Top Doctors: Managing diabetes risk

Diabetes can wreak havoc head to toe, leading to nasty and life-threatening complications. Yet it's possible to delay or even prevent the devastation with weight loss, a healthy diet and regular physical activity.

Not that it's easy.

"The initial shock of being diagnosed with diabetes wears off and people often go back to their unhealthier habits," said Dr. Craig B. Wexler, an East Patchogue endocrinologist who underscores the importance of a team of professionals - including a physician, dietitian and diabetes educator - in managing the condition.

"It requires a great deal of time to motivate someone to make the changes," he said.

Type 2 diabetes is a disorder that affects metabolism, the process of converting food into fuel for the body. An estimated 24 million adults and children in the United States have this type of diabetes, the most common form of the disease.

After a meal, the carbohydrates in food that was eaten become glucose, a type of sugar. Glucose is the body's main energy source. But human cells cannot absorb glucose without a sufficient supply of insulin, a hormone produced in the pancreas.

People with type 2 diabetes become "insulin resistant," meaning their cells do not use insulin properly. To compensate, the pancreas makes more. Eventually, however, it cannot keep up with the demand. As a result, glucose builds up in the bloodstream, damaging nerves and blood vessels throughout the body.

SYMPTOMS

Nearly 6 million people in the United States have the disease but don't know it.

"In the early phases of the disease, people can be largely asymptomatic," explained Dr. Steven Lomasky, a Rockville Centre endocrinologist and clinical assistant professor at Albert Einstein College of Medicine in the Bronx.

Symptoms may include fatigue, frequent urination, increased thirst or appetite, unexplained weight loss, blurred vision, slow healing of wounds or sores, tingling or numbness in the hands or feet and erectile dysfunction.

RISK FACTORS

Being overweight significantly raises the risk for diabetes and appears to be the reason for the rampant prevalence of the disease, even among children and adolescents, according to the U.S. National Institutes of Health.

Other risk factors include:

* Having a family history of diabetes

* Maintaining a sedentary lifestyle

* Being older than 45

* Belonging to a certain racial or ethnic group. The risk is higher among people who are African-American, Asian, Hispanic/Latino, Alaskan American, Native American or Pacific Islander

* Having a history of gestational diabetes, which is diabetes first diagnosed during pregnancy

* Having polycystic ovary syndrome, a hormonal disorder that affects women of reproductive age.

* Having a history of heart disease

* Having low levels of the good type of cholesterol - high-density lipoprotein, or HDL - or having high blood fat levels.

CURRENT THINKING

It may be hard to take, but the best medicine for managing diabetes cannot be injected or swallowed.

"Nothing is as good as diet and exercise," Lomasky stressed.

The advice mirrors the results of a landmark study published in 2002 in the New England Journal of Medicine that involved 3,234 people considered prediabetic because they were overweight and had higher-than-normal blood sugar levels, though not high enough for a diagnosis of diabetes. Even modest weight loss (the goal was to shed 7 percent of their body weight) combined with regular physical activity reduced the onset of diabetes by 58 percent, compared with those who had taken a placebo pill. Taking metformin, an oral medication that helps control blood-sugar levels, also reduced the risk, but by just 31 percent.

Even for those who already have diabetes, studies suggest that losing a flabby midsection, eating healthfully and being physically active can help keep blood sugar in check and stave off complications, such as heart disease and stroke, blindness, kidney disease, nerve damage and amputation.

THE LONG ISLAND SCENE

To find a support group near your home or workplace, check out the Diabetes Resource Coalition of Long Island (longislanddiabetes.org), an initiative of the Cornell Cooperative Extension of Suffolk County in Riverhead.

This is the seventh installment of a 26-week series in which Newsday presents Castle Connolly's list of top L.I. doctors. Today: Endocrinology, diabetes & metabolism, clinical genetics & reproductive endocrinology

Who's who

ENDOCRINOLOGY, DIABETES & METABOLISM

Dr. John Aloia

222 Station Plaza N., Mineola, 516-663-3511

Dr. Michael Balkin

191 E. Main St., Huntington, 631-549-2525

Dr. Anjani Bhatt

871 E. Park Ave., Long Beach, 516-889-8853

Dr. Rachelle Bitton

2 Pro Health Plaza, Lake Success, 516-390-5760

Dr. Howard Brand

2500 Nesconset Hwy., Stony Brook, 631-751-2400

Dr. Harold Carlson

Stony Brook Univ. Medical Ctr., Dept. Medicine, Div. Endocrinology & Metabolism, 26 Research Way, East Setauket, 631-444-0580

Dr. Seth Friedman

560 Northern Blvd., Great Neck, 516-466-6165

Dr. Marie Gelato

26 Research Way, East Setauket, 631-444-0580

Dr. Leonard Gioia

53 Brentwood Rd., Bay Shore, 631-666-6275

Dr. Alan Goldenberg

East End Endocrine Associates, 189 Main Rd., Riverhead

631-288-7120

Dr. Jeffrey Gordon

3 School St., Glen Cove, 516-759-2420

Dr. Martin Greenfield

2 ProHealth Plaza, Lake Success, 516-608-6823

Dr. Kenneth Hupart

2201 Hempstead Tpke., East Meadow, 516-572-4848

Dr. Irwin Klein

2800 Marcus Ave., Lake Success, 516-708-2540

Dr. Steven Lomasky

242 Merrick Rd., Rockville Centre, 516-536-3700

Dr. Paul Margulies

444 Community Dr., Manhasset, 516-627-1366

Dr. David Rosenthal

Nassau Univ. Med. Ctr. Div. Endocrinology, 2201 Hempstead Tpke., East Meadow, 516-572-4848

Dr. Lawrence Shapiro

222 Station Plaza N., Mineola, 516-663-3511

Dr. Ashok Vaswani

901 Stewart Ave., Garden City, 516-739-0414

Dr. Stuart Weinerman

2800 Marcus Ave., Lake Success, 516-708-2540

Dr. Craig B. Wexler

285 Sills Rd., East Patchogue, 631-758-5858

Dr. Ching-Hui Wu

2500 Nesconset Hwy., Stony Brook, 631-751-2185

CLINICAL GENETICS

Dr. Martin Bialer

1554 Northern Blvd., Manhasset, 516-365-3996

Dr. Joyce Fox

1554 Northern Blvd., Manhasset, 516-365-3996

Dr. David Hyman

48 Route 25A, Smithtown, 631-862-3620

Dr. Margaret McGovern

Stony Brook Univ. Med. Ctr. Pediatrics, Nicolls Rd., Stony Brook, 631-444-5437

REPRODUCTIVE ENDOCRINOLOGY

Dr. Steven Brenner

2001 Marcus Ave., Lake Success, 516-358-6363

Dr. Richard Bronson

Stony Brook Univ. Med. Ctr. Reproductive Endocrinology Dept., Health Sci. Ctr., T9-080, Stony Brook, 631-246-9100

Dr. Daniel Kenigsberg

2500 Nesconset Hwy., Stony Brook, 631-331-7575

Dr. Michael Lydic

Reproductive Specialists of NY, 2500 Nesconset Hwy., Stony Brook

631-246-9100

Dr. David Rosenfeld

North Shore-LIJ Health Systems Ctr. for Human Reproduction, 300 Community Dr., Manhasset, 516-562-2229

How they were picked

Castle Connolly Medical Ltd. is a health care research and information company founded in 1991 by a former medical college board chairman and president to help guide consumers to America's top doctors and hospitals. Castle Connolly's established survey and research process, under the direction of a doctor, involves tens of thousands of doctors and the medical leadership of leading hospitals.

Castle Connolly's team of researchers follows a rigorous screening process to select doctors on national and regional levels. Using mail and telephone surveys, and electronic ballots, they ask physicians and the leadership of top hospitals to identify exceptional doctors. Careful screening of doctors' educational and professional experience is essential to the committee. Newsday is not part of the selection process.

Doctors do not and cannot pay to be selected and profiled as Castle Connolly Top Doctors.

To see the whole list . . .

Who else is on the list of Top Doctors? More than 6,000 listings are in the New York Metro Area edition of "Top Doctors," published by Castle Connolly Medical Ltd. The soft-cover list price is $34.95. For more information, go to castleconnolly.com, or call 800-399-DOCS.