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Diabetes: A talk with the doctor of the nation
CRI President and 17th U.S. Surgeon General Richard H. Carmona, M.D., M.P.H., FACS, understands diabetes from many perspectives, including its economic burden for the nation and the emotional toll it takes on patients.

Diabetes Information Resources

• American Diabetes Association in Savannah 5105 Paulsen Street, Suite C236 Savannah, GA 31405 912-353-8110 • American Diabetes Association - • Diabetes Prevention and Control Program, Georgia Department of Health - Dwana Calhoun, MS, CHES 404-657-0603 • Chatham County Health Department Diabetes Information – Cristina Gibson, • University of Georgia Cooperative Extension “Focus on Diabetes” Program - • Centers for Disease Control and Prevention (CDC) National Diabetes Prevention Program -

Here in Savannah, diabetes is far too commonplace. Maybe your parents were treated for it, or your grandparents. Perhaps you've been diagnosed as pre-diabetic or diabetic. For many people, understanding what this disease really is and how it's treated is complicated.

We spoke with 17th U.S. Surgeon General and Canyon Ranch Institute President Richard H. Carmona to get a clearer picture of diabetes and what we can do to prevent and manage it.

Jan McIntire: Through CRI’s work in Savannah, we’ve heard people say that being diagnosed with diabetes is not a matter of if, but when. Is diabetes inevitable, as so many people seem to believe?

Dr. Carmona: Type 2 diabetes is absolutely preventable, and we know which lifestyle factors to monitor in order to avoid diabetes. Being overweight and being sedentary start a chain reaction that makes the body resistant to insulin, the hormone our bodies needs to process glucose, which is sugar in the blood. The glucose level builds up and can cause serious metabolic problems, which in turn over time can lead to eye, kidney, and cardiovascular problems.

Jan McIntire: Some people are diagnosed with type 1 diabetes. How is it different from type 2?

Dr. Carmona: With type 1, which usually occurs in a person's mid-teens, the cells that produce insulin are destroyed so the body has little or no insulin at all. That's a different scenario than type 2 diabetes. When a person has type 2 diabetes, the body still produces insulin, but the natural levels of that hormone and glucose become out of balance to such an extreme that insulin production and efficiency are impaired.

The key factor is that while both type 1 and type 2 diabetes have a genetic, or family history, component, type 2 diabetes can be prevented or controlled by what we eat and how active we are.

Jan McIntire: I’ve heard diabetes called “the sugar disease.” Can eliminating sugary or sweet foods and drinks protect you from it?

Dr. Carmona: It's not that simple. Our bodies convert all the food we eat—from potatoes to fruit to vegetables, grains, and meat—into glucose, which is the body's fuel source. When we overload the body's system with large amounts of sugar-sweetened food or beverages, or too much food of any kind, beyond what the body needs to give you the energy for your level of activity, we are feeding fat cells. Without changing the amount of activity or the amount and type of food, we are setting ourselves up for diabetes.

Jan McIntire: Is there a special diet that can help?

Dr. Carmona: Yes there is, and here's an important point: it's the same recommendation we make to people who don't have diabetes. I say "recommendation" because the word "diet" implies that you eat certain foods for a while, and then you go back to your previous food habits. Our recommendation is for a permanent lifestyle change that includes whole grain foods, vegetables and fruits, lean meat or fish, limited saturated fats, and no trans fats.

Jan McIntire: Can't it be controlled with medication?

Dr. Carmona: Medications can be helpful in adjusting glucose levels, and anyone who is taking diabetes medicine should always follow a lifestyle "prescription" of healthy eating and regular exercise. In other words, there is no magic pill for diabetes.

Jan McIntire: Where should people start in preventing or treating type 2 diabetes?

Dr. Carmona: Start with a visit to your health professional. Then, stand up and start walking—today. You don't have to go fast or far. Tomorrow, walk again, and do it the next day and the next. Move every day for the rest of your life. Invite children or grandchildren or friends to keep you company, and notice the good conversation that results.

I never pass up the opportunity to remind people to never use tobacco, always wear a seatbelt, and get all recommended health screenings. Put it all together and you have my prescription for a healthy life.

Richard H. Carmona is president of Canyon Ranch Institute. Jan McIntire is Canyon Ranch Institute Senior Advisor for Outreach.