Understanding Diabetes

What is diabetes?

• Understanding diabetes

  Understanding type 2 diabetes

  

  Our bodies use glucose as fuel by taking glucose into cells, the building blocks of our body, and changing the glucose into energy. Glucose does not go into our cells on its own. It needs a very important hormone called insulin to enter the cells of our body.

  In most diabetics there is an excess of insulin in the blood, but the cells do not respond well to the hormone insulin.

  When the body does not respond normally to the insulin signal, excess sugars build up in the blood instead of going into the tissue cells.

  When the cells of the body do not respond well to the hormone insulin, the condition is called insulin resistance. Insulin resistance leads to high levels of sugar in the blood (hyperglycemia).

  The effect of prolonged high blood sugar levels can cause many health problems which we will discuss later.

• Insulin resistance

  Understanding insulin resistance

  The food we eat is broken down in the stomach into glucose that is absorbed into our blood. The blood carries the glucose to our muscles and organs where the glucose is used as fuel.

  Glucose does not move freely into the muscle and organs on its own. There is a door it must pass through that is controlled by the hormone, insulin. Insulin is the key that allows glucose to move from the blood to the body.

  

  In persons with type 2 diabetes, the body does not respond to the insulin signal of high levels of glucose in the blood. The insulin does not open the cell doors to the muscles and the organs. In response, the body produces large quantities of insulin from the signal for the key to unlock cells for glucose. Thus, excess levels of insulin and glucose are circulating in the blood which the body cannot use.

  

  Patients can reduce insulin resistance and help the body become more sensitive to insulin by exercising, following a diabetic diet low in carbohydrates and fats, and taking all medications as prescribed. A diabetic diet means eating healthy food choices at regular mealtimes.

  

• Diagnosing diabetes

  

  Signs and symptoms of type 2 diabetes often develop slowly. People may have diabetes for years and not know it.

  Persons with type 2 diabetes may experience increased thirst, frequent urination, increased hunger, unintended weight loss, fatigue, blurred vision, slow wound healing and frequent infections.

  Persons are generally diagnosed with diabetes by a blood test called Hemoglobin A1C.

  The Hemoglobin A1C test measures the average blood sugar during the past two to three months.

  Like a sugary drink spilled on the floor that becomes sticky, as glucose floats in the blood for a long period of time, glucose sticks to our red blood cells. Hemoglobin A1C measures how many of our red-blood cells have glucose stuck to them.

  A normal A1C is less than 5.7%. An A1C greater than 6.5% or higher on two separate tests is a diagnosis of diabetes. An A1C between 5.7 and 6.4% is generally considered prediabetes.

• Complications of uncontrolled diabetes

  

  

  • Diabetes can damage the small blood vessels in the kidney.
  • Over time the damaged kidneys are unable to filter the blood of excess fluid and waste from the body.
  • Chronic kidney disease if left untreated can get worse over time and progress to kidney failure.
  • When the kidneys stop working, dialysis or a kidney transplant may be necessary for life.
  • Chronic kidney disease can contribute to the development of heart disease or stroke.
  • Not all patients with chronic kidney disease develop kidney failure.
  • Blood sugar and blood pressure control can help prevent the development of chronic kidney disease.
  • Lose weight, quit smoking and take your medications as prescribed. Choose foods lower in salt and eat more fruits and vegetables.

  

  • Over time, high blood sugar can damage the nerves in your body.
  • One type of nerve damage affects the nerves in legs.
  • Symptoms can range from mild numbness of the feet to pain that makes it difficult to do normal activities.
  • Persons may develop sores or wounds on their feet that the person may not feel which may delay healing or cause more damage.

  

  • People with diabetes are 2 to 4 times likely to develop a stroke or heart disease.
  • The extra sugar in the blood can cause increased deposits of fats or blood clots in the blood vessel walls. Blood clots or deposits can reduce blood flow or completely cut off blood flow to the brain or heart.
  • Brain and heart function depend on receiving oxygen flow from the blood.
  • By following a heart healthy diabetes diet, avoiding all tobacco, exercising and taking all your medications as prescribed, you may prevent stroke or heart attack.
  • Call 911 for any symptoms of stroke or heart attack.

  

  • High blood sugar can damage the blood vessels in the eye leading to a condition called diabetic retinopathy.
  • Early symptoms include floaters, blurriness, dark areas of vision and difficulty perceiving color.
  • Over time, blindness can occur.
  • This is why you should get an eye exam every one to two years.
        

• Goals of diabetes care

  

  The goal of care in treatment of type 2 diabetes is to achieve and maintain an ideal blood glucose, healthy fat levels of the blood (lipids / cholesterol), and blood pressure control to prevent or delay problems from diabetes.

  Some persons can manage their blood glucose by eating well and exercising regularly. Losing excess weight and taking care of yourself by following a self-management plan will help a person achieve blood glucose control.

  The goal for the blood glucose is to range between 80-130mg/dL before a meal and less than 180 mg/dL 1-2 hours after a meal.

  For most patients, the hemoglobin A1C goal is < 7% and the recommendation is for a A1C test every three months.

  However, depending on your age and other medical conditions, your provider may set a higher A1C goal.

  Some patients need medication or insulin to manage their blood sugar.

  Your diabetes provider may prescribe oral medications or insulin to keep your blood sugar at the target levels.

  Blood pressure goal for many patients is 140/90

  Your provider may choose an individualized blood pressure goal based on your medical history and age.

  Goals for lipid management will be defined by your provider based on your overall health, age and goals of care.

  Diabetes education resources

  The YMCA of Seattle offers a Diabetes Prevention Program - contact your local YMCA for more information about the program.