Thanks to modern medicine many people are living longer and longer, but many Americans are developing Diabetes at an alarming rate. There are many risk factors for developing Diabetes including heredity, obesity, sedentary lifestyle and increased consumption of fast food. Diabetes was once common in people in their 60s and 70s but has rapidly become common in younger people in their teens and 20s.
Diabetes Mellitus, (DM), is a very common disease caused by insufficient production of the hormone Insulin by the pancreas. There are two types of diabetes: Type 1, Juvenile Diabetes also known as Insulin Dependent Diabetes Mellitus (IDDM) and Type 2, also known as Non-Insulin Diabetes Mellitus (NIDDM). Type 1 is caused by total failure of the pancreas to make adequate levels of insulin to lower blood sugars that may range from 200 to close to 1000. Type 1 is diagnosed in the pediatric and adolescent population and is a life threatening event. The cause of Type 1 remains unknown and is a topic of much research. Without insulin supplementation, these patients will die from Diabetes Ketoacidosis or Diabetic Coma. Fortunately, Type 1 is much less common than Type 2.
Type 2 Diabetes is much more common, affecting millions of Americans each year. The pancreas does not quit working, it just produces less insulin than the body demands to keep blood sugars normal. Poor diet, lack of exercise and obesity tax the pancreas to keep up with normal Insulin production. Blood sugars are constantly rising and lowering, thanks to the complexity of the pancreas and insulin production. Normal insulin levels range from 60 to 120 in the fasting non-diabetic patient. Blood sugars may rise after eating a meal to levels above 140 and are lowered by the production of insulin in the normal patient.
Many of us have normal fasting blood sugars, less than 126 mg/dl, but are still considered pre-diabetic because we do not produce enough insulin for our bodily demands. Screening for Diabetes includes measuring a random, non fasting blood sugar. If the blood sugar is higher than 126mg/dl on two occasions, the diagnosis of Diabetes is made. Other patients are diagnosed with a glucose tolerance test. But a relatively new test, the Hemoglobin A1C, HgbA1C, is now the gold standard for the diagnosis of Diabetes. A HgbA1C of 6.0 or higher is diagnostic of Diabetes Mellitus. You can ask your Health Care Provider to order this test the next time you are due for bloodwork.
Many Type 2 Diabetics can be controlled with diet alone. Reducing the total number of calories taken in can reduce insulin levels. Sugars are not the only foods that raise insulin levels. Carbohydrates, such as bread, potatoes, pasta and rice, and bad fats increase levels of insulin. Many diabetics eat out at Mom and Pop Diners or eat fast food. These foods are full of fat and carbohydrates. A Diabetic friendly meal consists of one serving of lean protein, one serving of carbohydrate, and two or more servings of fresh vegetables. Exercise also plays an important part in keeping insulin levels low. Exercise helps the body move insulin from the blood stream into the muscle where it can be used as energy.
When diet and exercise alone are not enough to control sugar levels, there are many by mouth medications that can be prescribed by your Health Care Provider. Diet and Exercise are still important. Medicines can’t do it all. But medications can keep blood sugars in check. If the Diabetes is no longer controlled with diet, exercise and by mouth medications, Insulin and other medications administered under the skin are added to keep blood sugars normal. Many Type 2 Diabetics end up taking Insulin because the supply of insulin producing cells in the pancreas dwindles after years of overuse. The key is to preserve the pancreas function as long as possible with diet, exercise, controlling weight and if needed, medications.
But what is the big deal about high blood sugars? Many of my Diabetic patients say they feel just fine, even when their sugars are high. I use this analogy when teaching my patients about blood sugars. If the blood sugar is too high, it gets too thick, just like maple syrup is thicker than water alone. This thicker consistency of the blood makes it more sluggish and more difficult to flow through large and small blood vessels that feed the organs of the body. Long term high blood sugars can affect the eyes, leading to blindness. Many patients on dialysis are being treated because their kidneys were damaged from elevated blood sugars. Sugar enriched blood flows slower to the brain and heart leading to an increase in heart attacks and strokes. Blood that is thick with sugar cannot properly flow to legs, feet and hands and many poorly controlled Diabetics have to have amputations to treat a local major infection (gangrene) and to prevent the risk of a total body infection (sepsis).
But Diabetes doesn’t run in my family! Do I need to worry? Yes, you do. Because blood sugars rise gradually over time, you may not feel bad. Some symptoms that lead to suspicion of Diabetes are fatigue, frequent eating, frequent liquid consumption and frequent urination. Some patients may have extremely high blood sugars, greater than 300 mg/dl, and have fruity or acetone smelling breath and are at risk of Diabetic Ketoacidosis and Diabetic Coma.
So what can you do to lessen your chance of becoming a Diabetic? Well, you can’t change your genetics. But even patients with a family history of Diabetes can prevent the disease. All patients can greatly reduce the risk of developing Diabetes with improving their diet. Include lean meat, less beef and pork, more fish and chicken, less bad fats like lard and fatback, and more good fats like nuts and olive oil in your diet. We all need to eat more fresh fruits and vegetables. Try to eat foods in their original state, less processed. Instead of drinking orange juice, eat an orange. You will get all the juice, plus the pulp that is fiber. When fresh fruits and vegetables are not available, try frozen varieties over canned ones. Canned foods have less nutrients and more additives like salt. Eat less processed foods like chips, soda, candy, and sweets. When you go to the grocery store concentrate on buying food from the perimeter of the store, the fresh fruit, vegetables, meat and dairy. Try to stay away from the center of the store where the processed foods are located.
Get moving! Exercise greatly reduces your risk of developing Diabetes and helps you control Diabetes if you have it. You should exercise for at least 30 minutes a day, 4 to 5 times a week. Choose something you enjoy doing. Walk, run, hike, play golf, play tennis, garden, surf, rollerblade, snowski, waterski, play with your grandchildren.
Get closer to your ideal body weight. You don’t have to get back down to the size you were when you married. And a few extra pounds will not hurt you as you get older. But you cannot afford to be obese. Calculate you BMI by using the formula provided by the National Heart Lung and Blood Institute at http://www.nhlbisupport.com/bmi. Your Health Care Provider can help you calculate your ideal body weight at the office.
You can find out more about Diabetes from talking with your Health Care Provider. He or she can provide you with pamphlets or reliable internet sites. And you can visit the American Diabetes Association at http://www.diabetes.org.