It’s an epidemic in our country. And because one can’t feel it, it does its damage silently. That is the biggest problem with diabetes: If you wait until you have obvious problems from it to do something about it, the damage has already been done.
The good news is, with lifestyle changes and newer medications, you can do a lot to prevent this from happening.
There are two types of diabetes. Type 1 is when the pancreas does not produce enough insulin. This is usually seen in people who are thin, and is often the type seen in children. The only treatment for type 1 is insulin. Insulin is necessary for glucose to get into the cells of our body to provide energy. The insulin binds to receptors on the cells, allowing the glucose to enter.
When a person becomes overweight, the number of insulin receptors sometimes isn’t enough, so the glucose remains in the bloodstream and high blood sugars result. This is what happens with type 2 diabetes. The pancreas responds by trying to make more insulin. Eventually the pancreas cannot keep up the demand, and insulin is depleted. Thus, even type 2 diabetics most often end up on insulin if not well-controlled.
Type 2 diabetes can be avoided if one makes lifestyle changes with exercise and diet to reduce body size back to normal. This should be done in the “pre-diabetic” phase to be most effective. This phase means that fasting blood sugars are higher than 100, but less than 126.
There is also another blood test we do, called Hemoglobin A1C, which measures the percent of hemoglobin molecules bound to glucose in our blood. Normal is less than 5.7 percent. Pre-diabetes is between 5.7 percent and 6.5 percent. We make the diagnosis of diabetes when the fasting blood sugar is 126 or higher, and the hemoglobin A1C is >6.5 percent. In a known diabetic, a hemoglobin A1C less than 7.0 is the goal for good control. Sometimes when you are definitively diagnosed with type 2 diabetes, there is still a chance to reverse it with weight loss, diet and exercise, but the longer you go without doing this, the less the chance of reversing the diabetes.
Uncontrolled diabetes is called the silent killer because it can cause kidney failure, raise the risk of heart attacks and strokes, increase the risk of infections, as well as cause blindness and loss of limbs through circulatory problems. This is why it is so important to do something about it while you can.
When you are diabetic or pre-diabetic, your body doesn’t process sugar normally for the reasons given above. So, a diabetic diet must be low in sugar (not just sugar itself, but honey, syrups, sweet drinks and candy) and also low in other things that turn into sugar when they are metabolized, such as pasta, breads, baked goods, and starches like potatoes, rice and corn. Limiting these types of foods can often lead to weight loss, as well as immediate improvement in blood sugar. Exercise is extremely important. If a diabetic does 30 minutes of brisk walking five days a week, it has the same effect on blood sugar as adding a medication. Even a 10-minute brisk walk after a meal can significantly lower the expected blood sugar rise after eating. If diet alone doesn’t control blood sugar, we add medication. There are many to choose from, and each doctor tailors the particular regimen to the individual patient. But we always hope that diet, exercise and weight loss will eliminate the diabetes altogether, and that is something only the patient can do.