Introduction

To say that we’re experiencing a diabetes epidemic hardly begins to describe the problem. Chances are that just about everyone knows someone with diabetes. And in fact, some experts believe that it will soon affect nearly half our population.

Maybe you’re asking yourself: just how serious is diabetes? If 7 million people are walking around with it undiagnosed, is it really such big a deal? Unfortunately, it’s a very, very big deal. According to National Diabetes Statistics, diabetes is the seventh leading cause of death in the U.S. It’s also the leading cause of kidney failure, lowerlimb amputations not caused by trauma, and new cases of blindness among adults. It can also cause other deadly or devastating health complications, like heart attacks; strokes; severe neuropathy (nerve damage); musculoskeletal changes; and sexual dysfunction for both men and women.

That said, these outcomes absolutely are not inevitable. And while diabetes is a serious condition that requires careful monitoring, coordination with healthcare providers, and real effort to manage, it can be managed—in rare cases, even reversed.

For a diabetic to stay healthy, feel well, and avoid complications, the trick is to keep blood sugar levels within normal limits carefully and consistently. Managing blood sugar can cut a diabetic’s risk of having a heart attack or stroke in half (N. Engl. J. Med. 2005).

Of course, controlling blood sugar is easier said than done. But for those motivated to make a few significant lifestyle changes—changes that would benefit all of us, not just people with elevated bloodsugar levels—the effects can be dramatic. Even life-saving.

But what exactly is diabetes? And what causes it?

When a person has diabetes, his blood is flooded with sugar (glucose), and yet his cells can’t get the energy they need from it. That’s because a diabetic’s insulin, the hormone that processes glucose, either isn’t working properly or there isn’t enough of it.

There are two kinds of diabetes. In type 1, the immune system attacks the pancreas and destroys the beta cells there that produce insulin. Because insulin is crucial for the proper functioning of our cells, type 1 diabetics have to get it by injection.

Type 1 diabetes is sometimes referred to as “juvenile diabetes”—though that’s misleading, both because it can come on in adulthood, and because type 2 diabetes is increasingly common in kids and teens. In fact, the Centers for Disease Control predicts that one in three kids under age 5 will develop type 2 in the course of their lives. If they’re Latino, those numbers shoot to one out of two. This is especially alarming since obesity-linked type 2 diabetes advances more quickly in kids and is harder to control than in adults.

With type 2 diabetes, which is far more common, the problem isn’t a lack of insulin. In fact, sometimes there’s an overabundance. But the body’s cells don’t respond well to it; that’s what’s meant by “insulin resistance.”

As for type 2’s causes, there’s a general consensus that obesity and inactivity are important factors. But some experts believe there could be other triggers, too, like high-fructose corn syrup—found in everything from soda to cereal to salad dressing—which can affect insulin resistance in animals. We suggest avoiding it whenever possible.

Some experts believe that the endocrine disrupter bisphenol A (BPA) also may lead to insulin resistance. It’s a compound found in many plastics, cans and cash register receipts. Apart from avoiding sodas and plastics—and, needless to say, all sodas in plastics—what else can someone with type 2 diabetes or prediabetes do to get and stay healthy? The good news is: a lot.

Experts estimate that more than 26 million Americans are living with diabetes. That exceeds 8 percent of the population, or just about one out of every 12 people. Of those, 7 million are undiagnosed—they don’t know they have it. Perhaps even more alarming, roughly 80 million Americans may have “prediabetes.”

10 Key Steps for Keeping Diabetes in Check

1. Monitor & control blood sugar
2. Exercise (with friends when possible)
3. Eat a low-carb diet
4. Maintain a healthy body weight
5. Enlist your support network
6. Manage stress
7. Feel free to indulge in coffee if you have prediabetes
8. Consider adding cinnamon to your diet
9. Get adequate vitamin D
10. If needed, talk to your doctor about medications

The treatment for type 1 diabetes is fairly complicated, and requires a doctor’s vigilant supervision. So we’ll be focusing mostly on type 2 diabetes in this guide. Many of these suggestions can be helpful for type 1 diabetes, not to mention those of us who don’t have diabetes

Tracking Blood Sugar Over Time

Fasting Blood Sugar

As we noted above, monitoring blood sugar is crucial for determining if you are have diabetes or prediabetes. The usual thresholds for diagnosis require a blood test taken when you are fasting (have had nothing to eat for at least eight hours). Under those conditions, a result of 99 mg/dL or lower indicates no diabetes. A test result of 126 mg/dL or higher is the signal that you have diabetes. Then there is the gray zone. With fasting blood sugar results between 100 and 125 mg/dL, doctors classify people as having pre-diabetes. Following through on the suggestions in this Guide may help you drive your blood sugar down so that you no longer fall in the prediabetic range.

HbA1c

When your healthcare provider wants to get a sense of your blood sugar over time, they will probably use a test of glycosylated hemoglobin, or HbA1c (sometimes abbreviated A1c). This measures how much sugar has attached itself to the hemoglobin protein in your red blood cells. This gives a sense of what your blood sugar has been doing over the past six to eight weeks.

People with normal blood sugar generally have an A1c level below 5.7%. At 6.5% or higher, the A1c clearly indicates diabetes. As with blood sugar, intermediate results for the A1c test (between 5.7 and 6.4%) suggest prediabetes. Getting the A1c down below 5.7% is desirable. 

If your primary care provider is concerned that you might have diabetes, but you haven't fasted, you might get a "random blood sugar test." If the blood sugar is 200 mg/dL, your provider will probably swing into action. You may be asked to undergo a glucose tolerance test and you will almost certainly be required to do a fasting blood sugar test. Those will give a more definitive assessment of diabetes. If you do have diabetes, you will learn how to test your own blood sugar. This may feel daunting or scary at first. But as you will read further on, this can be a very powerful tool for learning how your body reacts to the things you eat.

Publication Information

Published on: November 12th, 2019 | Last Updated: February 6th, 2023
Publisher: The People's Pharmacy

© 2023 The People's Pharmacy

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