November is National Diabetes Awareness Month

An opportunity to cover the basics of diabetes, take control of our health!

Shaili K. Felton, M.D

Diabetes is simply a condition that is characterized by blood sugar elevations. Type 2 diabetes starts off with insulin resistance which means that the pancreas needs to make more insulin to keep blood sugar levels in the normal range. Over time, the pancreas can no longer keep up with the demand and blood sugar levels start to increase. Type 1 diabetes is an autoimmune condition where the body starts to make antibodies against the cells in the pancreas that produce insulin. When enough of these cells are destroyed and insulin production goes down below a certain threshold, blood sugars start to rise.

It is estimated that 425 million people worldwide have diabetes, making it an epidemic. More than 10% of the US population carries a diagnosis of diabetes and there are an additional 1.5 million people diagnosed every year. Type 2 diabetes is significantly more common that type 1. Of the new cases diagnosed every year, only 5% of these cases are due to type 1 diabetes. There are certain populations that are at higher risk of developing type 2 diabetes such as Hispanic Americans, African Americans, and the Pima Indians. Genetics also seems to play a role. Thirty-nine percent of type 2 diabetics have at least one parent with the disease and the lifetime risk of a first degree relative of a patient with type 2 diabetes is 5-10 times higher than that of a person that is of similar age and weight without a family history of diabetes.

Some signs and symptoms that might indicate that your blood sugars are running high are frequent urination, excessive thirst and weight loss. If you are experiencing these symptoms, then please talk to your doctor about a diabetes screen. If you have a fasting glucose greater than 100 and a random blood sugar greater than 200, then you should have an A1C test performed. The A1C gives your doctor an estimate of what your average blood sugars have been in the last 3 months. There are well established cutoffs to identify people that are in the prediabetes range and the diabetes range.

Uncontrolled and untreated diabetes can have long-term ramifications. High blood sugar can cause damage to the small vessels, which leads to neuropathy (misfiring of the nerves which can cause numbness/tingling/pain in the extremities), retinopathy (bleeding of the blood vessels in the back of the eye), and nephropathy (damage to the kidneys), and to the large vessels which leads to heart attacks and strokes.

Unfortunately, we cannot change our genetics or family history, but lifestyle changes can be very impactful in helping to prevent or slow down the progression of type 2 diabetes.  Moderate intensity exercise for 3045 minutes 45 days per week can help decrease insulin resistance. It has been shown in numerous studies that when one loses 15% of their body weight, there is a significant disease modifying effect in reversing or halting type 2 diabetes. Ideally, the best dietary modifications when discussing diabetes, are those that limit, not eliminate, carbohydrate intake. Meals high in carbohydrates or sugars cause blood sugars go up quickly and put an extra burden on the pancreas. When one has insulin resistance, this burden is magnified. The goal of limiting carbohydrates and combining carbohydrates with protein is to help decrease the blood sugar spike that occurs after eating as protein can help to slow the absorption of carbohydrates from the GI tract. Also, any diet that leads to a calorie deficit and promotes weight loss will also help with insulin resistance in the long term. The thing to remember that these need to be lifestyle changes. If one goes back to eating the way they used to or gains back the weight they lost, diabetes can recur and pharmacologic treatment may need to be started or intensified.

Diabetes is a lifelong disease and it is easy to get complacent. We recommend using all the resources that are available to stay on track including routine visits with your doctor to monitor progress, meal planning with a dietician and an exercise buddy to help with accountability. With the right lifestyle changes in place and sometimes medications, diabetes can be effectively managed without progressing and causing the complications in the years ahead.

Shaili K. Felton, M.D., is an endocrinologist for Texas Tech Physicians and associate professor at the Texas Tech University Health Sciences Center Department of Internal Medicine.

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