Approximately 37 million Americans are currently living with diabetes. The rate at which people are being diagnosed with diabetes is continuing to increase, making prevention, education, and management an important task for our healthcare system. Understanding what the disease is, why it matters, and how we can manage (or prevent) it can change someone's quality of life. With one in three Americans having diabetes, it is likely that diabetes impacts the life of you or someone you know.
What is diabetes?
Diabetes is a disease involving how our body responds to glucose and insulin. Glucose is a sugar that is important to fuel our brain and high-intensity physical activity. Glucose can either be made by our body through a process called gluconeogenesis, ingested from the food we eat, or released from our body’s glycogen stores.
In order to utilize glucose for fuel, we need a hormone called insulin. Insulin is made in the pancreas and pulls glucose from our bloodstream into our cells, where it can be used as fuel. In some instances, the production or function of insulin is impaired. A person with diabetes is either unable to make insulin (type 1 diabetes) or does not utilize insulin effectively (type 2 diabetes). Since glucose can’t enter cells without the help of insulin, any impairment to the function of insulin results in excess glucose in the bloodstream.
Why does blood sugar matter?
Occasionally elevating our blood sugar can impact our mood, cravings, and fatigue. While these feelings are not ideal, most people’s metabolism is able to successfully compensate for the intermittent spike. However, when blood sugar is chronically elevated, or when we continually cause dramatic spikes in our blood sugar, it takes a toll on our metabolic health.
Over time, this escalates to metabolic dysfunction, pre-diabetes, and possibly diabetes. If diabetes is not managed and high blood sugar persists, heart disease, stroke, eye problems, nerve damage, foot problems, and lower-limb amputations can all occur.
Are there different types of diabetes?
There are three main types of diabetes (not counting prediabetes), type 1, type 2, and gestational. Each type involves a separate impact on the production and function of insulin.
Type 1 Diabetes
Type 1 diabetes is also known as insulin-dependent diabetes mellitus. It occurs when there is a malfunction within the immune system. It destroys the cells in the pancreas that make insulin. As a result, individuals with type 1 diabetes are unable to create insulin on their own. They need to inject insulin daily for survival, hence the name “insulin-dependent” diabetes.
Approximately five to ten percent of people with diabetes are type 1 diabetics. It is the form of diabetes that usually has the earliest age of diagnosis. Type 1 diabetes is usually diagnosed in youth 13-14 years, although infrequent, it can be diagnosed into adulthood. Unlike type 2 diabetes, type 1 can have a sudden onset of symptoms. Some signs include: urinating often, feeling very thirsty, extreme fatigue, weight loss (even though you are eating sufficient amounts of food), cuts that are slow to heal, and/or blurry vision. While there is currently no way to prevent type 1 diabetes, working with a healthcare team can help to manage blood sugar and lead a healthy life.
While prediabetes is not a diabetes diagnosis, it is a precursor to type 2 diabetes. Prediabetes occurs when blood sugar levels are high (fasting blood sugar between 100 and 125 mg/dL), but not high enough to rise to the level of type 2 diabetes. The Center for Disease Control reports that more than one in three American adults have prediabetes. Thus, while it is not an official type of diabetes, it can be a valuable sign of the status of our metabolic health. However, prediabetes is challenging to diagnose since it develops over a long period of time. Over 80% of individuals with prediabetes are unaware that they have this condition. Thus, it is incredibly important to keep up with our fasting blood sugar tests in order to catch prediabetes before it crosses that threshold into type 2 diabetes. The good news is, prediabetes is reversible. With proper diet, exercise, and lifestyle choices, our metabolic health can dramatically improve.
Type 2 Diabetes
Type 2 diabetes develops over time. It is preceded by prediabetes and is usually diagnosed over the age of 45. It is the most common type of diabetes with 34 million Americans living with type 2 diabetes. People with type 2 diabetes have the physical ability to make insulin but their body does not make enough or use insulin effectively. A family history of diabetes, being overweight, being physically inactive, or having prediabetes increases the odds of developing type 2 diabetes. While symptoms tend to present themselves gradually over time, numbness in the hands/feet, extreme fatigue, cuts that are slow to heal, urinating often, and extreme thirst are a few signs to see a healthcare professional. In coordination with healthcare professionals, type 2 diabetes can be prevented or delayed by managing blood sugar, increasing physical activity, and making other healthy lifestyle choices.
Gestational diabetes can develop in some women during pregnancy. While it often resolves after giving birth, women who have had gestational diabetes have an increased risk of developing type 2 diabetes later in life. One of the challenges of diagnosing gestational diabetes is that women often have no symptoms. This is why it is important for women to undergo a glucose screening test between weeks 24 and 28 of pregnancy. The test can be performed earlier if prenatal urine glucose levels are high or if the woman has an increased risk of diabetes. Women can reduce the risk of developing gestational diabetes by performing regular physical activity and maintaining a healthy weight before becoming pregnant.
How is diabetes diagnosed?
Fasting Blood Sugar Test
A fasting blood sugar test is likely the test with which the majority of people are familiar. It is a blood draw that is typically done in the morning (because you have to be fasted before giving blood). The test is sent to a lab and you and/or your physician receive the results. A fasting blood sugar result of less than 100 mg/dL is considered healthy. Individuals with a test result between 100 and 125 mg/dL would be considered prediabetic. Diabetes would be diagnosed by a physician after two separate tests showing a fasting blood glucose level over 126 mg/dL.
Glycated Hemoglobin (A1C) Test
A glycated hemoglobin (A1C) test measures an average level of blood sugar in hemoglobin over the past three months. The higher your blood glucose levels, the more hemoglobin you’ll have with sugar attached. An A1C of 6.5% or higher on two separate tests is indicative of a diabetes diagnosis.
Random Blood Sugar Test
A random blood sugar test is just that, random. It is a spontaneous measurement of blood glucose used to detect extraordinarily high blood sugar levels. Regardless of when food was last consumed, a blood glucose measurement greater than 200 mg/dL should prompt further tests.
Continuous Glucose Monitors
Continuous glucose monitors (CGMs) are a way in which users can more accurately and conveniently track glucose levels at home. While your healthcare provider may assign additional tests after viewing the results, CGMs can be incredibly helpful as a preventative and testing tool for individuals concerned with their metabolic health. By following glucose levels over time, testing foods, and measuring the glucose response, users can make more informed choices for foods that will not dramatically spike blood sugar. It has recently become a trend to test foods and beverages intended to lower your blood sugar response to meals. Foods and drinks that stabilize glucose levels can lead to improved metabolic health. In the long run, targeting ways in which we can reduce post-meal glucose spikes can significantly reduce the risk of type 2 diabetes.
What can we do to manage our diabetes with our healthcare team?
Manage the Diabetes ABCs
The diabetes ABCs is an acronym used to help people with diabetes keep track of the appropriate aspects that can help to manage their diabetes. The “A” stands for A1C test. This test provides an average value that indicates how well diabetes has been managed over the past three months. The National Institute of Diabetes and Digestive and Kidney Diseases suggests that people with diabetes set a goal to achieve an A1C value lower than 7%. However, it is important to consult with your healthcare team to determine what goals are appropriate for you.
“B” is for blood pressure. Managing blood pressure can help to prevent health problems that are associated with diabetes. A common blood pressure goal for people with diabetes is to be below 140/90 mm Hg.
“C” stands for cholesterol. There are two types of cholesterol, LDL and HDL. LDL, low-density lipoprotein, is an unhealthy cholesterol. It can clog blood vessels and impair our vascular health. If left unmanaged, elevated LDL levels can lead to strokes or heart attacks. HDL, high-density lipoprotein, aids in the removal of bad cholesterol from our vasculature. Diabetes can lower the amount of HDL and increase LDL. Thus, speaking with your healthcare team about ways to manage cholesterol can help to reduce the risk of heart attack or stroke.
The “s” represents smoking. Smoking is problematic for people with diabetes. Both smoking and diabetes narrow the blood vessels, which requires the heart to pump harder than it should. This increases the risk of heart attack, stroke, nerve disease, diabetic eye disease, and hampers circulation. When people with diabetes stop smoking, their risk factors greatly improve.
There are a lot of factors involved in the management of diabetes. Along with the ABCs, our food selection can dramatically improve our health. When we make food choices that do not spike our blood sugar, we can maintain more stable blood glucose levels. The tricky aspect is everyone’s metabolism is a bit different. Foods that spike some people's blood sugar do not increase the blood glucose of others to the same extent. However, there are some staples that consistently increase blood glucose: sugar, processed foods, candy, and sugary drinks. People with diabetes should shoot to keep blood glucose levels between 80 and 130 mg/dL before eating. Approximately two hours after starting to consume food, the goal is to have blood sugar below 180 mg/dL. Choose healthy, protein-rich foods when possible.
Physical activity is a great way to improve metabolic health and increase sensitivity to insulin. This makes the body more effective at pulling glucose from circulation and putting it to use in our cells as fuel. Activity also helps to reduce the likelihood of developing diabetes-associated concerns (like heart disease or nerve damage). We understand that exercise can be a daunting task for some people. Start small, take the stairs instead of the elevator, park further away from your building, or walk on a lunch break. Try to work up to 30 minutes of physical activity per day.
Take Away Message
Diabetes is a complex disease. There are three main types, each with its own challenges. Type 1 diabetes requires dependence on insulin and constant vigilance of blood sugar levels. Type 2 diabetes develops over time and can be delayed or prevented with the help of lifestyle changes like food selection and physical activity. Gestational diabetes can develop during pregnancy and can be found via a glucose screening test. With the diabetes ABCs, informed choices about food selection, and physical activity, you and your healthcare team can devise a plan to manage diabetes.
Author: Dr. Colleen Gulick