EMS in Focus
by Dean Meenach
11/01/2014

Why EMS is at risk for Type 2 diabetes


According to the Centers for Disease Control and Prevention, about 29.1 million Americans, or 9.3 percent, have diabetes [1]. It is estimated that 8.1 million Americans, or 27.8 percent, have diabetes, but don’t know it.

Diabetes affects more men than women, and afflicts almost 30 percent in the over 65 age group. Although believed to be an under-reported cause of death, diabetes was still the seventh leading cause in the United States in 2010. In 2012, diabetic-related illnesses cost Americans more than $245 billion in health care costs [2]. The worldwide cost of diabetes is $825 billion per year

Diabetes is a group of diseases marked by high glucose levels resulting from problems in how insulin is produced or works. It may result in the development of serious complications such as heart disease, stroke, kidney failure, blindness and early death.

There are two types of diabetes: Type 1 and Type 2. Type 1 is usually diagnosed in the mid-teens, but can be appear at any age. It develops when insulin-producing beta cells of the pancreas are destroyed. This is usually caused by abnormal functioning of the body's own immune system.

While Type 1 diabetes is a problem with insulin production, Type 2 diabetes is a problem with insulin resistance, and accounts for almost 95 percent of all diagnosed cases of in the United States [1].

The cells of the muscles, liver and fat tissue become resistant to insulin. The beta cells of the pancreas gradually lose the ability to produce adequate amounts of insulin.

The impact of Type 2 diabetes

The development of Type 2 diabetes places the body at risk for serious complications such as heart disease, stroke, blindness, peripheral nerve damage (diabetic neuropathy), kidney failure, and non-traumatic amputations.

Cardiovascular disease death rates are about 1.7 times higher, and hospitalization rates for heart attack are almost 1.8 times higher among adults diagnosed with diabetes than among adults without diabetes. The incidence of stroke is also 1.5 times higher [3].

Diabetics may also develop other complications such as nerve disease, non-alcoholic fatty liver disease, periodontal (gum) disease, hearing loss, erectile dysfunction, depression and complications of pregnancy to list a few.

  • In 2012, of adults with diagnosed diabetes, 71 percent had blood pressure greater than or equal to 140/90 mmHg, or used prescription medications to lower high blood pressure. Sixty-five percent had blood LDL cholesterol (bad cholesterol) greater than 100 mg/dl, or used cholesterol-lowering medications [3].                        
  • Diabetes was listed as the primary cause of kidney failure in 44 percent of all new cases in 2011 (CDC, 2014) [4].
  • Since 2010, 4.2 million people had diabetic retinopathy, damage to the small blood vessels in the retina that may result in severe loss of vision [5].                       
  • In 2010, about 73,000 non-traumatic lower-limb amputations were performed on adults 20 years or older with diagnosed diabetes, which accounts for about 60 percent of all non-traumatic lower-limb amputations [2].

Are EMS providers at risk for Type 2 diabetes?

The biggest risk factor for developing Type 2 diabetes is obesity, and the EMS profession sets the framework for considerable weight gain. It is well known that night shifts and long work schedules that result in sleep deprivation are major components that contribute to the weight gain of health care workers [6, 7, 8, 9, 10, 11, 12].

Weight gain in EMS is a national issue [13]. A recent study in Boston found that among new recruits for fire and EMS services, only 22 percent were at a healthy weight, while 44 percent were overweight and 33 percent were obese [14]. More than 80 percent of FDNY workers are overweight or obese [15].

Cortisol is a fight or flight hormone that is released every time the body is stressed. Part of its purpose is to replenish energy after exertion through fighting or fleeing the perceived threat. Primitive humans certainly needed this energy boost after physically battling a wild animal.

Today's humans respond similarly to stressors like worrying about money or job security. The body's neuro-endocrine system doesn't know that it is not physically fighting or fleeing, and it still responds to stress with the hormonal signal to replenish nutritional stores.

In another words, we feel hungry when we are stressed. This can lead to weight gain and a tendency to store belly fat.

To complicate matters, the fuel your muscles need during the fight or flight response is glucose, a reason you crave carbohydrates when stressed. To move the glucose from our blood to our muscles requires more insulin.

High levels of sugar and insulin set the stage for the body to store fat. People who are under frequent stress will gain weight for that very reason. Some research shows that abdominal fat causes specific chemical changes that can lead to lower metabolism and cravings for sweets, possibly leading to even more weight gain.

Waking up in the middle of the night to bright lights and loud whistles causes a tremendous release of cortisol as part of the stress response. It is believed that chronically elevated cortisol makes one vulnerable to developing high blood pressure, diabetes, lowered immunity and weight gain.

Cortisol can cause an increase in appetite. Add some of the ways we adapt to the stress of working in EMS - eating fast food, eating at odd hours, poor sleep habits, drinking caffeinated beverages, smoking, drinking alcohol off duty, and irregular exercise habits - it's not surprising how our work behaviors contribute to a generally unhealthy lifestyle.

The more weight we gain, the more we are at risk for Type 2 diabetes.

Tips to decrease the risk of Type 2 diabetes

Research shows that there are some simple, but not necessarily easy ways to interrupt the cycle and stop the weight gain. 

  • Exercise regularly.
  • Eat a balanced diet and never skip a meal. Some research shows that eating six small vs. three large meals a day may balance your blood sugar levels, inhibiting insulin production and reducing cortisol levels, all helping to control appetite and weight.
  • Get enough sleep. When you don't, cortisol levels rise, increasing your hunger.
  • Engage in relaxing activities off duty.
  • Snack on whole-grain, high-fiber foods. The typical American snack diet of sugary, simple-carbohydrates like cookies, crackers, chips, can actually increase stress hormone production and making you feel hungrier.
  • Avoid caffeine, cigarettes and alcohol. These can cause cortisol levels to rise, and blood sugar to drop, which spurs hunger.
  • Take vitamins regularly. Stress depletes the B complex and Vitamin C, and possibly calcium and magnesium. These nutrients help balance the effects of cortisol and may even play a role in burning fat.

References

1. Center for Disease Control (CDC). (2014). National Diabetes Statistics Report, 2014. (2014, July 28). Retrieved October 10, 2014, from http://www.cdc.gov/diabetes/pubs/statsreport14.htm

2. CDC. (2012). Diabetes Report Card 2012. Retrieved October 10, 2014, from http://www.cdc.gov/diabetes/pubs/pdf/diabetesreportcard.pdf

3. CDC. (2014b). Workplace health promotion: Type 2 diabetes prevention and control. (2013, October 23). Retrieved October 10, 2014, from http://www.cdc.gov/workplacehealthpromotion/evaluation/topics/type2-diabetes.html

4. National Chronic Kidney Disease Fact Sheet. (2014). Retrieved October 10, 2014, from http://www.cdc.gov/diabetes/pubs/pdf/kidney_factsheet.pdf

5. National Eye Institute. (2010). Statistics and Data. (2010, June 10). Retrieved October 10, 2014, from http://www.nei.nih.gov/eyedata/

6. Biggi, N., Consonni, D., Galluzzo, V., Sogliani, M., & Costa, G. (2008). Metabolic Syndrome in Permanent Night Workers. Chronobiology International, 25(2-3), 443-454. doi: 10.1080/07420520802114193

7. Buxton, O. M., Cain, S. W., O'connor, S. P., Porter, J. H., Duffy, J. F., Wang, W., ... Shea, S. A. (2012). Adverse Metabolic Consequences in Humans of Prolonged Sleep Restriction Combined with Circadian Disruption. Science Translational Medicine, 4(129), 129ra43-129ra43. doi: 10.1126/scitranslmed.3003200

8. Chronic stress puts your health at risk. (2013, July 11). Retrieved October 10, 2014, from http://www.mayoclinic.org/healthy-living/stress-management/in-depth/stress/art-20046037

9. Colles, S. L., Dixon, J. B., & O'brien, P. E. (2007). Night eating syndrome and nocturnal snacking: Association with obesity, binge eating and psychological distress. International Journal of Obesity, 31(11), 1722-1730. doi: 10.1038/sj.ijo.0803664

10. The effects of sleep deprivation on fire fighters and EMS responders. (2007). IAFC International Association of Fire Chiefs, 1-104. Retrieved October 10, 2014, from http://www.iafc.org/files/progsSleep_SleepDeprivationReport.pdf

11. Marqueze, E. C., Lemos, L. C., & Soares, N. (2012). Weight gain in relation to night work among nurses. Work, 41, 2043-2048. Retrieved October 10, 2014, from http://iospress.metapress.com/content/m12n6281m71m23r5/fulltext.pdf

12. Tsismenakis, A. J., Christophi, C. A., Burress, J. W., Kinney, A. M., Kim, M., & Kales, S. N. (2009). The Obesity Epidemic and Future Emergency Responders. Obesity, 17(8), 1648-1650. doi: 10.1038/oby.2009.63

13. Sleep Deprivation. (2009, July). IAFC International Association of Fire Chiefs. Retrieved October 10, 2014, from http://www.iafc.org/Operations/content.cfm?ItemNumber=1331

14. Kales, S. N., Tsismenakis, A. J., Zhang, C., & Soteriades, E. S. (2008). Blood Pressure in Firefighters, Police Officers, and Other Emergency Responders. American Journal of Hypertension, 22(1), 11-20. doi: 10.1038/ajh.2008.296

15. The effects of sleep deprivation on fire fighters and EMS responders. (2007). IAFC International Association of Fire Chiefs, 1-104. Retrieved October 10, 2014, from http://www.iafc.org/files/progsSleep_SleepDeprivationReport.pdf

Dean Meenach, RN, BSN, CEN, CCRN, CPEN, EMT-P has taught and worked in EMS for more than 20 years and currently serves as Director of EMS Education/Paramedic Instructor and co-teacher in the Paramedic to RN Bridge Program at Mineral Area College. He has served as a subject matter expert, author, national speaker, and collaborative author in micro-simulation programs. Dean continues to serve patients part time as a member of a stroke team and in a pediatric and adult trauma center. He can be reached at dmeenach@mineralarea.edu.

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