/Calorie Intake It has been proven that regularly engaging in physical activities provides a protective barrier against diabetes and, on the contrary, the lack of activity increases the risk for contracting diabetes. Researchers have also shown that African Americans, by percentage, are lacking in their amount of physical exercise which is a contributing factor in the higher rate of diabetes among African Americans. “In the NHANES III survey, 50 percent of African American men and 67 percent of African American women reported that they participated in little or no leisure time physical activity” (Crespo et al, 1996). A Type One diabetes patient’s diet should include about 16 calories per pound of their individual body weight per day or about 35 calories per kg of body weight. Type Two diabetes patients are commonly regimented to a 1500 to1800 calorie diet per day. This is to control obesity issues and to maintain an ideal body mass. These numbers, of course, vary somewhat depending on the patient’s gender and age along with their current weight and body type and their level of physical activity (American Diabetes Association, 2006). In addition, a diabetic’s daily calorie intake, generally speaking, should consist of 40 to 60 percent carbohydrates because the lower the carbohydrate intake, the lower levels of sugar enters the bloodstream. The advantages associated with carbohydrate intake are negated by the patient’s intake of foods that are high in fat. This dilemma can be improved upon by the substitution of polyunsaturated and monounsaturated fats for saturated fats. “Most people with diabetes find that it is quite helpful to sit down with a dietician or nutritionist for a consultation about what is the best diet for them and how many daily calories they need. It is quite important for diabetics to understand the principles of carbohydrate counting and how to help control blood sugar levels through proper diet” (Norman & Politz, 2006). Ancillary Affects of Diabetes on African Americans In addition to experiencing higher rates of diabetes occurrences, African Americans experience higher rates of complications associated with diabetes such as limb amputations, kidney failure and eye disease as compared to white Americans. Additionally, African Americans that have diabetes, by percentage, suffer a greater number of disabilities that are a product of those complications as compared to white Americans. Of course many factors ultimately have influence on the occurrence of diabetes-related complications such as high blood pressure, smoking cigarettes and high blood glucose levels, all of which can be controlled by the diabetic. Amputations In one year alone, more than 13,000 African Americans must have a limb amputated because of complications related to diabetes and this number grows every year according to a survey of U.S. hospitals. This involves hospital stays numbering over 150,000 days each year for African American diabetics who are more probable to endure an amputation than white Americans. In the year of the study, “the hospitalization rate of amputations for African Americans was 9.3 per 1,000 patients, compared with 5.8 per 1,000 white diabetic patients” (Geiss, 1997). An interesting side-note to the study was that the average hospital stay of African Americans undergoing amputation (12 days) was lower than white Americans who averaged more than 16 days in the hospital following surgery. Kidney Failure African Americans afflicted with diabetes experience four times the rate of end-stage renal disease (ESRD), which is the medical terminology that describes kidney failure, than do white American diabetics. Yearly, close to 30,000 diabetic African Americans are treated for ESRD. Diabetes has been identified as the primary cause of kidney failure and hypertension runs a close second. The two combined account for more than 90 percent of such cases. The good news for African Americans is though they suffer these illnesses at higher rates, they also enjoy a higher rate of survival following kidney failure than do other American ethnic groups (Cowie et al, 1998). Eye Disease Persistent high blood glucose levels cause diabetic retinopathy which describes the deterioration of the eye’s blood, a condition that leads to weakened vision and, eventually, blindness. According to current scientific data, “the frequency of diabetic retinopathy is 40 percent to 50 percent higher in African Americans than in white Americans. Retinopathy may also occur more frequently in African Americans than in whites because of their higher rate of hypertension” (Harris et al, 1996). While blindness brought about from a diabetic retinopathy condition is thought to occur at a higher rate among African Americans than in white Americans, no credible studies exist that evaluates the rate of blindness between the two races when diabetes had been taken into account. Death Rate of Diabetes in African Americans A century ago, diabetes was not a common cause of death among African Americans. It is now the seventh leading cause of death for the American population overall and, for African Americans over 45 years of age, diabetes ranks as the fifth leading cause of death. The mortality rate for diabetics is unsurprisingly higher in the African American community than for the white population. “The overall mortality rate was 20 percent higher for African American men and 40 percent higher for African American women, compared with their white counterparts” (Geiss, 1997). Diagnosis and Treatment An A1C test measures the level of glucose in blood cells. The diabetic who has not received treatment may show levels as high as 10 percent while a person not afflicted with the disease generally tests at close to five percent. As previously discussed, the lack of insulin production allows higher levels of glucose in cells. High levels of blood glucose (or sugar in the bloodstream) lead to various diabetic related health complications if allowed to go unchecked (Becton & Dickinson, 2006). According to the Florida Department of Health, the proper management of glucose in the bloodstream benefits people with both type of diabetes. “For every one point reduction in A1C, the risk for developing micro-vascular complications (eye, kidney and nerve disease) decreases by up to 40 percent. Blood pressure control can reduce cardiovascular disease (heart disease and stroke) by 33 to 50 percent and can reduce micro-vascular disease (eye, kidney and nerve disease) by approximately 33 percent. Improved control of cholesterol and lipids (e.g. HDL, LDL, and triglycerides) can reduce cardiovascular complications by 20 to 50 percent. Detection and treatment of diabetic eye disease with laser therapy can reduce the development of severe vision loss by an estimated 50 to 60 percent. Comprehensive foot care programs can reduce amputation rates by 45 to 85 percent.” (“Prevention of Diabetes”, 2003). Proper weight control, increased activity and not smoking should also coincide with regular visits to the doctor in order to better regulate blood pressure, glucose and cholesterol levels. The patient would be best served if they form a team-like relationship with their health care professionals. “Because people with diabetes have a multi-system chronic disease, they are best monitored and managed by highly skilled health care professionals trained with the latest information on diabetes to help ensure early detection and appropriate treatment of the serious complications of the disease” (American Diabetes Association, 2006). Conclusion While there is no known cure for the disease, diabetes can be managed effectively with proper treatment. “The key to treating diabetes is to closely monitor and manage your blood-glucose levels through exercise, diet and medications” (Freudenrich, 2006). The type of diabetes dictates the type of treatments to be followed. Type One diabetics must examine their blood-glucose levels many times per day and inject insulin accordingly, usually at mealtime so as to help manage the glucose being ingested. The supplementation of insulin assures that blood glucose levels maintain stability. Type Two diabetics have the ability to control the disease through personal lifestyle decisions such as the loss of weight, exercising more and not smoking at all. In severe instances, medication may need to be given to control glucose levels. Diabetics are able to significantly decrease the risks of complications due to the disease if they are willing to educate themselves then apply that knowledge to their daily lives. Lack of medical insurance, genetics and lifestyle habits contribute to a higher rate of diabetes in African Americans who are about twice more likely to contract the condition than other ethnicities. Until genetic science advances to the point to where the ‘thrifty’ gene can be manipulated or eliminated, improved access to medical care and education is the best method to combat the ethnic imbalance of diabetes. References American Diabetes Association. (2006). “Diabetes Statistics for African Americans.” All About Diabetes. American Diabetes Association. Retrieved March 25, 2007 from Becton & Dickinson. (2006). “Hemoglobin A1c Testing.” BD Diabetes. Retrieved March 25, 2007 from Cowie, C.C.; Port, F.K.; Wolfe, R.A.; Savage, P.J.; Moll, P.P.; Hawthorne, V.M. (1989). “Disparities in Incidence of Diabetic End-stage Renal Disease by Race and Type of Diabetes.” New England Journal of Medicine. Vol. 321, pp. 1074-1079. Crespo, C.J.; Keteyian, S.J.; Heath, G.W.; Sempos, C.T. (1996). “Leisure-time Physical Activity Among US Adults.” Archives of Internal Medicine. Vol. 156, pp. 93-98. “Diabetes in African Americans?” (2000). BlackHealthCare.com. Retrieved March 25, 2007 from Freudenrich, Craig. (2006). “How Diabetes Works.” How Stuff Works. Retrieved March 25, 2007 from Geiss, L.S. (Ed.). (1997). Diabetes Surveillance. Atlanta: Centers for Disease Control and Prevention. Harris, M.I.; Flegal, K.M.; Cowie, C.C. et al. (1998). “Prevalence of Diabetes, Impaired Fasting Glucose, and Impaired Glucose Tolerance in US Adults: The Third National Health and Nutrition Examination Survey, 1988-94.” Diabetes Care. Vol. 21, pp. 518-524. National Center for Chronic Disease Prevention and Health Promotion. (January 31, 2005). “Basics About Diabetes.” Diabetes Public Health Resource. Center for Disease Control. Retrieved March 25, 2007 from National Diabetes Information Clearinghouse. (2002). “National Diabetes Statistics Fact Sheet.” National Institutes of Health publication 02-3892. Available March 25, 2007 from Norman, James & Politz, Douglas. (June 26, 2006). “The Diabetes Center.” EndocrineWeb. Norman Parathyroid Surgery Clinic. Retrieved March 25, 2007 from “Prevention of Diabetes.” (2003). Florida Department of Health. State of Florida. Retrieved March 25, 2007 from Tull, E.S. & Roseman, J.M. (1995). “Chapter 31: Diabetes in African Americans.” Diabetes in America. (2nd Ed.). National Institutes of Health publication 95-1468. Bethesda, MD: National Institute of Diabetes and Digstive and Kidney Diseases, National Institutes of Health, pp. 613-630. Read More