By Dr. Vivek Sinha
Diabetes. You know that it has to do with sugar. You know that being overweight can be bad for you and may lead to it. But what exactly is diabetes? How can you get it? If your parents have it, can you also have it? And most importantly, how can you decrease your chances of getting it?
As a primary care physician, discussion about diabetes and its treatment with patients, takes up a large portion of my day. According to the 2017 National Diabetes Statistics Report put out by the Centers for Disease Control and Prevention, 12 percent of all US adults – more than 30 million people – had diabetes. Of this number, more than 7 million people were unaware or did not report that they had diabetes.
So how can we treat, or, better yet, prevent diabetes from occurring? In order to understand this, we must first understand exactly what diabetes is and how it is caused.
Simply said, diabetes is a condition where our bodies cannot properly use the food we eat, leading to an abnormal amount of sugar or glucose in our blood. This high amount of glucose can then lead to significant medical problems like heart disease, kidney disease, blindness and many more conditions.
When we eat food, it is broken down into glucose. Glucose is what our body uses as energy. However, once this glucose is produced, it cannot be used by the body unless it is sent into the cells that need it for energy. For the glucose to be transported into the cells it uses a transport device called insulin. Insulin is a hormone that is made by the pancreas, a small organ located near the stomach. When the body senses that glucose is high, it sends a signal to the pancreas to make more insulin. The insulin then “takes” the glucose and transports it into the proper cells where we use it up as energy. This is how it normally works.
Diabetes occurs when our body either does not make insulin, or the insulin it does make does not work. Without properly functioning insulin, the glucose builds up in our blood. This is why we test people’s blood for the level of sugar in their body. While it is very important to determine which predominant type of diabetes one has, because treatments may differ, it is also important to know that the lines between both types may be blurred, especially if someone has had uncontrolled diabetes for some time.
If sugar remains high in a person’s blood for too long, very serious problems can occur, including blindness, limb amputation, kidney failure, a weakened immune system and increased risk of heart attack and stroke.
Symptoms of high blood sugar are often subtle at first. They can include fatigue, frequent urination, excessive thirst, extreme hunger, unexplained weight loss or numbness and tingling in the hands or feet. These symptoms often can develop so slowly and gradually that the person may not notice that he or she is having new symptoms. Often, patients may not have any symptoms at all. Many patients find out they have diabetes from their primary care physicians on routine screening physicals or labwork.
So how do we detect diabetes if symptoms are not always present? Assuming we are talking about people who do not have symptoms, we must look at various risk factors. Risk factors for diabetes are vast. They include different categories:
A.) Things we can change, such as being overweight or having a sedentary lifestyle;
B.) Things we cannot change, such as age greater than 45, diabetes in a first-degree relative, history of diabetes during pregnancy, history of vascular disease or being in a high risk ethnic or racial group, including African American, Hispanic, Native American, Asian American and Pacific Islanders; and
C.) Things we may be able to change, such as high blood pressure and high cholesterol.
The U.S. Preventative Task Force and the American Diabetes Association both give recommendations to physicians about who should get tested for diabetes. Generally speaking, the ADA advises all adults who have a body mass index greater than 25 and an additional risk factor for diabetes should get tested at least once every three years. In adults without any risk factors, the ADA advises to start checking at age 45. The USPSTF advises that testing for diabetes as part of a cardiovascular risk profile assessment should begin on all adults with an elevated BMI starting at the age of 40 and should be repeated every three years, at a minimum.
There are different guidelines that apply to children and people with certain higher risk conditions, such as pregnancy. If someone is having the subtle signs and symptoms of diabetes, they should have a thorough medical history, physical exam and appropriate blood work drawn, regardless of their age.
The most common tests used to screen for diabetes are several types of blood and urine tests. One type looks at the actual blood glucose at the specific time of testing and the other type looks at the average blood glucose over a period of three to four months. The urine test looks for the presence of glucose and a specific type of protein. There is also a test called the oral glucose tolerence test — a short version of this is often used to test pregnant women during a specific time in their pregnancy.
Once a person has tested positive for diabetes, it is extremely important to start treatment right away. There are multiple types of pill and injection medications available. Some of these medications help the body produce more insulin, some help the body recognize the insulin that it already produces, and, of course, actual insulin can be given as well.
The type, dosage and number of medications that a person with diabetes needs is a very personal decision that should be discussed with the patient’s physician. Various factors should be considered. If the likely reason that a person has diabetes is due to factors that they cannot change then the medications may be permanent, however if a person likely has diabetes due to reasons that they can change, such as sedentary lifestyle and obesity, then the medications may be temporary until they can control their risk factors.
I advise my patients that regardless of what type of diabetes they have or for whatever reason, they should always participate in an active lifestyle which includes 30 to 60 minutes of moderately-intensive aerobic activity three to five days a week. Prior to starting an exercise regimen, a clearance examination by their physician should be performed so other risk factors, such as heart disease, can be identified. In my opinion, exercise and dietary changes should be “prescribed” to every single person with diabetes.
Diabetes is an extremely serious condition, but there is hope. We know how to test for it, we know who to test for it and we know how to treat it. Most importantly, in certain patients, it is possible to manage diabetes with proper diet and exercise, under a physician’s guidance. So, talk to your doctor. Get tested if appropriate and know your numbers. As the saying goes, knowledge is power.
The writer is the chief medical officer of Belleview Medical Partners, an office and house call practice based in Old Town.