When a patient comes into the clinic and is diagnosed with diabetes, they usually have lots of questions. Often we discover that they are diabetic when they come in for another reason and time is often limited so I thought it would be helpful to discuss some information that I think is important for a newly diagnosed diabetic patient to understand.
Diabetes: A condition that disrupts the way your body uses blood sugar (glucose). We classify diabetes as type 1 or type 2. About 90 percent of people in the United States, Canada and Europe with diabetes have type 2.
To understand the difference between type 1 diabetes and type 2 diabetes, it’s important to understand a little about insulin. Insulin is a hormone in the body that allows all the microscopic cells inside your body to absorb and use glucose, the fuel for your body. Without enough fuel (glucose) you can become tired, shaky, and not feel well. People with diabetes usually have enough glucose (digested from food) in their blood, the problem is that the cells inside the body cannot use it. Insulin is like a key that unlocks the cells inside our bodies and allows us to absorb the glucose that is present in the bloodstream. If our insulin level is low or our bodies cannot use our own insulin effectively (the key to letting glucose into the cells so that it can be absorbed and used by our organs), the sugar in body cannot be absorbed and rises in the blood.
Type 1 diabetes is a problem where the pancreas (an organ inside your abdomen) does not made enough insulin. Remember, insulin is the key that unlocks cells/organs inside the body so that we can absorb glucose (sugar) from the blood. Without enough insulin, our blood sugar goes up and cannot be absorbed. We often treat patients with type 1 diabetes by giving them insulin because their body does not make it at all. That way the insulin will allow their body to absorb the sugar in their blood and use this “fuel” to live.
Type 2 diabetes is a problem where the body cannot use the insulin that is normally present inside our body effectively. We sometimes refer to patients who have type 2 diabetes as having insulin resistance because their bodies becomes resistant to the level of insulin that is normally present. We often treat patients with type 2 diabetes with medications that help the body use insulin more effectively. Sometimes when patients with type 2 diabetes develop too much insulin resistance we have to give them even more insulin to overcome the insulin resistance.
Many patients are overwhelmed after being told they have diabetes, especially because the treatment involves lifelong lifestyle changes that can sometimes be challenging and difficult. Treatment includes medications, dietary changes, and exercise routines. Often weight loss is important in the treatment of type 2 diabetes.
When a patient is newly diagnosed with diabetes, we often recommend that they meet with a registered dietician who can help with dietary changes, a nurse educator who can help teach patients how to take their medications or insulin. It is also often helpful to meet with a social worker or psychologist to discuss the social/emotional impact of a new medical diagnosis such as diabetes.
Causes of type 2 diabetes: Medical experts understand that it’s a combination of both genetic and environmental factors that lead to diabetes. Many people with type 2 diabetes have a family member with the disease as well. The lifetime risk of developing type 2 diabetes is 5-10x greater in first-degree relatives (sister, brother, son, daughter) of a person with diabetes compared to a person with no family history of diabetes. The likelihood of developing diabetes is also higher in certain ethnic groups such as people of Hispanic, African and Asian descent.
Environmental factors such as what you eat and how active you are can also affect the risk of developing type 2 diabetes.
Pregnancy: About 3-5% of patients who are pregnant develop “gestational diabetes” or diabetes in pregnancy. Diabetes during pregnancy usually resolves after the delivery of the baby however these women are at increased risk of developing type 2 diabetes later in life.
Symptoms of diabetes: Some people develop symptoms and many people who have diabetes don’t have symptoms. Possible symptoms include:
1) Feeling thirsty
2) Fatigue or feeling tired frequently
3) Needing to urinate frequently
4) Blurred vision
Testing for diabetes: There are several tests to measure blood sugar (glucose) to establish a diagnosis of diabetes:
1) Random blood sugar: If you check your sugar and at any time of day regardless of when you ate and your blood sugar is 200 mg/dl or higher, and you have symptoms – it is likely that you have diabetes.
2) Fasting blood sugar: A blood test that is performed after not eating or drinking anything except water for 8-12 hours (overnight usually). If your blood sugar is less than 100mg/dl – you probably do not have diabetes. If it’s between 100-125, you have an impaired test and are at risk of developing diabetes if lifestyle changes are not made. If the fasting glucose is greater than 125, and symptoms are present, you have diabetes.
3) Hemoglobin A1c: A blood test that measures your average blood sugar over the past 2-3 months. The normal value is usually 4-6%. This test can be done at anytime of day. A result of 5.7-6.4 indicates a high risk of developing diabetes and greater than 6.4 indicates diabetes.
4) Oral glucose tolerance test: A patient who is fasting for 8-12 hours usually comes in and then drinks a special glucose solution (usually orange or lemon flavored) and your blood sugar is tested before drinking it and again an hour and sometimes 2 hours after drinking the solution. If your blood sugar is higher than 200 two hours after the glucose tolerance test, you have diabetes.
Other medical problems: Often people who have diabetes also have high blood pressure, and/or high cholesterol as well.
Reasons to get your blood sugar under control: Many newly diagnosed diabetic patients aren’t really sure about the value of having good control of their blood sugars because many people don’t have symptoms when their blood sugar is elevated. I think it’s important to remind ourselves of the adverse consequences of poorly controlled diabetes:
1) Increased risk for heart attack/stroke – with poorly controlled blood sugars, you increase your risk of heart attack or stroke dramatically
2) Diabetic retinopathy – diabetes can cause blindness
3) Diabetic nephropathy – diabetes can cause permanent kidney damage and is a leading cause for patients to require kidney dialysis
4) Diabetic neuropathy – diabetes can cause chronic pain or numbness which usually starts in the toes and feet. This can progress and become very painful with time.
5) Poor wound healing – when blood sugars are not well controlled, wounds such as a common scrape or cut can take much longer to heal and become prone to infection.
6) Poor circulation – many patients with poorly controlled diabetes have such poor circulation into their feet or toes that then have partial amputations of limbs performed when chronic infection or death of tissue occurs because of poor circulation.
1) Talk to your primary care physician.
2) Meet with a nutritional counselor to discuss dietary changes that will help bring the blood sugars into control
3) Meet with a diabetic nurse educator to make sure you understand how to use your glucometer, check your blood sugars and take your medication.
4) Record your blood sugars every day with a glucometer. Usually, I recommend that when you first are diagnosed with diabetes that you check more frequently including first thing in the morning before breakfast, 2 hours after breakfast, 2 hours after lunch, and right before going to bed. Write the dates and times down in a journal or computer spreadsheet and remember to bring this with you when you come to your doctor appointment. You can also email or fax these records to your doctor if this is easier for you.
5) Record your blood pressures twice a day – first thing in the morning and also right before going to bed. Try not to check your blood pressure right after exercise or after drinking a cup of coffee, tea or other caffeinated beverage.
6) Make a list of all the medications that you take, and bring the list with you each time you go to your doctor. If your doctor changes any of your medications or dosages, have them write the change on your medication list and update the list at home at your first opportunity.
If you think that you or someone that you know has diabetes, please make sure to be seen by a medical provider.
This document is for informational purposes only, and should not be considered medical advice for any individual patient. If you have questions please contact your medical provider.
I hope that you have found this information useful. Wishing you the best of health,
Scott Rennie, DO
The following organizations also provide reliable health information.
- National Library of Medicine
- National Institute of Diabetes and Digestive and Kidney Diseases
- American Diabetes Association (ADA)
(800)-DIABETES (800-342-2383) (www.diabetes.org)
- The Hormone Foundation
(www.hormone.org/public/diabetes.cfm, available in English and Spanish)