The Ellis Exclusive: Take Action Today – 3 Crucial Changes To Treating Type 2 Diabetes

Outline

Introduction

Types & Risk Factors of Diabetes

Detecting Type 2 Diabetes

Type 2 Diabetes Treatment

Take Action Today

Introduction

Today we’re talking about one of the most common diseases in the US – affecting 1 in 10 people – and the seventh leading cause of death in the country: diabetes. 

In the last 20 years, the number of adults diagnosed with diabetes has more than doubled – and it continues to rise at an alarming rate. Today, more than 37 million Americans are diabetic, and perhaps the most concerning part is that 1 in 5 of them don’t know they have it. 

Because diabetes occurs when the body develops insulin deficiency or resistance, over time it can cause serious health problems, such as heart disease, vision loss, kidney disease, and peripheral vascular disease (which leads to lower extremity amputations). In fact diabetes is the number one cause of kidney failure, lower-limb amputations, and adult blindness.

Unlike many health conditions, diabetes is managed mostly by you, with the support of healthcare professionals. The good news is that you can fight or control your diabetes through serious lifestyle changes. 

So in this post we hope to spread awareness on different types of diabetes, their symptoms, treatment, and natural ways to reduce your risk. We’ll particularly focus on Type 2 diabetes, which affects around 90-95% of diabetics. 

Types & Risk Factors of Diabetes

Let’s take a minute to first understand what diabetes is, as that will give us insight on how to properly manage and treat it. 

Diabetes is a chronic health condition that affects how your body turns food into energy. Most of the food you eat is broken down into sugar (or glucose) and released into your bloodstream for energy. Your pancreas gets a signal when your blood sugar goes up so that it releases insulin, which regulates glucose in the body. 

Insulin helps blood sugar enter the body’s cells so it can be used for energy, and also signals the liver to store blood sugar for later use. With diabetes, your body doesn’t make enough or release the insulin needed to control your blood sugar levels. When there is a lack of sufficient insulin, or if cells stop responding to insulin, it causes too much blood sugar to stay in your bloodstream. 

Now that we have an overview on what causes diabetes, let’s take a closer look at the 3 main types of diabetes, which all have different risk factors. 

Type 1 Diabetes

There is much less known about Type 1 diabetes, commonly called juvenile diabetes, compared to the other two. Studies indicate it may be caused by an immune reaction; unfortunately, currently there is no known way to prevent Type 1 diabetes. Risk factors are also not as clear as for prediabetes and Type 2 diabetes; however, known risk factors include: 

• Family History: Having a parent, brother, or sister with Type 1 diabetes.
• Age: Though you can get Type 1 diabetes at any age, it usually develops in children, teens, or young adults.
• Race: In the US, White people are more likely to develop Type 1 diabetes than other races. 

Type 2 Diabetes

Type 2 diabetes, usually called adult onset diabetes, is the most common type. This condition develops when the cells in your body don’t respond normally to the effects of insulin, referred to as insulin resistance. There are several risk factors for Type 2 diabetes, including: 

• Age: Type 2 diabetes most often develops in people over age 45, but more and more children are also getting it. 
• Family History: Having a parent, brother, or sister with Type 2 diabetes increases your risk. More than 75% of children with Type 2 diabetes have a close relative who has it. 
• Other Health Conditions: Being obese or overweight, or having prediabetes, gestational diabetes (diabetes during pregnancy), or medical treatments that require steroid medications, increases your risk of Type 2 diabetes.
• Lifestyle: If you have an inactive lifestyle or are physically active less than 3 times a week.
• Race: Are an African American, Hispanic or Latino, American Indian, or Alaska Native person. Some Pacific Islanders and Asian American people are also at higher risk.

Gestational Diabetes

Gestational diabetes is a type of diabetes that can develop during pregnancy in women who don’t already have diabetes. In the US, 2% to 10% of pregnancies are affected by gestational diabetes every year. 

All pregnant women have some insulin resistance during late pregnancy. However, some women have insulin resistance even before they get pregnant, which means they start their pregnancy with an increased need for insulin and are more likely to have gestational diabetes. 

Gestational diabetes usually goes away after you give birth, but about 50% of women with gestational diabetes go on to develop Type 2 diabetes. Your baby is also more likely to be born early, have low blood sugar, have obesity as a child or teen, and develop Type 2 diabetes later in life.

You’re at risk for gestational diabetes if you: 

• Are 25 years or older.
• Have given birth to a baby who weighed over 9 pounds.
• Have a hormone disorder called polycystic ovary syndrome (PCOS).
• Have a family history of type 2 diabetes.

Detecting Type 2 Diabetes

Type 2 diabetes symptoms often develop over many years, and often go unnoticed for a long time. Sometimes the classic symptoms may not even occur; in fact many patients are asymptomatic when diagnosed. 

That said, some things you can look out for include: unexplained weight loss, fatigue, excess urination, blurred vision, excess appetite, and excess thirst. Because these symptoms can be hard to pinpoint, particularly as they’re not specific to diabetes and can occur in other health conditions, it’s important to know the risk factors we discussed earlier. 

Furthermore, the best way to check if you have diabetes is through a simple blood sugar test. It is well recognized that a persistent blood sugar of greater than 140 mg/dL can lead to diabetes complications, even in people who have no symptoms.

You can also visit your doctor for an A1C test (also known as hemoglobin A1C or HbA1c test), a common blood test that measures your average blood sugar level over the past 2-3 months. It’s used to diagnose Type 1 and Type 2 diabetes, and to monitor how well you’re managing your diabetes if you have it. 

The higher your A1C level is, the poorer your blood sugar control and the higher your risk of diabetes complications. A normal A1C level is below 5.7%, while Type 2 diabetes is usually diagnosed with a level greater than 6.5%. 

A level between 5.7% to 6.4% indicates prediabetes, where blood sugar levels are higher than normal, but not high enough yet to be diagnosed as Type 2 diabetes. In the US, 96 million adults (more than 1 in 3) have prediabetes – and more than 80% of them don’t know they have it. 

Over a 5-year period, as much as 25% of people with prediabetes will go on to develop Type 2 diabetes. It’s also recognized that people with prediabetes have an increased risk of cardiovascular disease and stroke. Therefore many providers require that prediabetes patients undergo treatment to delay or prevent the onset of full-blown diabetes.

Type 2 Diabetes Treatment

In general, the goal of Type 2 diabetes treatment is to maintain a hemoglobin A1C of less than 7%. This occurs when the average blood sugar is less than 154 mg/dL. 

Treating Type 2 diabetes is highly individualized based on risk factors, unique lifestyle changes, and target blood sugar levels specific to you. However, it usually comprises of 3 main components: dietary management, regular exercise, and medications. 

Making serious lifestyle changes are a crucial part of preventing or managing Type 2 diabetes, both for the patient and their family – Type 2 diabetes is increasing in children and teens not just because family members are related, but because they share certain habits that increase their risk. 

Remember that you can make these changes today – please don’t want until you’re diagnosed with diabetes to start eating healthier or moving more. By developing a diet and exercise plan for the whole family, you can prevent diabetes and other serious health problems. 

Diet Management

The first stage of treatment is getting educated on and implementing the right diet. Carbohydrate-rich foods that rapidly enter the bloodstream and increase blood sugar should be avoided – cut down foods containing processed sugars, such as cakes, pies, and candies, and highly processed starches, such as sugar, white bread, rice, pasta and cream potatoes. 

Instead, opt for complex carbohydrates: foods that are high in fiber (such as whole-wheat bread), raw fruits and vegetables, lean meats, legumes (beans, peas, etc.), and low-fat milk or cheese. Drink more water instead of soft drinks and sugary juices. 

When preparing meals, make sure portion sizes are well-balanced. Your doctor or nutritionist would be able to best advise on what your specific balanced diet looks like; however, generally you should look for a healthy combination of proteins, fats, and unrefined carbs. A great rule of thumb you can follow is the plate method – fill half your plate with non-starchy vegetables, a quarter with lean protein, and a quarter with whole grains or starchy food.

It’s also important to note if your meal times and quantities are consistent. If you often skip meals, let too much time pass between meals, or eat too much or too often, this can impact your blood sugar levels. Start eating regularly (every 3-5 hours), and eat similar-sized portions at meals and snacks. Make sure to plan meals ahead of time to help you stay on track.

Regular Physical Exercise

Getting regular physical exercise increases the body’s general conditioning and its ability to absorb sugar from the bloodstream. This is referred to as insulin sensitivity, which is the opposite of insulin resistance. 

Physical activity is also a major determinant in managing a healthy weight and preventing obesity, as well as reducing stress and getting restful sleep. These are all important factors in managing your blood sugar levels. 

It is recommended that diabetics get 30 minutes to 1 hour of moderate physical activity 3-5 times per week. The goal should be at least 150 minutes of activity per week. Effective moderate-intensity exercises include brisk walking, running, swimming, and cycling. Housework such as vacuuming, lawn-mowing, and raking leaves also counts! 

If you’re presently inactive, start small – aim for small increments, such as 10 minutes per day, and slowly build up. Look for ways to make physical activity more fun: pick an activity you enjoy, such as dancing or a specific sport, and if possible do it in a group to encourage progress.

Medications

Medications available to treat Type 2 diabetes have greatly improved in recent years. Although long-acting insulins remain one of the most effective treatments, other oral and injectable medications may be very effective. 

Because diabetes can lead to other diseases and conditions, certain medications may be required to prevent or control your risk. In particular, diabetics often have an increased risk of cardiovascular disease due to 3 common conditions: hypertension, hyperlipidemia, and obesity.

Effectively managing obesity is an imperative aspect of managing diabetes. The healthiest weight loss program consists of a calorie-restricted diet, along with regular exercise and frequent weight monitoring. There are multiple FDA-approved drugs to help promote weight loss, but bariatric surgery has been proven more effective.

Obtaining the ideal body weight also helps to improve blood pressure and cholesterol levels. To obtain the desired cholesterol levels, it is usually necessary and strongly recommended that all diabetics take medications to lower the cholesterol. Having low cholesterol helps reduce the risk of heart disease and kidney disease in diabetics, who are at high risk of these conditions.  

Hypertension also increases the risk of kidney disease, amputations, heart disease, and strokes. To maintain the aggressive blood pressure control generally required for diabetics and help reduce the risk of kidney failure, it’s recommended that all diabetics take blood pressure medications that block angiotensin. These medications are called ARB and ACE inhibitors.

All diabetics should discuss medication treatment options with their provider, whenever their condition is out of control. However, it’s important to note that medications used to treat diabetes cannot overcome the negative effects of a poor diet and inadequate exercise.

Implementing Your Plan

Through maximizing efforts to control the hemoglobin A1C, all diabetics should be able to live a long and healthy life and avoid complications such as renal failure, heart attacks, amputations and strokes, which are especially common in communities of color.

Most providers have seen patients develop complications of diabetes in spite of their best efforts to comply with prescribed medications and treatment goals. It is impossible for providers to identify which patients will develop diabetes complications; therefore, we struggle to have patients comply with all recommended treatments to help reduce the risk of complications, premature disease, and premature death. 

We encourage all diabetics to follow recommendations from their medical provider to obtain a hemoglobin A1C less than 7%, through taking prescribed medications, regular exercise, and a healthy diet. You can visit the National Diabetes Prevention Program website for more info. 

Take Action Today

While there isn’t a specific cure for diabetes, it can be prevented or controlled by following the right diet, exercise, and medication plan. You can manage your risk or severity of diabetes by healthy eating, being active, and taking prescribed medication. Make a habit of regularly monitoring your body weight, blood sugar levels, blood pressure, and cholesterol levels as well.

If you are currently struggling with increased obesity or weight gain, unhealthy eating patterns, and lack of exercise, it’s important to take action as soon as possible. Start making lifestyle changes today using the tips shared in our article, and get necessary screening tests. 

Whether you’re at increased risk of diabetes, or are already diagnosed with prediabetes or another type, make regular appointments with your doctor for a proper treatment plan. This guidance includes developing a healthy eating and exercise plan, setting target blood sugar levels and other goals for you, testing your levels regularly, and providing self-management education on diabetes. 

If you’d like to schedule a test or have any questions, please don’t hesitate to contact us. 

Wishing you continued health and wellness always,

Clarence Ellis, MD