November is Diabetes Awareness Month, a time to focus on a serious health condition that affects millions of people. This is an important time in the fight against diabetes, as significant new advances in treatment are yielding encouraging results. In addition, greater awareness of the factors that increase risk for diabetes gives people more power to prevent the disease in the first place by making healthy lifestyle choices.
“Diabetes is a major health threat, but it’s one that we can treat and manage,” says Dr. Elizabeth King, an adult endocrinologist in Dallas. “In many cases, the most common form of diabetes, Type 2, can be prevented by making healthy lifestyle choices. At Privia Medical Group North Texas, we want our patients to have the information and tools to avoid this disease.”
Diabetes Statistics
Diabetes impacts 38 million Americans, about one in ten people in the United States. Additional key statistics:
- One in five people with diabetes do not know they have it.
- Diabetes is the eighth leading cause of death.
- Diabetes is the leading cause of kidney failure, lower limb amputations and loss of eyesight.
- More than one in three people have prediabetes, the precursor to diabetes.
- 80% of those with prediabetes do not know they have it.
What is Diabetes?
A disorder of the metabolism, diabetes results from the body not using food correctly. This is what should happen when we metabolize food:
- The liver breaks down carbohydrates into glucose, also known as blood sugar.
- The liver releases glucose into the blood stream.
- Meanwhile, the pancreas, a gland located near the stomach, produces insulin.
- Insulin helps the body’s cells absorb glucose.
- Those cells then use glucose for energy.
If cells are unable to absorb enough glucose – or if the body is not producing enough insulin – blood sugar levels rise. Blood sugar levels that are consistently too high can lead to diabetes and cause serious damage to the body.
Forms of Diabetes
Type 1 diabetes
Formerly called “juvenile diabetes,” Type 1 diabetes occurs when the body is unable to create insulin, usually due to an attack on the immune system. Type 1 diabetes is usually diagnosed in childhood but can also occur in adults. About 5% of people with diabetes have Type 1 diabetes.
The causes of Type 1 diabetes are not fully understood, but it is known that genetics and some environmental factors play a role in the disease. If a parent or sibling has Type 1 diabetes, your risk is greater. Some people have autoantibodies – harmful immune system cells – in their systems, which increase the risk of Type 1 diabetes.
Gestational diabetes
Gestational diabetes affects between 5% – 9% of pregnant women. It’s harder for the body to use insulin efficiently when pregnant, requiring extra insulin to be produced. If insulin levels don’t keep up, gestational diabetes can develop. Gestational diabetes goes away after the baby is born; however, it is a risk factor for later developing Type 2 diabetes.
Women older than 25 and women who are overweight are at greater risk for gestational diabetes. African Americans, Hispanics, Asian Americans and Native Americans are at elevated risk.
Type 2 diabetes
Type 2 diabetes is the most diagnosed form of diabetes, accounting for 90-95% of all cases. It is also preventable in many cases. This disease is usually diagnosed in people aged 45 and older, but it is becoming increasingly common in children, teens and younger adults.
Type 2 diabetes is generally caused when the pancreas is still producing insulin, but the body’s cells are unable to use it properly. This is called insulin resistance and leads to elevated blood sugar levels.
Family history increases risk of Type 2 diabetes. Additional risk factors include:
- Having prediabetes
- Being overweight
- Physically active less than three times a week
- Race – African Americans, Hispanics, Asian Americans and Native Americans are at greater risk
- Age – our risk increases the older we get. People aged 45 or older are more at risk.
- History of gestational diabetes
Prediabetes
Prediabetes is a precursor to full-blown diabetes – think of it as a big flashing warning sign. People are diagnosed with prediabetes when their blood sugar levels are elevated, but not yet high enough to be classified as Type 2 diabetes. If lifestyle adjustments are not made to lower blood sugar levels, prediabetes is likely to lead to Type 2 diabetes. Being overweight, not getting enough physical activity and being 45 or older are key risk factors for prediabetes.
Prediabetes is very common: 88 million people—one-third of American adults—have prediabetes. Screening is essential to knowing if you have prediabetes. Eight out of ten people do not know they have it.
Screening for Diabetes & Prediabetes
“Diabetes often produces no initial symptoms, the main reason many people who have the disease are unaware of it,” explains Dr. Mouna Gunda, a Frisco endocrinologist. “That’s why periodic screenings are so important.”
A diabetes screening is a simple blood test that measures glucose level in the blood. This is generally done at the same time as a cholesterol screening, which allows you to get a picture of several important health benchmarks at the same time. Fasting glucose levels, measured in mg/dL, are categorized as follows:
- Normal: 99 or lower
- Prediabetes: 100 to 125
- Diabetes: 126 or higher (measured on at least two separate occasions)
The A1C test is another common diabetes screening. A1C measures the average of blood sugar levels over the course of 2-3 months. A1C results are expressed as a percentage:
- Normal: below 5.7%
- Prediabetes: between 5.7 – 6.4%
- Diabetes: 6.5% or higher
A random blood sugar test can be conducted at any time and does not require fasting. A glucose reading of 200 mg/dL or more is indicative of diabetes.
The following are general screening guidelines for diabetes:
- Adults 35 and older, at least once every three years
- Women who have had gestational diabetes
- Children between ages of 10-18 who are overweight and have at least two other risk factors.
These are general screening guidelines. Your primary care provider (PCP) will provide screening guidance specific to you based on your medical history and other factors.
Possible Symptoms of Diabetes
When diabetes does cause symptoms, those can include:
- Extreme thirst
- Frequent urination, especially at night
- Dry skin
- Sudden and unexplained weight loss
- Extreme hunger
- Exhaustion
- Numbness and tingling in arms and feet
- Blurry vision
- Sores that don’t heal quickly
- Frequent infections
These symptoms can be caused by other conditions unrelated to diabetes, but if you experience any of them, be sure to schedule a visit with your PCP.
How Diabetes Harms the Body
The elevated blood sugar levels caused by diabetes can lead to several serious health problems:
- Heart disease: Diabetes is one of the main causes of heart disease, heart attack and stroke. People with diabetes are twice as likely to suffer from heart disease and stroke. They are also more likely to experience these conditions at a younger age.
- Nerve damage & amputations: Diabetes can cause pain, numbness and tingling in the arms, hands and feet. Diabetics are prone to developing sores and infections on their feet, sometimes necessitating amputation to halt the spread of infection. Diabetes is the leading cause of lower-limb amputation.
- Kidney damage: Diabetes is the leading cause of kidney failure. High blood sugar damages the kidneys, causing the buildup of waste and fluid in the blood.
- Mouth problems: Diabetes can cause gum disease; loss of teeth; and thrush, a fungus that grows in the mouth.
- Vision loss: Diabetes can cause several eye problems, including:
- Diabetic retinopathy, which damages the blood vessels in the eyes
- Cataracts, which occurs when the lens becomes clouded
- Glaucoma, which results from the buildup of fluid in the eye.
Diabetes is the leading cause of adult-onset blindness.
Living with Diabetes
Diabetes can often be successfully managed by working with your doctor, taking prescribed medications, following a meal plan and increasing physical activity.
Managing glucose levels is critical. A patient checks blood sugar levels with a skin prick test, which provides an instant reading. The goal is to not allow blood sugar to rise or drop too much.
Your doctor may tell you to test your blood sugar several times per week or a few times a day. One of the benefits of monitoring blood sugar levels is that you’ll learn which events trigger readings outside of your recommended range – eating, not eating, eating certain foods, exercise, not exercising, etc. As you learn these patterns, it becomes easier to adjust behavior to optimize your blood sugar levels.
Diabetes Medication
For anyone with Type 1 diabetes, regular insulin injections (or insulin administered through a pump attached to the body) are required to compensate for the lack of insulin naturally produced in the pancreas. For some patients with Type 2 diabetes, insulin injections may also be necessary. These are done by the patient.
Most Type 2 diabetes can be treated with oral medications. Some medicines help stimulate the production and release of insulin from the pancreas and others help to slow the release of glucose from the liver.
Newer medications have shown additional promise in the treatment of diabetes. A class of medications known as GLP-1s and SGLT-2s are now recommended as a first-line treatment for those with Type 2 diabetes who have additional risk factors. These medicines work to lower blood sugar, provide added protection for the heart and kidneys and aid with weight loss.
“For everyone with diabetes, it is essential to be physically active and to eat a healthy diet,” says Dr. Shamsher K. Lakhian, an adult endocrinologist in Plano. “These are two of the most important things you can do to manage diabetes. Your health care provider will help you determine which foods to eat, which to avoid and how much to consume overall, as well as how much and what type of exercise to get.”
Preventing Type 2 Diabetes & Prediabetes
The good news for most people – including many who have prediabetes – is that the risk of getting Type 2 diabetes can be significantly reduced through lifestyle changes. A better diet, physical activity and not smoking all help fight diabetes.
Losing Weight
If overweight, shedding some pounds can make a big difference in reducing risk and improving overall health. A small weight loss of just 5% – 7% of total body weight has been shown to be meaningful. The main ways we can lose weight and keep it off are changing what we eat, eating less and getting more exercise.
Limit Portion Size
While 2,000 calories per day is considered the amount the average person should consume, our individual recommended totals vary. Your PCP can help you determine about how many calories you should consume each day.
Many of us have gotten used to large portion sizes that we accept as normal; however, food servings are often much larger than they should be. This is especially true when we go out to eat at a restaurant.
Eat Balanced Meals
Our bodies need different types of food:
- Meat, fish, beans and nuts provide protein and some healthful fats
- Whole grains give us the carbohydrates we use for energy and help our digestive process
- Fruit and vegetables provide essential minerals and vitamins.
Our goal should be to eat meals that are 25% meat or fish, 25% whole grains and 50% fruits and vegetables. These ratios apply to everyone, but especially to people who have been diagnosed with prediabetes.
“Good” Foods
Keeping in mind portion control and overall calorie consumption, these foods are generally friendly to a prediabetes management program:
- Whole grain breads, pasta, cereals and rice
- Fresh or frozen fruits and vegetables (canned produce should be avoided, as it often contains unhealthy amounts of salt and sugar)
- Low-fat dairy products
- Beans
- Lean meats, such as chicken and turkey without skin; fish
- Water
Foods to Cut Back On
These foods should be avoided or eaten only in moderation:
- “White” foods, such as bread, pasta and rice
- Foods high in sugar, saturated fat and salt
- Fruit juices, soda and alcoholic beverages
- Fatty meats
- Whole milk dairy products
Foods containing trans-fat should be avoided.
Exercise
We should all get exercise most days of the week, ideally 30 minutes a day, 5-7 days a week. This is especially important for someone with diabetes or prediabetes. Beneficial exercise can include brisk walking, light jogging, bicycling, swimming and strength training.
Exercise moves blood sugar into cells to be converted to energy and helps insulin work more efficiently. Additionally, exercise provides a good workout for the heart and burns calories, helping us lose weight. Consult your physician before beginning an exercise program to ensure that it is safe for you to do so.
Beating Diabetes
Eating right, staying physically active, not smoking and staying in your recommended weight range are the best things we can do to avoid Type 2 diabetes and prediabetes.
If you have not had a diabetes screening before or are not sure the last time you had your blood sugar checked, make an appointment with your PCP. It’s fast, easy and can help you avoid a lot of problems down the road.
This article has been reviewed and approved by a panel of Privia Medical Group North Texas physicians.
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