Brian (not his real name) had always been athletic in junior high and high school, but when he started to put on some weight in his mid-20s, he didn't worry too much about it. He didn't have time. Later, as a single man and small-business owner in his early 40s, Brian ate most of his meals in junk food at his desk and rarely exercised. He'd been diagnosed with high blood pressure and high cholesterol about five years earlier, but he paid little attention when his brother, a doctor, warned him that his weight and his family history of diabetes put him in a high-risk category.
Then he walked into his doctor's office weighing 330 pounds -- even at his 6'4" height, 100 pounds more than his ideal weight. When the doctor measured his blood sugar, it registered at a whopping 550 milligrams per deciliter, or about five times higher than normal. "You just don't see that kind of blood sugar," marvels Lenore Coleman, PharmD, CDE, founder of Black and Brown Sugar, a diabetes information web site for minority populations, and author of the forthcoming Healing Our Village: A Self-Care Guide to Diabetes Control.
Brian, like millions of other black men, has type 2 diabetes. Diabetes is the fifth deadliest disease in the U.S., and it's hitting black communities especially hard. If current trends continue, black men will be facing an epidemic of diabetes by the year 2050.
- Approximately 2.7 million or 11.4% of all African Americans aged 20 years or older have diabetes -- but at least one-third of them don't know it.
- The average African American born today has a 50% chance of developing type 2 diabetes in his or her lifetime.
Why does diabetes hit African-American men so hard, and what can they do about it? "First, there's the obesity issue. Caucasians tend to have a different body image than African Americans; we don't feel like we're overweight when we're 30-60 pounds above our ideal weight," says Coleman, who is black.
"My patient thought he had a little too much around the middle, but he never considered himself morbidly obese, which he was. And like many black men, he lived alone and managed his own meals, which is a huge issue," she says. "If you're married, you tend to plan your meals more and eat a little better. African Americans also tend to eat a lot of fried foods, foods that are very high in carbohydrates, lots of sweets and sugars and starches." In fact, some studies have shown that African-American men eat fewer fruits and vegetables than any other demographic group.
When black men have diabetes, they're also much more likely to develop one or more of the serious complications associated with the disease, including amputation, kidney failure, blindness, and cardiovascular disease. For example, African Americans are 1.5 to 2.5 times more likely to have a limb amputated than are others with diabetes.
African-American men need to know how to prevent type 2 diabetes and how to control it if they already have it, says Coleman. "A lot of people have a fatalistic attitude that if your mother and your father and your grandmother had diabetes, that you're destined to have it and there's nothing you can do about it, and that's just not true."
"Start by setting achievable goals," advises Jane Kelly, MD, director of the National Diabetes Education Program, a joint effort of the CDC and the National Institutes of Health. "Not just long-term goals like losing 50 pounds, but goals for next Tuesday. Set goals like walking 10 minutes a day, or having one scoop of ice cream for dessert instead of two. Small steps add up. Write them down and commit to them, and ask a friend to monitor you."
Some simple strategies to add healthy, diabetes-prevention strategies into your lifestyle:
- Share your dessert. "Many people in the African-American community tell us that it's rude not to eat when someone offers food, so instead of passing up something you enjoy and offending your host, split dessert with a friend," says Kelly. And if your host urges you to take seconds, skip the potatoes and bread and ask for more of the green stuff!
- Build exercise into your day. "You don't have to take an hour off work to exercise," Kelly says. "Get off the bus one stop earlier, or park your car at the far side of the lot whenever you go to the grocery store or the mall."
- Drink more water. "Find a souvenir water bottle you really like, such as something with the logo of your favorite sports team, or your church," says Kelly. "Keep it with you as encouragement to drink more water instead of taking in calories from sugary sodas and juices."
These same strategies of maintaining a healthy diet and getting more exercise can help black men -- and anyone with diabetes -- manage their condition if they already have the disease. "There's a medical model myth that taking care of your diabetes means taking your medicine. Although medication is important, managing diabetes is about lifestyle," Kelly says.
"A lot of people think that once they're diagnosed with diabetes, they have to stop eating sugar altogether, and they have to eat all this expensive 'diabetic food,'" Coleman says. "That's not true. You simply have to eat a balanced diet, three meals a day, and eliminate simple sugars. No, you can't have cakes and doughnuts and candy, but you can have fruit, and you can have things like frozen yogurt."
Another key to managing diabetes, says Kelly: know your ABCs.
- A is your hemoglobinA1c level, which tells you how well you're managing your blood sugar. Keeping A1c levels at 7 or below reduces the risk of eye, kidney, and nerve damage.
- B is your blood pressure. The goal is to maintain a reading of 130/80 or below to protect your kidneys and eyes and prevent stroke.
- C is your cholesterol. Have your doctor check your cholesterol level and keep it within a safe range. LDL or "bad" cholesterol should be less than 100 mg/dL.
"If you keep an eye on these numbers and work with your doctor to keep them out of the danger zone, you can keep diabetes under control," Kelly says.