Surviving disease: Diabetes Type 2

According to the CDC, about 38 million Americans have diabetes (1 in 10 people), and approximately 90-95% of that number are type 2 diabetics. The average age is about 45 years old. They also say that childhood obesity rates are rising, and so are the rates of type 2 diabetes in youth. They have found that more than 75% of children with type 2 diabetes have a close relative who has it as well.  

What is diabetes? 

Insulin is a hormone created in the pancreas that is essential to help transport the sugar over the cell wall. It is the key that opens the door to the cell.

There are two primary problems. The pancreas (which creates the hormone Insulin) does not produce enough insulin to move the sugar into the cells. The second issue is the cells do not respond to the insulin available, also known as Insulin Resistance.

When the body develops insulin resistance, the pancreas creates more insulin to move sugar into the cell. However, eventually, the pancreas can not keep up any longer. Blood sugar rises. When that happens, the person enters the stage referred to as prediabetic.

Type 2 diabetes usually occurs when there is a problem with how the body regulates and uses sugar (glucose) for fuel in muscle, fat, and the liver. The pancreas can’t make enough insulin to keep blood sugar levels within normal range. When too much sugar is circulating in your blood, those high blood sugar levels can cause illness in circulatory, nervous, or immune systems.

Prediabetic fasting blood glucose range is about 100-125 mg/dl, and 126 mg/dl or higher indicates diabetes. 

What are the contributing problems or risk factors of diabetes?

According to the CDC:

• Having prediabetes already.
• Being overweight (BMI of 25 or more) or obese (BMI of 30 or more) are the main risks. 
• Are 45 years of age or older.
• Have a parent, brother, or sister with type 2 diabetes.
• Are not physically active for at least 150 minutes a week. The less active a person is, the greater the risk of diabetes (and disease in general). 
• Being diagnosed with diabetes during pregnancy or giving birth to a baby who weighed more than 9 pounds.
• African Americans, Hispanic/Latino Americans, American Indians, Pacific Islanders, or   Alaskan Americans are all at higher risk. 
• Asian Americans are also at higher risk if their BMI is 23 (overweight) or more.
• Carrying most of your fat in your abdomen versus hips and thighs
• Thin individuals with fat around their organs. Fat that’s stored in our stomach and surrounds internal organs (visceral fat) can’t be seen from the outside.
• Family history of a parent or a sibling that has type 2 diabetes.
• Age. Especially over 35 years old.
• Polycystic Ovary Syndrome. 
• Blood Lipid levels with low high-density lipoprotein (HDL) cholesterol and high levels of triglycerides. HDL is the good cholesterol that offsets the bad cholesterol.

Here is a BMI calculator (standard and metric) and waist measurement guide from the Mayo Clinic:

Tool: BMI and waist circumference calculator – Mayo Clinic

Symptoms of type 2 diabetes often develop over time and can be missed. However, you should report any of the following to your primary care physician.

• Increased thirst.
• Frequent need to urinate.
• Increased hunger.
• Unintentional weight loss.
• Fatigue.
• Blurred vision.
• Slow wound healing.
• Frequent infections.
• Numbness in feet or hands, unusual sensations.
• Darkening of your skin around the neck or armpits 

What are the complications of type 2 diabetes? 

Risk factors for diabetes are risk factors for other diseases. Management of blood glucose is needed to reduce the risk of complications. 

• Dementia (currently proposed to be called type 3 diabetes). 
• Slow healing. Poor circulation and infection can result in loss of fingers, toes, feet, and legs.
• Eye damage. Diabetes can increase visual issues and potential blindness.
• Hearing loss. 
• Sleep apnea due to obesity in diabetics is common. 
• Increased risk of Heart disease. (Stroke and elevated blood pressure due to narrowing of the blood vessels).
• Nerve damage. (Numbness, tingling, or burning of feet and hands damages the heart, and digestive system and can cause erectile dysfunction as the high blood sugar damages the nerves). 
• Kidney disease. Chronic or End-Stage Kidney disease could result in dialysis.  

Type 2 Diabetes is NOT curable but can be mitigated through diet. Prevention is the imperative. 

The best time to address your issues with elevated blood glucose is during the phase of insulin resistance or prediabetes.  

• Lose weight. Make your goal a normal BMI for your body. Measure your waistline and determine where you should be. Even losing just 10% of your body weight may help improve your risks. Work with your primary care physician regarding a weight loss plan. 
• Be active daily with a goal of about 30 minutes of walking daily. Walk during lunch break. Take even short breaks throughout the day. Be creative.  
• Develop a healthy eating plan.   
• Eat healthy fats (avocado, olive, coconut oils), lean meats, fresh fruit, and vegetables as much as possible to meet your calorie intake for weight loss.  

If you have type 2 diabetes, hope is NOT lost. While it does require more work, you can live a long and healthy life. 

The American Diabetes Association recommends a diabetes meal plan that is “moderately low

In carbs” and includes the following:

• Less than 25 grams of carbohydrates in each meal or snack.
• Protein and healthy fats in every meal.
• Eat plenty of fiber to aid digestion and help manage blood sugar levels.
• No highly processed carbohydrates or added sugars
• Limited natural sugars (from fruit or sweeteners) can cause blood sugar spikes.
• Moderation in sodium  

Managing your type 2 diabetes can help prevent an escalation of your disease.  

• Do the things mentioned for prediabetics – it will help you keep your glucose level and avoid highs and lows of your blood sugar.  
• Take your medications (oral and injectables) as directed. Taking medications is critical as you can miss your glucose spike (it takes the glucose a while to rise to the peak level). Always eat after taking your medication. Hypoglycemia (low blood sugar) is dangerous.  
• Check your blood glucose daily. Morning and evening are best. Some health plans now offer 14 systems that automatically track your glucose day and night. Keep good records of your numbers. Your physician will need to review your trends. Report unexpected changes as it could be the symptom of an infection or some other problem.  
• Make sure you are enlisting the help of all available resources (your primary care doctor, foot doctor, dentist, eye doctor, registered dietitian, diabetic educator, pharmacist, and community groups).
• Do not use extra insulin to offset foods that should not be on your diet in the first place. I had a patient who liked to eat sweets after dinner and would check her blood glucose at bedtime and take more insulin to cover it. She was taking her dinner insulin before dinner, eating, and checking her blood sugar 4-5 hours after dinner. Different types of Insulin work have different lengths of time they are active. She could easily take too little insulin or too much. You will need a routine if you want to be successful.  
• Check your feet daily for any injury and report issues to your primary care physician.  You may not be able to feel any foot injuries due to a lack of feeling from neuropathy.  

Living with diabetes changes your life. You can learn to live with it. Avoiding complications is the goal. You still can have a good quality of life. 

Hopefully, I have given you enough knowledge so you can reverse, mitigate, or avoid the health risks of type 2 diabetes.