The pancreas, a tapered seven-inch long gland situated beneath the stomach, secretes a hormone called insulin, which plays a major role in the absorption of glucose into the cells of the body.
Glucose is a simple sugar that is released into the bloodstream after we eat and digest certain foods, particularly carbohydrates. Glucose provides fuel for the body. Just as cars run on gas, our bodies run on glucose. We are able to walk and run because glucose fuels our muscles. However, glucose cannot enter the cells without the assistance of insulin.
In type 2 diabetes, the body either does not make enough insulin or does not effectively use the insulin it produces. Sugar builds up in the blood, starving the cells of their much-needed energy, and causing potentially serious health complications.
Rising obesity rates partly to blame
Kiaralix Guillenramos, 17, was diagnosed with gestational diabetes while pregnant with her son, Jacobi. After his birth her pre-diabetes eventually progressed to type 2 diabetes. (Ernesto Arroyo photo)
Kiaralix Guillenramos, 17, is not your typical high school junior. She says she likes math and English, but she has more pressing responsibilities. First is her new baby boy.
But that birth triggered an unexpected consequence. Seven months into her pregnancy, Guillenramos was diagnosed with gestational diabetes. “I never heard of it,” she readily admits.
Gestational diabetes occurs for the first time when a woman is pregnant, meaning that diabetes did not exist before pregnancy and may not exist after birth. However, women who have gestational diabetes are more likely to develop type 2 diabetes as they age.
Guillenramos’ gestational diabetes disappeared after birth, but she was not completely out of the woods. She was told that she was borderline or high risk, for type 2 diabetes.
Blood glucose levels, an indication of diabetes, don’t always take one leap from normal to a full-blown case. Sometimes there’s a warning — an intermediate stage called pre-diabetes or impaired glucose tolerance. That means that the level of sugar in the blood is higher than normal — but not high enough to be labeled diabetes. If the blood sugar levels continue to rise, then the diagnosis may progress to diabetes.
The aim of any intervention is to prevent the progression of borderline cases.
Such is the case with Deidre Dyette and her 12-year-old daughter. Diabetes runs in the family, and race and weight are contributing factors. Her daughter has gained as much as 30 pounds a year, raising her BMI to the 95th percentile.
A blood test during her last physical diagnosed the pre-diabetes. And a blood pressure test found pre-hypertension, meaning a blood pressure also at the border between normal and abnormally high.
The seriousness of the situation hasn’t sunk in yet for Dyette’s daughter. For her part, Dyette is taking an honest look at herself as well. The apple does not fall far from the tree, she reasons. She too also has borderline hypertension and diabetes and carries a bit more weight than she should.
She knows it’s time to do something. She and her daughter are in this together, but she admits it’s a struggle. They both see a nutritionist. She acknowledges that she has to change some of her habits that affect her daughter. “I fry a lot,” she said. “But I try to bake or roast more now.”
Kiaralix Guillenramos, a patient at Children's Hospital Boston, gets her exercise by pushing her son, Jacobi. (Ernesto Arroyo photo)
Dyette is right about one thing — it’s extremely difficult to change habits, Guillenramos agrees.
Her period of pre-diabetes was short-lived. She was soon diagnosed with type 2 diabetes, which did not completely surprise her. Diabetes runs in her family, and her weight added another risk.
She readily admits living with the disease — especially at such a young age — is hard. She takes medicine twice a day — after breakfast and after dinner. She knows she’s supposed to watch what she eats, and has visited a nutritionist. “They tell you what to do,” she says. “But I’m not used to it [food recommendations].” She says she likes her soda and juice — both sources of sugar. She has managed to switch to diet soda, but has not yet tackled her penchant for juice. “I drink it three times a day,” she said.
And 2 percent milk? “I don’t think so,” she quips. “I’ve tried it, but it just doesn’t taste right.” She admits needing a little more work on whole grains as well. “I like white rice,” she explains.
She has made progress on portion sizes. She says she loves meat and beans — lots of it. Fortunately, she can still eat both — just in smaller amounts.
She also has managed to incorporate some exercise into her routine. She walks her baby in a stroller for about 20 minutes three times a week.
The pin pricks to check her glucose levels are another story. She checks three times a day. “You wouldn’t want to do it,” she said. I’m still scared of it.”
The most difficult part for Guillenramos is taking care of her diabetes and taking care of her baby at the same time. She gets up before 6 a.m. to be in class at 7:30. In that short span of time, she needs to check her glucose, eat, take her medicine, get her baby ready for day care and get herself ready for school. She cannot skip one step.
“You have to do things different from when you were not sick,” she said.
But Guillenramos still has her eye on her future. “I want to be a medical assistant,” she said.
Dyette says she too has made progress. She makes more salads and eats more yogurt. She buys fresh fruits and vegetables, substituted sweetened cereal with unsweetened and has even acquired a taste for light mayonnaise.
Her daughter is not as gung-ho. “She doesn’t think she has a weight problem,” said Dyette. “She does not understand why we have to keep going to the nutritionist.”
But Dyette is not backing down. She is enrolling her daughter in a fitness center and hopes her desire for pretty new clothes will be an incentive. “She’s a pre-teen now,” said Dyette. She sees clothes that she likes, but her mother warns “you can’t fit into that.”