Diabetes: A Primer (Part 1)

According to recent statistics, almost 10% of Americans (approx. 30 million individuals) have diabetes, and 12.2% of New Yorkers are diagnosed with either Type 1 or Type 2 diabetes. Diabetes is a condition in which a person’s insulin response to the metabolism of carbohydrates is impaired, which leads to increased amounts of glucose in the blood and urine. Insulin resistance characterizes Type 2, which is the most common form, and those with Type 2 may not require insulin injections. Those with Type 1 diabetes, also known as ‘insulin-dependent’ diabetes, require insulin to be given via an injection to regulate their blood sugar. Type 1 diabetics are usually diagnosed as children, and make up a much smaller percentage of the total number of those diagnosed with diabetes.

With diabetes diagnoses on the rise, it’s likely you know someone with diabetes, or perhaps you’ve heard the term ‘pre-diabetes.’ Pre-diabetes is just that—a phase of insulin resistance one experiences prior to being diagnosed with ‘full-blown’ diabetes. Simply put, people with both pre-diabetes and diabetes have trouble lowering their blood sugar after meals because of a lack of insulin.

First, some quick definitions:

Carbohydrates – the macronutrient that contributes directly to the rise of blood sugar; made up of grains, dairy products, fruit and vegetables

Insulin resistance – a state in which your body requires more insulin to remove glucose from the bloodstream that previously required

Insulin dependence – a state in which your body does not produce enough or any insulin, requiring insulin injections

Now, let’s talk a little about what happens when we consume carbohydrates. Digestion begins in the mouth with our saliva, and continues in our stomach. Carbohydrates are broken down into glucose, which travels to the bloodstream. Insulin, secreted by our pancreas, removes the glucose from the blood and it’s either used for energy, or gets stored for later use in the muscles (called glycogen), or is converted to fatty acids for long-term storage. When our bodies need energy, we use our available blood glucose first, and then rely on other sources, such as muscle or liver glycogen.

In someone with diabetes, blood glucose remains elevated after meals because of insulin resistance. In order to lower it, those with Type 1 diabetes must give themselves insulin injections (either before meals or as part of a scheduled series to provide overall coverage), while those with Type 2 diabetes may be able to manage their blood sugar levels with diet alone, oral meds alone, or a combination of oral meds and insulin.

Symptoms of diabetes include increased urination and thirst, increased hunger despite normal intakes, weight loss (Type 1), tingling in hands and feet (Type 2), fatigue and blurry vision. As part of an annual physical, you doctor may run a variety of blood tests to see what your blood sugar is. If it’s elevated, you may require further testing to diagnose pre-diabetes or diabetes. These tests include:

HgA1C – a measure of average blood sugar over a period of the previous 3 months, normal is less than 5.7%

Fasting Plasma Glucose (FPT) – a test administered after a period of fasting for 8 hours, normal is less than 100 mg/dl

Oral Glucose Tolerance Test (OGTT) – a test that measures how your body processes sugar, normal is less than 140 mg/dl, often used to diagnose gestational diabetes

Pre-diabetes – diagnosed by HgA1C 5.7-6.4%, FPG 101-125 mg/dl, OGTT of 140-199 mg/dl

Diabetes – diagnosed by HgA1C 6.5%, FPG 126 mg/dl or more, OGTT of 200 mg/dl or more

If you suspect you may be pre-diabetic, it’s wise to schedule an appointment with your doctor, as chronically elevated blood sugar levels can lead to neuropathy, amputation, blindness, stroke and kidney disease.

Whether you have pre-diabetes or diabetes, or simply need to lose weight, diet and lifestyle changes can improve your blood sugar levels. Losing as little as 5% of your body weight (approximately 10 lbs for a 200-lb individual) and exercising for 30 minutes a day can lead to better health outcomes and decreased risk for co-morbidities, such as heart disease.

Be sure to tune in next month for Part 2 of this installment: how you can manage your blood sugar through diet and lifestyle changes!



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