DIABETES. Spotlight on... What is Diabetes? A NEWSBRIEF OF THE ENTERTAINMENT INDUSTRIES COUNCIL, INC. NO. 28. In This Issue:

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1 A NEWSBRIEF OF THE ENTERTAINMENT INDUSTRIES COUNCIL, INC. NO. 28 Spotlight on... DIABETES In This Issue: What are the Scope and Impact of Diabetes?... 2 dlifetv: Making a Difference for TV Audiences... 2 How is Diabetes Treated?... 3 New Advances Help People Live with Diabetes... 3 First Draft Technical Assistance... 4 Diabetes Glossary... 5 According to the National Institutes of Health (NIH), nearly 21 million Americans 7% of the population have diabetes. Of those, about 6.2 million people have not yet been diagnosed because there are no symptoms in the early stages of the disease (National Institute of Diabetes and Digestive and Kidney Diseases, 2006). As we can see above, our industry is not invulnerable to diabetes. Scientific researchers have knowledge of what causes diabetes, and how to prevent and treat it but most of the public, unless directly affected, knows very little. This is something our industry can change. By depicting diabetes onscreen and showing the importance of prevention, diagnosis and treatment options, the entertainment industry can help influence public opinion and help tear down the stigmas associated with the disease, which many people associate only with unhealthy lifestyles. DEPICTION SUGGESTION: New medications administered through inhalers make it possible to treat conditions such as diabetes and the flu virus without suffering the pain of a needle piercing the skin. Consider showing patients who might otherwise suffer from their fear of needles benefiting from new such medications. Editor in Chief: Brian Dyak Editors: David Michael Conner Larry Deutchman Marie Gallo Dyak Steven Edelman, M.D. Paula Ford-Martin, Author, The Everything Diabetes Book Writers: Jane Kim John Duckwitz Design & Production: Output Printing & Graphics Spotlight on...diabetes is a publication of the Entertainment Industries Council, Inc., with support from Pfi zer Inc What is Diabetes? Diabetes is a disease in which the body is unable to produce or unable to properly use and store glucose (a form of sugar). Glucose accumulates in the bloodstream causing one s blood glucose (sometimes referred to as blood sugar) to rise too high. Chronic high blood glucose levels can affect most organs in the body, especially the eyes, kidneys, nerves and blood vessels. Type 1 and Type 2 Diabetes There are two major types of diabetes. In type 1 (formerly called juvenile-onset or insulindependent) diabetes, the body completely stops producing any insulin, a hormone that is normally produced by the pancreas and enables the body to use glucose found in foods for energy. People with type 1 diabetes must take daily insulin injections to survive. This form of diabetes usually develops in children or young adults, but can occur at any age. Type 2 (formerly called adult-onset or non insulin-dependent) diabetes results when the body doesn t produce enough insulin and/or is unable to use insulin properly (insulin resistance). This form of diabetes usually occurs in people who are over 40, overweight, and have a family history of diabetes, although today it is increasingly occurring in younger people, particularly adolescents. For more information, go to Continues on page 2

2 What are the scope and impact of diabetes? Diabetes is widely recognized as one of the leading causes of death and disability in the United States. However, diabetes is likely to be underreported as the underlying cause of death on death certificates. About 65 percent of deaths among those with diabetes are attributed to heart disease and stroke. Diabetes is associated with long-term complications that affect almost every part of the body. The disease can lead to blindness, heart and blood vessel disease, stroke, kidney failure, nerve damage, and amputations. Uncontrolled diabetes can complicate pregnancy and cause birth defects and/or macrosomia (fetal weight of over 4500 g). Diabetes cost the United States $132 billion in 2002 (the most recent figure available), according to the National Diabetes Information Clearinghouse. Indirect costs, including disability payments, time lost from work, and premature death, totaled $40 billion; direct medical costs for diabetes care, including hospitalizations, medical care, and treatment supplies, totaled $92 billion. This is not to mention the emotional and physical pain that diabetes can cause to the person living with the disease and his or her loved ones. Minorities are at the greatest risk of having diabetes. Continued from page 1 People with diabetes frequently experience certain symptoms. These include: Being very thirsty Frequent urination Weight loss Increased hunger Blurry vision Irritability Tingling or numbness in the hands or feet Frequent skin, bladder or gum infections Wounds that don t heal Extreme unexplained fatigue It is very important to note that many or all of these symptoms may be absent in the early stages of type 2 diabetes, which is why screening is so vital. Diabetes can occur in anyone. However, people who have close relatives with the disease are somewhat more likely to develop it. Other risk factors include obesity, high cholesterol, high blood pressure, and physical inactivity. The risk of developing diabetes also increases as people grow older. People who are over 40 and overweight are more likely to develop diabetes, although the incidence of type 2 diabetes in adolescents is growing. Diabetes has higher incidence rates among Native Americans, African Americans, Hispanic Americans and Asian Americans/Pacific Islanders. Also, people who develop diabetes while pregnant (a condition called gestational diabetes) are more likely to develop full-blown diabetes later in life. Poorly managed diabetes can lead to a host of long-term complications among these are heart attacks, strokes, blindness, kidney failure, and blood vessel disease that may lead to a stroke or heart attack, nerve damage that could lead to amputations, and sexual dysfunction in men and women. Type 2 diabetes is associated with older age, obesity, family history of diabetes, previous history of gestational diabetes, physical inactivity, and ethnicity. About 85 percent of people with type 2 diabetes are overweight. However, people of normal weight can also develop type 2 diabetes, and family history of the disease plays a larger role in the development of type 2 diabetes than in the development of type 1 diabetes. Gestational Diabetes Gestational diabetes develops only during pregnancy. Like type 2 diabetes, it occurs more often in African Americans, Native Americans, Hispanic Americans, and among women with a family history of diabetes. Women who have had gestational diabetes have a 20 to 50 percent chance of developing type 2 diabetes within 5 to 10 years. dlifetv: Making a Difference for TV Audiences dlifetv is the fi rst of its kind a television series dedicated to empowering the millions of Americans living with diabetes. dlifetv brings leading experts, timely medical information, inspirational stories, and recipes for healthy food right to your television screen. Each week, dlifetv delivers the latest in diabetes research and treatment advances in an entertaining and in-depth format. Viewers learn about new diabetes therapies and products, watch delicious diabetic dishes take shape in the dlife kitchen, get practical management tips from experts, and hear inspirational stories of real people with real stories about living with diabetes. dlife airs on CNBC and CoLours TV. Taking education seriously, dlife is more than just a television show. DLife.com is a thriving and growing online community for people with diabetes and anyone looking for diabetes information and resources. For more information, go to 2

3 How is Diabetes Treated? Before the discovery of insulin in 1921, a starvation diet was the only available treatment for type 1 diabetes, and everyone with the disease typically died within a few years after diagnosis. Although insulin is not considered a cure, its discovery was the first major breakthrough in diabetes treatment. Today, healthy eating, physical activity, and taking insulin via injection or an insulin pump are the basic therapies for type 1 diabetes. The amount of insulin must be balanced with food intake and daily activities. Blood glucose levels must be closely monitored through frequent blood glucose checking. Some people with type 1 diabetes may also supplement their treatment with an injectable drug that is taken at mealtime along with insulin. Healthy eating, physical activity, and blood glucose testing are the basic management tools for type 2 diabetes. In addition, many people with type 2 diabetes require oral medication, insulin and/or complementary therapies to control their blood glucose levels. Percent Prevalence of diagnosed diabetes in people aged 20 years or older, by age and race/ethnicity United States, Non-Hispanic whites Hispanic/Latino Americans Non-Hispanic blacks Source: National Health Interview Survey estimates projected to 2002 and 2002 outpatient database of the Indian Health Service. American Indians/Alaska Natives New Advances Help People Live With Diabetes Researchers continue to seek innovative ways to address diabetes. Recent advances in knowledge, medicine and technology are providing people with more options in the management of the disease and its complications. Among the options, new forms of insulin may help patients manage their diabetes without injections. An inhaled form of insulin, for example, will be available this year for adult patients who need mealtime insulin. Although, injections of insulin in conjunction with the inhaler or antidiabetes pills may still be needed in some patients. A new class of drugs, incretin mimetics, could also help with blood sugar control for adult type 2 diabetes patients. For some people, external insulin pumps have replaced the need for daily injections and implantable insulin pumps are also in development. And, although outcomes may be decades off, research is underway on cell transplants, gene therapy, and even a vaccine to combat and ultimately prevent the disease. As with all disorders, no existing course of treatment should be changed without consulting a physician. Any person experiencing diabetic symptoms should consult a physician immediately. Under no circumstances should a person self-diagnose diabetes or attempt treatment without the supervision of a doctor. DEPICTION SUGGESTION: Diabetes used to be a death sentence, much like HIV and AIDS were in the 1980s. Consider showing how older people might react to news that a loved one has diabetes versus younger people, who might not take the threat seriously enough. This could be particularly important for period pieces set before DEPICTION SUGGESTION: Many of the symptoms of diabetes can be easily missed. Consider showing how often-overlooked symptoms can become noticeable when many of them begin to present themselves at the same time. DEPICTION SUGGESTION: Type 2 diabetes is greatly affected by lifestyle choices, especially diet and exercise. Consider showing your characters motivations to exercise and eat well to be influenced more by health than a desire to look good. With so many Americans affected, many of us have family histories to keep in mind when deciding how much exercise to get and how to eat; your characters may have family histories of diabetes, as well, even if they don t have it themselves. 3

4 Age-adjusted total prevalence of diabetes in people aged 20 years or older, by race/ethnicity United States, 2002 American Indians/Alaska Natives Hispanic/Latino Americans Non-Hispanic blacks Non-Hispanic whites Percent Source: National Health Interview Survey and National Health and Nutrition Examination Survey estimates projected to 2002 and 2002 outpatient database of the Indian Health Service. Complications of Diabetes Most people don t realize that uncontrolled diabetes can bring about terrible complications in virtually every system of the body. These include: Cardiovascular disease Neuropathy/nerve damage and Diabetic Nerve Pain Eye disease Sexual dysfunction in both women and men Kidney disease Periodontal disease Hypertension Skin and wound infections The good news is that with tight blood sugar control, people with diabetes can greatly reduce their risk of these diabetic complications. Go to for more information on the complications listed above. Nearly half of the estimated 21 million Americans with diabetes will develop some form of neuropathy over the course of their disease. At any given time, about 15 percent of diabetics (or nearly 3 million people) experience diabetic nerve pain. Diabetic nerve pain symptoms can be controlled, but not reversed, through various medical treatments including medication, physical rehabilitation, biofeedback, cognitive behavioral therapy and acupuncture (American Diabetes Association, 2006). Distinguished Experts First-Hand Accounts Script Feedback Questions Answered Searchable Online Database Research Assistance Tailored Briefings Phone or Face-to-Face Consultation the source to turn to for free research-based, factbased, or anecdotal information on a myriad of health or social issues when you need it, where you need it, how you need it. Here are just a few of the issues First Draft can help you with: Diabetes Drugs Alcohol Tobacco Addiction Prevention Treatment Recovery Bipolar Disorder Mental Health Suicide Aging Humor & Healing Gun Violence Firearm Safety Injury Prevention Conflict Resolution Body Image Skin Cancer Sun Safety Human Trafficking Terrorism Homeland Security Disaster Preparedness (West Coast) (East Coast) firstdraft@eiconline.org For more information, go to 4

5 Diabetes Glossary: Glossary A1c (or HbA1c) - a blood test that measures the amount of glycated hemoglobin in the bloodstream over a 120-day period (shorthand: a three month blood glucose average). Glycated hemoglobin is produced when excess glucose attaches itself to hemoglobin (red blood cells). A high percentage of glycated hemoglobin indicates problems with long-term blood sugar control. Blood glucose (or just glucose) - a type of sugar that is created when the carbohydrate that one eats is broken down in the body. During digestion, glucose passes through the wall of the intestine into the bloodstream to the liver and eventually into the general circulation. From there glucose can then enter individual cells or tissues throughout the body to be used for fuel and provide energy. The liver also manufactures glucose. Blood glucose meter (or monitor) - a testing device used by people with both type 1 and type 2 diabetes to check their blood sugar levels. People with type 1 diabetes use their monitor results to adjust their insulin dose. Testing can and should be done frequently at waking and bedtime, before and after meals, before and after exercise, and during times of stress and illness. Blood pressure - the pressure against the walls of your blood vessels. High blood pressure is more common in persons with diabetes and increases the risk of stroke, heart attack, kidney and eye diseases. It should be measured at every doctor visit, or at least once a year, with a goal of 130/80 mm Hg or lower. Many diabetic people have home BP monitoring devices. Carbohydrate - the main source of fuel for the body. Carbohydrate includes starches and sugars and are found in bread, pasta, fruits, vegetables, milk, and sweets. Carbs are broken down into a sugar called glucose. Controlling carb intake is one of the primary dietary treatment methods of controlling blood sugar levels in people with diabetes. Endocrinologist - a doctor who specializes in diseases of the endocrine system such as diabetes. Fructosamine test - a blood test that can detect overall changes in blood glucose control over a shorter time-span than the A1c test. Fructosamine levels indicate the level of blood glucose control over the past two or three weeks. Thus, when rapid changes are being made in your diabetes treatment plan, this test quickly tells you how the changes are working and whether other changes should be considered. Fructosamine is commonly used to follow women with gestational diabetes. Glucose - a simple form of sugar that is created when the body s digestive processes break down the food we eat. Glucose is the body s main source of energy. (see also Blood glucose ) Glycemic index (GI) - a system of ranking foods containing equal amounts of carbohydrate according to how much and how fast they raise blood glucose levels. For instance, the carbohydrate in a slice of 100% stone-ground whole wheat bread (a low glycemic index food) may have less impact on blood glucose than a slice of processed white bread (a high glycemic index food). The GI can be an additional meal-planning tool to help one understand how carbohydrate foods can differ in their effects on blood glucose. [NOTE: research is mixed on validity of GI in diabetes care.] 5

6 Hyperglycemia - high blood glucose levels. Blood glucose is generally considered high or abnormal when it is 110 mg/dl or higher when fasting or 140 mg/dl or higher two hours postprandial (or after meal). These are American Association of Clinical Endocrinologists (AACE) guidelines the American Diabetes Association suggests slightly higher goals. It s important to note that each person will have his or her own individual blood glucose targets. Hypoglycemia - a blood sugar low; characterized by blood glucose levels below 80 mg/dl with or without symptoms or below 90 mg/dl with symptoms. Symptoms of hypoglycemia include shakiness, dizziness, sweating, heart palpitations, and mental confusion. Also sometimes called an insulin reaction (because it can be caused by taking too much insulin). This can also be caused by not having eaten enough food or unanticipated exercise. Hypertension - high blood pressure (blood flows through the blood vessels with a greater-than-normal force) which is defi ned as blood pressure equal to or greater than 130/85 mm Hg and affects a high proportion of adults with diabetes. It increases one s risk of heart attack, stroke and kidney problems. Insulin - a hormone made in the pancreas that helps glucose pass into the cells where it is used to create energy for the body. Ketones - acids produced due to lack of enough insulin to use the glucose in your bloodstream. Your body turns to its fat stores for energy. When this occurs, ketones are produced, which accumulate in the blood and spill into the urine. These ketones are made when fat is metabolized as a source of energy. The excessive formation of ketones in the blood is called ketosis, and the presence of ketones in the urine is called ketonuria. Allowed to go untreated, the combination of high blood glucose and ketones can lead to ketoacidosis (also called DKA, and sometimes referred to as diabetic coma ). This occurs mainly in people with type 1 diabetes. Pre-diabetes - a condition in which either your fasting or two-hour post-meal blood glucose levels are higher than normal, but not high enough for a diagnosis of type 2 diabetes. Studies show that most people with pre-diabetes will develop type 2 diabetes within 10 years if they don t change their lifestyle. They also have a higher risk of developing cardiovascular disease. The U.S. Department of Health and Human Services (DHHS) and the American Diabetes Association (ADA) estimate that 41 million Americans between the ages of 40 to 74 are living with pre-diabetes, and most remain unaware of their condition. Spotlight on...diabetes works cited: Allrefer.com Health. Halle Berry s gift from God is diabetes! Available online: news/index.php?id=6840. Accessed May 25, American Diabetes Association. Diabetic Neuropathy (Nerve Damage) and Diabetes. Available online: Accessed June 14, dlife: For Your Diabetes Life! Available online: National Center for Chronic Disease Prevention and Health Promotion, Diabetes Public Health Resource, U.S. Centers for Disease Control and Prevention. Take Charge of Your Diabetes: Glossary. Available online: Accessed May 5, National Center for Chronic Disease Prevention and Health Promotion, Diabetes Public Health Resource, U.S. Centers for Disease Control and Prevention. National Diabetes Fact Sheet: National Estimates on Diabetes. Available online: Accessed May 5, National Diabetes Information Clearinghouse (NDIC), a service of the National Institute of Diabetes and Digestive Kidney Diseases (NIDDK), NIH. Diabetes Overview. Available online: gov/dm/pubs/overview/index.htm. Accessed May 19, Glossary Washington Post. FDA Approves Inhalable Insulin. January 28, Available at: Accessed May 19,