Diabesity: The Obesity-Diabetes Epidemic that threatens America --and what we must do to stop it - Couverture rigide

Kaufman, Francine R. MD

Couverture rigide

ISBN 10 : 0553803840 ISBN 13 : 9780553803846

Editeur : Bantam Doubleday Dell Publishing Group, 2005

Synopsis

Book by Kaufman MD Francine R

A propos du livre

Extrait

ONE
A Tale of Two Children
The blaring telephone woke me from the already fitful sleep of a night on call. I struggled desperately to lift my mind from semiconsciousness. The year was 1981; the time was 1:30 a.m. At that hour, a ringing phone meant a critically ill child.

I'm a pediatric endocrinologist. Since 1978 I have cared for youngsters with diabetes. I've also worked with adults with this dread disease, as a researcher, teacher, and advocate. In 2002, I was elected president of the American Diabetes Association.

Many people today think of diabetes as a slow-moving chronic disease. But it can be swift and merciless, particularly when it attacks young children. An abnormally high blood sugar level, the hallmark of diabetes, is always a medical emergency. In my early years as a doctor, first as an intern and then as a resident, I spent every third night on call, ready to go into battle against diabetes. The telephone call on that night in 1981 came from the emergency department resident. He told me that a nine-month-old baby named Cameron had been rushed to Children’s Hospital Los Angeles in a coma. Cameron's blood sugar was ten times higher than normal. No one in the emergency department had ever seen such a high number. By the time the resident finished his terse description, I was on my feet, fully awake.

I had recently completed my fellowship in pediatric endocrinology, the specialized training that follows residency, and I'd joined the staff at Children’s Hospital, where I now head the Center for Diabetes, Endocrinology and Metabolism. My husband, Neal, who was also establishing a medical career, was out of town at a professional meeting. We had two young children: Adam, age three, and Jonah, who was almost one. Our babysitter had quit that afternoon, and I'd spent most of the evening patching together child care arrangements for the coming week. I'd fallen into bed at midnight, even more exhausted than usual.

A close friend had promised to babysit if I needed to go to the hospital in the middle of the night, but time was too short. Cameron was already unconscious. If his blood sugar wasn't brought down to a normal level in just the right way, he might not survive the night. I ran to the kitchen with a tote bag and grabbed a plastic bottle of juice for Jonah and other supplies. Then I carried both boys to the car and fastened them into their car seats, trying not to awaken them. I drove with dread anticipation to the hospital.

Cameron was my first concern, but I also had to find some secure spot for my children. Carrying one sleeping child in each arm, I entered ER Room 2. This is the room nearest to the ambulance bay. It's larger than the other ER rooms, with special equipment and extra space so more people can fit. You're brought to Room 2 when you're in real trouble. The resident brushed past me; he was rushing a blood sample to the lab. Cameron lay on the bed, naked, his tiny body pale and motionless. Hovering over him were two of the ER interns, a respiratory nurse, and Esther, the ER's senior nurse. Around them, machines beeped and monitors flashed. An IV dripped fluid into Cameron's limp body.

Cameron was so thin I could count every rib. His lips were dry; his eyes were sunken in his head and tearless--all obvious signs of dehydration. Despite the lack of fluid in his body, the sheet under him was soaked, indicating he was urinating copiously because of his diabetes. His breathing was deep and labored. I could smell a fruity odor on his breath, another sign of his disease.

Even though his appearance was what I had expected, I was still shocked to see such a gravely ill infant. His mother--slender, young, and alone--sat in a corner of Room 2. She looked overwhelmed by the commotion surrounding her child. Holding my own two children in my arms, I ran to Cameron's mother and introduced myself as Dr. Kaufman, the diabetes specialist. Then I motioned to Esther to step into the hall. "I'm going to need some help with my boys," I told her.

Esther shook her head. "We're already short of staff," she said. "I can't spare anyone for babysitting. Put them on those armchairs"--she pointed to two chairs in the hallway--"so you can keep an eye on them." Esther slid the chairs to face each other, forming a makeshift crib.

Adam curled up on his chair without awakening. But when I put Jonah on the chair facing Adam, he began to whimper. I dug the plastic bottle out of the tote bag. Jonah grabbed it and flung it across the hall. Juice sprayed out like a fountain. Now he was crying inconsolably. I knew that if he awakened Adam I'd be sunk. So I lifted him up and held him against my shoulder. As soon as he quieted, I hurried back into Room 2 and began to examine Cameron.

Carrying my own son with my left arm, I poked Cameron's abdomen with the fingers of my right hand. He didn't flinch, which told me he was deeply unconscious. When I removed my fingertips, little white circles remained on his skin, indicating extremely poor circulation. Cameron's mother stared, no doubt startled by the sight of a doctor at work while holding her own baby.
SUGAR TURNS TOXIC
Diabetes can devastate nearly every system of the body, but it all starts with the metabolism of glucose, a type of sugar. Glucose is what fuels our every move and our every thought. The glucose we need comes from the food we eat. But our body can't use it without insulin, a hormone produced by the pancreas. As I'll explain shortly, diabetes comes in different forms. In all of them, insulin is unable to play its proper role.

Because Cameron had lost the ability to process sugar, his cells were starving. That's why he was so thin. Meanwhile, sugar had accumulated to toxic levels in his blood--a condition called hyperglycemia. His body was drawing water from his tissues, trying to flush out the excess sugar in his urine. That's why he was urinating excessively. And because so much water was leaving his body, he had become severely dehydrated. Desperate for calories, he had begun burning stored fat. The fruity aroma of his breath came from ketones, a by-product of his abnormal metabolism. The ketones were making Cameron's blood dangerously acidic. Despite his body's attempt to blow these acids out with his breath, he could not exhale them fast enough. This condition, called diabetic ketoacidosis, can lead to coma and even death.

To bring Cameron back to life, he would need infusions of insulin, as well as salts and fluids to counter the effects of dehydration and ketoacidosis. Balancing these inputs is crucial and never easy. But it's especially tricky with a tiny infant. Intravenous fluid was essential, but fluid with the wrong salt concentration or excess fluid--or in some cases even the right amount of fluid--could cause fatal swelling of the brain.

The resident burst in from the lab with the test results. "The first blood sugar was 1,050 milligrams per deciliter; the repeat is down to 953," he told me. A normal sugar level for an infant is no higher than 110 milligrams per deciliter (mg/dl). Back then, in 1981, we could measure blood sugar in the ER with a drop of blood and a glucose strip. But the strips in the ER didn't register if the level was that high, so Cameron's blood had been checked in the hospital laboratory. "I didn't think someone could be alive with blood sugar at that level," the resident whispered, not wanting Cameron's mother to hear.

I told Esther what fluids Cameron needed and at what rate they had to be given. Jonah lifted his head from my shoulder and began to whimper. I ordered more blood tests to assess Cameron's body chemistry. Jonah was crying now. I rocked back and forth, trying to soothe him as I struggled to calculate how much insulin to put into Cameron's intravenous infusion. By the time I gave Esther the order, Jonah was screaming.

Cameron's mother was watching all this, visibly nervous. Finally she approached and said to me, "Dr. Kaufman--that's your name, right?"

"Yes," I responded. My child was crying hysterically, but I spoke as calmly as I could, trying to look as if I had the situation under control. Cameron's mother knew her son's life was in danger. She was terrified and exhausted and I wanted desperately to reassure her. But Jonah was inconsolable. I felt frustrated and embarrassed.

"I'll tell you what," she said. "I'll hold your child if you'll save mine."

We were two mothers. Our eyes met, and a look of understanding instantly passed between us. I transferred my baby to her, just as she had given hers to me. She took my son and held him tight. He quieted down. She rocked him, ran his blanket gently across his cheek, and hummed to him. Tears streamed down her face. Within minutes, my son was asleep in her arms.

Shortly after 6:00 a.m., Cameron's eyes opened. He took in the unfamiliar surroundings and the hovering strangers in white coats. Then he opened his mouth and screamed--the first sound he'd made through this terrifying night, other than his labored breathing. Cameron's mother lifted her head. We smiled at each other. Even Esther, whose face had been set in a worried frown, grinned with delight. Cameron had made it back from the abyss; he had recovered from diabetic ketoacidosis. Now he faced the rest of his life with diabetes. But as I told his mother, with scrupulously careful management of his disease, that life could be a long and healthy one.
TYPE 1 VERSUS TYPE 2
Diabetes takes two forms. Cameron suffered from type 1. His immune system had destroyed the beta cells in his pancreas, the cells that produce insulin, so he was unable to make this essential hormone. Type 1 diabetes typically appears in childhood and progresses rapidly. Fortunately, type 1 is relatively rare. Ninety percent of people with diabetes have the other kind, which is known as type 2. In type 2 diabetes, the key problem is not that insulin is lacking; rather, the body's c...

Revue de presse

“Incredibly important . . . Francine Kaufman will save lives”
--Wolf Blitzer, CNN anchor

“A dramatic, personal account of the human dimensions of the modern obesity epidemic.”
--Greg Critser, author of Fat Land: How Americans Became the Fattest People in the World

“No person is better suited than Francine Kaufman to write a groundbreaking book on obesity and diabetes. This book is a gem for coupling insightful analysis with creative recommendations for what might be done."
--Kelly D. Brownell, Ph.D., Director, Yale Center for Eating and Weight Disorders, and author of Food Fight

“Francine Kaufman is a warrior. Her enemies are type-2 diabetes and obesity, preventable conditions that menace our nation’s health. In this inspiring book, she leads us toward solutions."
--Miriam Nelson, Ph.D., author of Strong Women Stay Young and Strong Women Stay Slim

“Francine Kaufman writes with clarity and compassion, blending cutting-edge science with the stories of those affected. She makes a compelling case for change as individuals and as a society.”
--David S. Ludwig, M.D., Ph.D., Director, Obesity Program, Children’s Hospital Boston

“Parents today are unwittingly leading their children into a dietary danger zone. Dr. Kaufman’s wise book lays out a clear path guiding families back to safety.”
--Harvey Karp, M.D., author of The Happiest Baby on the Block and The Happiest Toddler on the Block

“A compelling combination of medical insight, practical treatment strategies, and Fran Kaufman’s special passion for ways to prevent this devastating epidemic.”
--James R. Gavin III, M.D., Ph.D., President, Morehouse School of Medicine; Chair, National Diabetes Education Program

“As obesity and diabetes emerge as the leading public health threats of the 21st century, Dr. Kaufman’s book becomes required reading.”
--Congresswoman Hilda L. Solis

"[A] first-rate, important book.... a call to arms for policy makers and those in the health-care industry."--Publishers Weekly

Détails de l'édition

• Éditeur: Bantam Doubleday Dell Publishing Group
• Date d'édition: 2005
• Langue: anglais
• ISBN 10: 0553803840
• ISBN 13: 9780553803846
• Reliure: Relié
• Nombre de pages: 326
• Coordonnées du fabricant: non disponible
• Personne responsable: non disponible