Understanding Diabetes: A Healthier Future Starts With Knowledge
Cassidy Crawford, M.S., RD, LN, CHI, Livingston HealthCare
November is a time for tucking in and getting our winter gear out of storage, but it is also a time to pay special attention to one important medical condition. November is National Diabetes Awareness Month. In the state of Montana, there are about 77,000 people living with diabetes, so let’s shed some more light on this condition.
There are a few ways to diagnose diabetes including a fasting plasma glucose (<100 mg/dL), A1C (<5.7%), random glucose (<140 mg/dL), or an oral glucose tolerance test. Once diagnosed, there are three main types of diabetes: Type 1 Diabetes (T1DM), Type 2 Diabetes (T2DM), and Gestational Diabetes (GDM).
T1DM is a chronic condition in which your body, specifically your pancreas, stops making insulin. This hormone works to lower the amount of sugar in our blood after we eat and drink. Without insulin, folks with T1DM are unable to bring their blood sugar back to normal levels. It was previously called Juvenile Diabetes since most people are diagnosed as children or young adults, but we now know that T1DM can appear well into adulthood. This type accounts for 5-10% of all diabetes cases.
The second main type of diabetes, and the one that account for the majority of cases, is T2DM. These are folks that make insulin, but whose cells are less responsive to it. Overtime the pancreas can also get tired and slow down or reduce its production of the hormone. This means even though their pancreas is working hard, their blood sugar remains high. Just like T1DM, medication, including insulin, can be used to keep blood sugar down and manage symptoms. The other key treatment for T2DM is lifestyle intervention in the form of balanced eating, physical activity, stress management, and more.
For both T1DM and T2DM there are some signs and symptoms we watch for, as well as complications we are trying to avoid. Common indicators of diabetes include feeling very hungry/thirsty, having to urinate frequently, blurry vision, fatigue, slow healing wounds, abnormal weight loss, and numbness/tingling in the hands and feet. Across time, consistently high blood sugar that is not being treated can lead to an increased risk of other chronic conditions including cardiovascular (heart) disease, which comes with an increased risk of stroke, and chronic kidney disease. Other common side effects include neuropathy, diabetes-related eye disease, changes in oral health, and foot and skin complications.
Finally, GDM affects up to 9% of pregnancies, typically being diagnosed between 24-28 weeks of pregnancy with an oral glucose tolerance test. Hormones made by the placenta can make the cells less sensitive to insulin. Sometimes the pancreas cannot keep up, and the blood sugar will remain high.
If GDM is not addressed it can increase the risk of large birth weight, preterm birth, low blood sugar after birth, and T2DM later in life for the baby. For the pregnant person it can increase the need for a C-section delivery, high blood pressure/preeclampsia, and T2DM after birth. The recommendations for managing GDM are frequent blood sugar checks (~4 times per day), and lifestyle change (dietary adjustment and movement). Medication including insulin may also be needed. The good news is, for many, once the baby is born your blood sugar should return to normal.
If you are reading this and noticing a feeling of stress or anxiety creeping over you, fear not, there are systems in place to support you. Your primary care provider is a great place to start if you are experiencing the symptoms above or are worried about your risk of diabetes-related complications. Endocrinologists are experts in conditions like diabetes. Additionally, Certified Diabetes Care and Education Specialists (CDCES) are here to walk you through the 9 pillars of diabetes management. Dieticians are among the healthcare professionals specially trained to help individuals make sustainable lifestyle changes. Leaning on your medical community is the best bet for the best outcome.
Enjoy the end of autumn and don’t forget to celebrate National Diabetes Awareness Month by popping in to see a CDCES, asking your PCP about your diabetes risk, or getting your A1C checked!
*Note* All information provided above comes from the Montana Department of Health and Human Services and the American Diabetes Association