November Is American Diabetes Month

November 1, 1997


Listed below are story ideas from the Columbia University Naomi Berrie Diabetes Center at the Columbia-Presbyterian Medical Center. To pursue any of these stories, call Carolyn Conway at 212-305-3900


The holidays with its many sweet treats and goodies can be an especially challenging time for people with diabetes. According to Kira Lieschke, nutritionist at the Naomi Berrie Diabetes Center, an occasional modest sampling of holiday sweets may not be out of the question. Although these items should not be a part of the everyday diet for a person with diabetes, they can on occasion fit into a health plan without detrimental effects. "Enjoying an occasional holiday treat is fine as long as it is adjusted for by either eating less carbohydrates at lunch or dinner, increasing exercise, or using fast-acting insulin," says Lieschke. If you are going to drink alcohol, the best bet is to stick to light alcoholic beverages like a white wine spritzer. Heavily sweetened liquors, such as punches or eggnog, should be avoided. If one does choose to drink, moderation is the key. More than two drinks can not only impair one's judgment but also may lead to low blood sugar, she says. Following are some food alternatives proposed by the Naomi Berrie Diabetes Center:

Individually packaged dried fruits like raisins or nuts. Low sugar, high fiber granola bars. Mini sealed packages of pretzels or popcorn. Mini packages of cookies naturally low in sugar like gingersnaps, animal crackers or graham crackers, or peanut butter crackers. "It is also important to remember that these snacks are not only healthy for people with diabetes but for all adults and children," says Lieschke. "Always remember to consult a dietician or physician about any major dietary changes."


Diabetes is a chronic disease that has no cure. According to Joe Solowiejczyk, nurse educator at the Naomi Berrie Diabetes Center, the majority of people diagnosed with diabetes learn to manage the medical condition but often overlook the emotional every day issues of the patient and the family. How a person with diabetes feels about the disease directly affects behavior and, consequently, management of his or her care. "People with diabetes don't want to feel any different,"says Solowiejczyk. "I understand because I was diagnosed when I was only 7 years old and have lived with this disease for over 30 years." Solowiejczyk incorporates a "family approach" as part of routine clinical diabetes practice. "Providing a family with support to include counseling and education is vital to help patients and families meet the challenge of living with diabetes for the rest of their lives," he says. The Columbia University Naomi Berrie Diabetes Center may investigate how this approach may reduce long-term overall diabetes health care costs which exceed $100 billion per year.


According to Dr. Robin Goland, the Florence Irving associate professor of medicine and director of the Naomi Berrie Diabetes Center, screening for diabetes is a critical issue for women who are pregnant or who are planning a pregnancy. An estimated 40 percent to 50 percent of all diabetes is undiagnosed. Research indicates that serious complications of the disease begin much earlier than once thought and, as a result, this year the American Diabetes Association lowered the threshold for monitoring blood sugar levels in the diagnosis of diabetes. "Most women are unaware of the importance of diabetes screening prior to pregnancy, especially in high-risk women," says Dr. Goland. "If diabetes is not diagnosed and controlled before pregnancy it can greatly complicate the pregnancy and increase the risk for birth defects." Columbia University researchers under the direction of Dr. Goland compared pregnancy outcomes in women with insulin-dependent diabetes (IDDM), or Type I diabetes, to those of women with non-insulin-dependent diabetes (NIDDM), or Type 2 diabetes. Researchers discovered that uncontrolled Type II diabetes resulted in a 25 percent incidence of severe birth defects, including two babies with heart defects and one case of anencephaly (the lack of a brain). The researchers found that while all of the Type I patients were referred for diabetes care before becoming pregnant, none of the Type 2 patients were referred before conception. Researchers concluded that it is vital to alert patients and physician to pre-existing Type 2 diabetes as a major risk during pregnancy. Dr. Goland recommends pre-screening for Type 2 diabetes before pregnancy in women who are overweight or who have a family history of diabetes or prior diabetes in pregnancy. Diagnosing and controlling Type 2 diabetes before pregnancy should improve pregnancy outcomes.


A research team led by Rudy Leibel, M.D., professor of pediatrics and medicine and head of the Division of Molecular Genetics, discovered that the diabetes gene in mice (db) and the fatty (fa) gene in rats are mutations in the same gene and that both carry the genetic blueprint to make the receptor for leptin, which signals the amount of body fat. Leibel and his colleagues at the Columbia University's Naomi Berrie Diabetes Center are continuing to investigate the receptor's structure and how it relates to human obesity. "The db gene is quite large, which allows for a greater chance of mutations," says Leibel. "By detecting how such mutations affect the receptor made by the db gene, we should learn more about the receptor's structure, how it binds and responds to db gene product, leptin." The National Institute of Diabetes and Digestive and Kidney Disease estimates that obesity affects one in three Americans and is a major risk factor for diabetes, heart disease, high blood pressure, stroke, gallstones, and some cancer. These Columbia University researchers are also looking for other rodent and human genes that determine susceptibility to diabetes.


Carolyn Conway, Joe Solowiejczyk, Kira Lieschke, Rudy Leibel