Why should I care about diabetes?

By now, the medical term “diabetes” is not unknown or foreign to the global population. Many friends, relatives, and even strangers have probably at one point told you they are controlling their diet, sugar intake, or cutting down on soda because of a scary lab result. They told you they were either taking pills or the dreadful injection to help them control this disease. I recently had a conversation with a relative in India and asked them, “Can you tell me what you know about diabetes?” And they said, “It means I have too much sugar in my blood.” While that is true, that is not the beginning or the end of the story. That is simply the middle.

Here are some plain facts about diabetes in the United States; they set the stage for why we should care about diabetes.

1. 38 million people have diabetes
2. 1 in 5 people do not know they have diabetes
3. 90-95% of all diagnosed cases of diabetes = type 2 diabetes
4. Diabetes is the 8th leading cause of death
5. Medical costs for people with diabetes are more than twice as high as people without diabetes

This condition is not an unthinkable illusion, but rather a reality that greater than 10% of the United States is battling with. While it may or may not affect you immediately, it is important to know some basics about diabetes so you are prepared if the occasion should arise. Being prepared for a conversation with a healthcare professional gives you more autonomy over your medical journey and your health.

What is diabetes?

The CDC defines diabetes as “a chronic (long-lasting) health condition that affects how your body turns food into energy.” Normally, when you eat a meal, let’s say a piece of apple pie, your body breaks down the food into glucose. Glucose is a type of sugar that the body can use to make energy. As the levels of glucose increase in your bloodstream, your pancreas (an organ nestled right behind your stomach) releases a hormone called insulin. Insulin lets the cells in your body know that there is glucose in the bloodstream that they can take up and use for energy. In diabetes, this entire process goes haywire because of one of two reasons:

1. The body stops producing enough insulin. OR
2.  The cells stop responding to the insulin.

To be more technical, there are two types of diabetes:

1. Type 1 Diabetes: Results from the immune system attacking and destroying insulin-producing cells in the pancreas. Individuals with Type 1 diabetes require insulin injections for survival.
2. Type 2 Diabetes: Linked to insufficient insulin production or cells ignoring insulin. Often associated with lifestyle factors such as poor diet and lack of physical activity.

Either way, one result is certain - there is more sugar in the bloodstream.

Now the question becomes…

How does increased sugar in the bloodstream affect me?

Many know that diabetes means more sugar in your bloodstream but rarely know why that can cause health problems. And without knowing the why, it is hard to motivate yourself to care or make a change.

Below are the most common symptoms of diabetes and how increased sugar brought about those symptoms.

Increased urination

If you have increased sugar in your blood, your kidneys need to work overtime to filter and absorb that extra sugar. Eventually, they are going to get exhausted and sugar will slip into the urine. Where there is increased sugar, there is increased water. So, that leads to increased urination.

Weight loss

If you are losing a lot of sugar and water through urination, you will lose calories and get dehydrated. This will lead to weight loss.

Blurry vision

Wherever sugar is, water follows. So when there is increased sugar in the blood, the water in the lens of the eye follows the sugar and leaves the lens. This leads to blurry vision.

Numb or tingling hands or feet

Too much sugar in the blood leads to blood vessel damage. Those blood vessels provide nerves with nutrients. If they are damaged, they cannot provide those nutrients which leads to numbness and tingling.

Feeling tired/fatigued

Since the sugar is not being used by cells and is just hanging out in the bloodstream, the cells are not producing energy. Also, the increased urination is making you dehydrated. The combination of less energy and dehydration leads to fatigue.

Dry skin

Same as blurry vision; where sugar is, water follows. Increased sugar leads to water being pulled from the skin cells which leads to dry skin.

Increased infections

High levels of sugar can lead to decreased blood flow and this can impact how the body heals. It may not be able to get the body’s infection-clearing cells to where the infection is.

Now, I understand what symptoms I should be looking out for, but how will the doctor diagnose me with diabetes?

Diagnosis of diabetes, like a few other diseases, involves blood tests. There are four main tests that doctors can use:

1. A1c - you are going to hear this a lot when doctors, relatives, and friends talk about diabetes. This number looks at the average amount of sugar in your blood for the last 2-3 months! If this number is between 5.7% and 6.5%, that is pre-diabetic. If that number is 6.5% or greater, that is diabetic.
2. Fasting plasma glucose (FPG) - this test requires you to not eat or drink anything (except for water) for at least 8 hours before. It checks how much sugar is in your blood when you have not had anything to eat. If this number is 100-125 mg/dL, that is pre-diabetic. If that number is 126 mg/dL or greater, that is diabetic.
3. Oral glucose tolerance test (OGTT) - unfortunately with this test, you are going to have to drink a sweet drink that may or may not suit your taste. Your blood sugar will be measured before you drink it and then two hours later. This test tells the doctor how well your body is able to absorb the sugar and remove it from the bloodstream. If this number is 140-199 mg/dL, that is pre-diabetic. If that number is 200 mg/dL or higher, that is diabetic.
4. Random plasma glucose test - this is done, as the name suggests, randomly. It is normally done when someone has severe diabetes, and it can be done at any time of day, fasting or not. If this number is greater than 200 mg/dL, that is diabetic.

In the event that I or someone I know gets diagnosed, how are the doctors going to treat it?

This answer can get very technical, so we will stick to the basics. There are two prongs of the treatment plan - changing lifestyle and adding medication.

Let’s first talk about lifestyle changes that your doctor will talk to you about and why those changes are important:

1. Modifying your diet - since the food we put in our body determines our blood sugar, it is important that we change what we are eating so that the blood sugar levels don’t rise and cause the symptoms that we talked about earlier.
2. Exercise - going to the gym is the hardest part of my day, so the question is why is it important? Exercising makes the cells in your body more sensitive to insulin, which means that the cells want to absorb the sugar out of your bloodstream and that therefore, decreases your blood sugar.
3. Weight reduction - when you have a few extra pounds that can build up around the organs (we call this visceral fat). More visceral fat leads to increased inflammation. Increased inflammation means that insulin cannot work as well. If insulin cannot work as well, the cells cannot absorb the sugar in your blood. If the cells cannot absorb the sugar in your blood, that means increased blood sugar which leads to all the symptoms that we talked about before.

Then the doctor will slip into medications. They will talk about some pills that can be taken (such as metformin) or injections that you will need to take (such as insulin). The goal of these medications, regardless of which one they recommend, is to decrease the sugar in your bloodstream.

But, what if I do not want it to get to that point? What can I do to prevent diabetes?

This is going to sound eerily similar to the lifestyle changes we discussed earlier:

1. Eat healthy
2. Exercise more
3. Maintain a healthy weight
4. Try to cut down on smoking and drinking
5. Say hi to your doctor yearly

We talked about tips 1-3, but 4 and 5 are new. Why is it important to cut down on your smoking and drinking? Nicotine changes the way that the cells in your body respond to insulin; if they don’t respond to insulin, they cannot absorb glucose, which raises blood sugar levels. And, for alcohol, we don’t know exactly why it lead to increased blood sugar levels, but we do know that diabetics who drink have higher blood sugar and A1c levels and lower insulin levels compared to diabetics who don’t drink.

And, lastly, check in with your doctor! Even if it is for them to say, “You’re doing great, see you next year!” Because doctors will catch symptoms that we often miss. They ask questions that seem inconsequential to us but can actually signify something of importance. And, more importantly, those patients who go to their yearly physical and preventative visits, can take advantage of the preventative services to prevent diabetes or manage it better.

Pearls of wisdom

Diabetes can be a scary diagnosis to receive, but you are not alone. Take advantage of your doctors, your family, and friends. Ask them for help in improving your diet (consider a referral to a dietitian or nutritionist), exercising more (talk to your best friend every day and go on a while walk while you do), and reducing your weight (join a weight loss group where you can support and motivate each other from a place of kindness).

Written by Prathyusha Dasari.

Edited by Alexander Habte Habtemariam, MD.

References

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