Diagnosed with diabetes? If you work with your doctor to closely monitor and control your blood sugar and commit to eating right, you’re likely to live a long, healthy life.
Diabetes is a dangerous condition that deserves serious attention if you’ve been diagnosed with it or suspect you’re at risk.Of all the disorders I treat, diabetes is among the sneakiest and most destructive. Sneaky, because unless you know you’re at risk and are checking for signs, you might not learn you have diabetes until your body is already damaged in some way. Nearly one-third of people who have diabetes don’t know it. Destructive because if it goes untreated, it can lead to one (or several) serious complications, including heart attack or stroke, continuous pain from degenerated nerves, the need for foot or leg amputations from gangrene, kidney failure, or vision loss from retinopathy. It’s a condition that deserves your serious attention if you’ve been diagnosed with it or know (or even suspect) you’re at risk. On a positive note, if you work with your doctor to closely monitor and control your blood sugar and commit to eating right and exercising regularly, you are likely to live a long, healthy life.
What Is Diabetes?
Your body’s most readily available source of energy is glucose, a simple sugar created when carbohydrates are broken down during digestion. If everything is working properly, glucose enters the bloodstream, which triggers the pancreas to release insulin; insulin allows glucose to leave the blood and enter and nourish every cell in your body. This energy transfer at the cellular level fuels all of your bodily functions, from thinking to digestion to movement. If you have diabetes, there is a problem with the way your body produces or uses insulin. If glucose can’t move into the cells, it stays in the bloodstream, leading to the high blood-sugar levels characteristic of the disease.
There are three main types of diabetes. With type 1 diabetes, the insulin-producing cells of the pancreas are destroyed, so there is no insulin available to let glucose enter body cells. It’s as if a circuit breaker tripped, and the power is simply cut off. No insulin means no energy is getting to the cells. Type 1 diabetes is an autoimmune disorder for which there is no known prevention or cure. It requires treatment with insulin and carefully planned meals.
With type 2 diabetes, there are two potential insulin problems: The pancreas can’t make enough insulin, or the cells have become resistant to the insulin your body produces. Either or both of these conditions may be present. Some energy gets through to the cells, but much of the glucose is blocked from entering them and stays in the bloodstream. Treatment options vary; some people can manage their disease with dietary changes alone, and others require medications or insulin replacement.
There is also a third type of diabetes called gestational diabetes, which affects about 4 percent of pregnant women. Although this type of diabetes usually disappears after the baby is born, research suggests that women who develop gestational diabetes have an increased risk of developing type 2 diabetes later in life.
What Affects Type 2 Diabetes?
Type 2 diabetes was once called adult-onset diabetes, but now we know that even young children can develop this disease. The number-one risk factor — by far — is being overweight. Genetics, age, and lack of exercise also contribute to your personal risk, but body weight is the biggest contributor. The American Diabetes Association recommends that anyone who is overweight talk to his or her physician to see if testing is appropriate. There are three tests used to check for diabetes:
- A fasting plasma glucose test (FPG) measures blood glucose after an overnight fast. It is quick, convenient, and inexpensive. Normal fasting blood sugar is below 100 mg/dL. If your blood glucose is 126 mg/dL or higher, the test will be repeated. Two readings of 126 mg/dL or higher means a diagnosis of diabetes. If your blood glucose is 100 to 125 mg/dL, your diagnosis is prediabetes.
- An oral glucose tolerance test (OGTT) measures blood glucose after an overnight fast, and again two hours after you drink a high-glucose liquid. This test is more sensitive than an FPG, but it is inconvenient because of the two-hour wait between blood draws. Normal two-hour blood glucose is below 140 mg/dL. If your two-hour blood glucose is 200 mg/dL or higher, the test will be repeated. Two readings of 200 mg/dL or higher means a diagnosis of diabetes. If your two-hour blood glucose is 140 to 199 mg/dL, your diagnosis is prediabetes.
- The glycated hemoglobin test (more commonly called A1C) was recently approved as a third method of diagnosing diabetes. The A1C test is a simple blood test that measures your average blood sugar level over a two to three month period. An A1C reading above 6.5 percent indicates a diabetes diagnosis. This test has many advantages over older tests, and many experts now consider it the “gold standard.”
What Are the Dangers of Prediabetes?
It’s probably obvious, but the greatest danger of prediabetes is that it can lead to diabetes. Research shows that most people with prediabetes will develop diabetes within ten years unless they lose at least 5 percent of their body weight, become more active, and make changes to their eating habits.
Prediabetes is also one of the hallmarks of another disorder called metabolic syndrome, a cluster of risk factors that, when taken together, create a toxic environment in your blood vessels. People are typically diagnosed with metabolic syndrome when they have at least three of the following conditions: elevated blood pressure (130/85 mmHg or higher), elevated triglycerides (150 mg/dL or higher), low HDL cholesterol (below 50 mg/dL for women, below 40 mg/dL for men), large waist circumference (greater than 35″ for women, greater than 40″ for men), or fasting blood sugar higher than 110 mg/dL. The combination of any three is dangerous, even if the numbers are only slightly out of the normal range. People with metabolic syndrome have an increased risk of heart attack and stroke, as well as type 2 diabetes.
The good news is that prediabetes doesn’t always progress to diabetes. The Diabetes Prevention Program, which studied more than 3,000 people with prediabetes, showed that participants who changed their diets, lost weight, and started exercising reduced their risk of developing diabetes by an astounding 58 percent. That’s slashing your risk of diabetes by more than half, without drugs! In fact the one-two punch of diet and exercise was more effective than treatment with the medication metformin, which reduced the risk of diabetes by 31 percent.
What Are the Dangers of Type 2 Diabetes?
It’s important to understand that diabetes is a chronic condition; you can control the disease, but it will never go away. The best you can hope is that your disease will go into a form of remission — contained, but still subject to return. You’ll need to monitor your blood sugars daily, and your doctor will want to periodically check your progress, too. The A1C test I mentioned earlier as a diagnostic tool is also incredibly useful for tracking how well you’re controlling your sugars. This test provides a status report on your average blood glucose level over a two- to three-month period. So A1C captures more than your blood sugar reading at the moment your doctor draws blood for the test—it is also a measure of whether you’re controlling your diabetes or your diabetes is controlling you.
High A1C levels indicate a high risk of complications from diabetes. To put it bluntly, uncontrolled blood sugar is a poison, and the effects of it are systemic. The most common problems faced by people with diabetes are:
- Cardiovascular Problems. Extra blood sugar is toxic to your blood vessels. High levels of glucose form free radicals, unstable molecules that damage cellular membranes, including the delicate cell membranes of your blood vessels. Over the long term, the damage may trigger the immune system to secrete inflammatory chemicals that further assault the blood vessels. The process can lead to serious cardiovascular problems — and may cause a heart attack or stroke. ·
- Eye Diseases. Diabetes increases your risk of cataracts, which clouds the lens, and glaucoma, which can lead to blindness from damage to the optic nerve. In addition, uncontrolled blood glucose damages the delicate blood vessels in the retina, leading to diabetic retinopathy, the leading cause of blindness in America. Studies show that people can prevent retinopathy by keeping their blood-sugar levels as close to normal as possible. ·
- Neuropathy. Uncontrolled diabetes exposes your nerves to something like a sugar bath, which leads to the degeneration of nerve cells, or neuropathy. In addition, if the blood vessels that feed the nerves are damaged by diabetes, then those nerves can die. Early nerve damage may cause tingling or numbness, particularly in the feet, and over time may cause pain or large areas of numbness; if nerves die, muscles of the feet or hands can whither. As the nerve damage becomes more extensive in the body, it can cause impotence, dizziness, gastrointestinal problems, and general weakness. Because the feet are usually affected first, good foot care is critically important.