Diabetes is a disease that is different from most other diseases for two important reasons. First, like hypertension, it can be a "silent killer." That is, there are few symptoms until late in the disease, at which time it is usually too late to reverse the damage. Because of this lack of symptoms, people with diabetes, and too often their physicians, do not give it a high priority. This is one of the reasons that diabetes is the leading cause of blindness in people less than 74 years of age, the leading cause of dialysis (using machines to replace kidney function), and the major reason for amputations of toes, feet, and legs. All of this need not happen if glucose levels in people with diabetes could be kept to near-normal levels.
Second, people with diabetes must be actively involved in its treatment. For almost all other diseases, doctors prescribe medicines and the only responsibility for the patient is to take them appropriately. Not so with diabetes. Patients must carefully watch their diet, exercise more often, measure their own glucoses in many cases, and keep appointments in which preventive tests (e.g., measurements of albumin leakage into the urine) and examinations (e.g., dilated eye exams by qualified ophthalmologists) are carried out — all of this when patients feel fine. Therefore, people with diabetes must know a lot about their disease to stay motivated and to be able to make appropriate decisions that would minimize bad outcomes from this disease.
Dr. Bryer-Ash's book, 100 Questions & Answers About Diabetes, should be very helpful in that regard. In addition to basic information about diabetes, it discusses topics not usually covered by more basic books for the public. These topics include discussions of potential cures for diabetes, prevention of diabetes, important information for family members and caregivers of people with diabetes; hints for developing a professional career in diabetes, for volunteering in diabetes, for advocating for diabetes causes, for developing support groups; critical information for participating in sports, for smoothing the experience of children in their school environments, and for travel across time zones. The book is written for the sophisticated reader. This audience will benefit immeasurably from reading Dr. Bryer-Ash's book and certainly will not feel "talked down to." Instead, with this information, they will be important members, indeed the most important members, of the team that is caring for their diabetes.
Mayer B. Davidson, MD
Professor of Medicine
Charles Drew University &
David Gejfen School of Medicine at UCLA
Past President, American Diabetes Association
I thank those who have given advice and assistance with this book, especially Dr. Mayer B. Davidson, who kindly reviewed the manuscript and gave many helpful suggestions, as he has done throughout my career. Jeffrey Hall, Janice Camino, and several of my patients contributed questions. Joann Jue provided administrative assistance. Michelle Dennison-Farris RD, CDE gave helpful advice on Questions 40 and 67 relating to nutrition and diet. I thank Dr. Keith G. Dawson for providing a superb clinical role model of a first-class diabetologist. Finally, I thank my family and loved ones for their patience and support. However, any omissions, oversights, or errors in this work are mine alone.
ONE . What Is Diabetes?
Why and how did I get diabetes?
What are the symptoms of diabetes?
Is there such a thing as borderline diabetes? What is it?
A lack or shortage, especially of something essential to health.
A hormone produced by the beta cells of the pancreas, which facilitates the entry of glucose and other substances into cells and which has several other functions.
A gland deep in the abdomen, behind the stomach, that produces hormones (insulin, glucagon) and digestive enzymes.
A basic sugar used to fuel body cells.
Type 1 diabetes
Characterized by an almost complete deficiency of insulin due to the immune system erroneously attacking and destroying the insulin-producing cells In the pancreas.