Managing Diabetes: A Doctor's Guide to Living Well

 

Introduction to Diabetes

Diabetes is a chronic condition that affects how the body turns food into energy. There are three main types of diabetes:

• Type 1 Diabetes - The body does not produce insulin. It is an autoimmune disease, usually diagnosed in children and young adults. People with type 1 diabetes need to take insulin every day to survive.

• Type 2 Diabetes - The body does not produce enough insulin or cannot use it well. It accounts for around 90-95% of diabetes cases and is largely linked to obesity, physical inactivity, family history, and genetics. It is typically diagnosed in adults over the age of 45, but increasingly younger as well.

• Gestational Diabetes - Develops in pregnant women who did not previously have diabetes. High blood sugar levels can complicate pregnancy and endanger both mother and baby. It often disappears after giving birth but increases the mother's risk of developing type 2 diabetes later.

Diabetes has reached epidemic proportions worldwide. According to the International Diabetes Federation, approximately 463 million adults aged 20-79 worldwide have diabetes as of 2019. This number is projected to increase to 700 million by 2045. The prevalence of diabetes is steadily rising in countries of all income levels, but low- and middle-income countries are disproportionately affected. Lifestyle changes, population growth, aging, urbanization, and increasing prevalence of obesity and physical inactivity are all contributing factors.

Symptoms and Diagnosis

Common Symptoms

The most common symptoms of diabetes are:

• Frequent urination
• Increased thirst and appetite
• Weight loss
• Fatigue
• Blurred vision
• Slow-healing sores
• Frequent infections

Symptoms can develop rapidly with type 1 diabetes, while they tend to develop more slowly and be less severe with type 2 diabetes. Some people with type 2 diabetes have no symptoms at all and are only diagnosed during routine bloodwork.

Diagnostic Tests

If diabetes symptoms are present, the following tests can help confirm a diagnosis:

• A1C test - This blood test provides an average of blood sugar levels over the past 2-3 months. An A1C of 6.5% or higher indicates diabetes.

• Fasting plasma glucose - A blood sample is taken after fasting overnight. A fasting blood sugar level of 126 mg/dL or higher suggests diabetes.

• Oral glucose tolerance test - Blood samples are taken before and 2 hours after drinking a sugary drink. Diabetes is diagnosed if blood sugar is 200 mg/dL or higher after 2 hours.

• Random blood sugar test - A blood sample is taken at a random time. A random blood sugar level of 200 mg/dL or higher, along with symptoms, points to diabetes.

These diagnostic tests help determine if someone has prediabetes or diabetes. They also aid in diagnosing the type of diabetes.

Prevention Through Lifestyle Changes

Diabetes prevention focuses heavily on lifestyle modifications. Even modest changes can have a big impact on your risk of developing type 2 diabetes. Here are some tips:

• Maintain a healthy weight. Excess weight contributes to insulin resistance and is a main risk factor for diabetes. Losing 5-10% of your body weight, even through moderate exercise and diet changes, can reduce your risk. Set a realistic goal and focus on slow, steady weight loss over time rather than a quick fix.

• Exercise regularly. Aim for 150 minutes per week of moderate activity like brisk walking. Regular exercise can improve insulin sensitivity and help manage weight. Mix up cardio, strength training, and stretching. Start slow if you're new to exercise and build up over time.

• Eat a balanced, healthy diet. Focus on vegetables, fruits, whole grains, beans, lentils, nuts, lean protein and healthy fats like olive oil. Limit processed carbs, sugary foods and beverages, saturated fats, and sodium. Portion control is also key.

• Get enough sleep. Not getting the recommended 7-8 hours per night is linked to insulin resistance. Work on good sleep habits like keeping a schedule, limiting evening screen time, and managing stress.

• Limit alcohol intake. Drinking alcohol, especially in excess, is associated with pancreatitis and disruption of blood sugars. Moderation is key.

• Stop smoking. Smokers have a higher risk of developing diabetes. Quitting can quickly reduce your risk as well as improve your health overall.

With consistency over time, these lifestyle changes can significantly impact your risk and are an important part of diabetes prevention. Consult your doctor for guidance on reducing your individual risk.

Treatment

The main treatment for diabetes focuses on keeping blood sugar levels under control. This is achieved through a combination of medications, insulin therapy, lifestyle modifications, and careful monitoring.

Medications

Several types of medications are available to help manage blood sugar levels in people with diabetes:

• Metformin is usually the first medication prescribed. It reduces glucose production by the liver and improves the body's sensitivity to insulin.

• Sulfonylureas stimulate the release of more insulin by the pancreas. Examples include glyburide, glipizide, and glimepiride.

• Meglitinides also prompt the pancreas to secrete more insulin. Repaglinide and nateglinide are examples.

• DPP-4 inhibitors slow the breakdown of incretins, which are gut hormones that stimulate insulin release after meals. Sitagliptin, saxagliptin, and linagliptin are in this class.

• SGLT2 inhibitors lower blood sugar by causing the kidneys to excrete excess glucose in urine. Canagliflozin, dapagliflozin, and empagliflozin are SGLT2 inhibitors.

• GLP-1 receptor agonists mimic the hormone GLP-1, which promotes insulin production while suppressing appetite. Exenatide and liraglutide are examples.

Insulin Therapy

People with type 1 diabetes, and some with advanced type 2 diabetes, require insulin therapy to control blood glucose. This involves injecting insulin under the skin using syringes, pen injectors, or insulin pumps. The timing, frequency, and dosage are tailored to the individual. Your doctor will advise on the best insulin regimen.

Lifestyle Changes

Making lifestyle changes is crucial for managing diabetes. Following a healthy diet, getting regular exercise, maintaining a healthy weight, managing stress, and not smoking can help keep blood sugar under control. Work closely with your healthcare team to make sustainable lifestyle changes.

Monitoring

Frequent self-monitoring of blood glucose levels allows you to assess the effectiveness of medications, insulin, and lifestyle changes. Keep a logbook and share readings with your doctor regularly. Getting HbA1c tests every 3-6 months provides an overall picture of blood sugar control.

In summary, modern treatments allow people with diabetes to effectively manage the condition through a multifaceted approach. Work closely with your doctor to find the optimal management plan for your needs and preferences. Consistency is key - stick to your treatment regimen and healthy lifestyle choices.

Blood Sugar Monitoring

Monitoring your blood sugar levels regularly is a critical part of diabetes management. This helps you understand how food, physical activity, and medications impact your blood sugar. It also alerts you to highs and lows so you can take corrective action when needed.

Testing Frequency

How often you need to test your blood sugar depends on the type of diabetes you have and your treatment plan. People with type 1 diabetes need to test more often, sometimes up to 10 times per day. For type 2 diabetes, testing 1-4 times per day is common, but your doctor may recommend more frequent testing.

Test when you wake up, before meals, 1-2 hours after meals, before bed, before exercise, after treating a low blood sugar, and anytime you have symptoms of a high or low. Keeping a log helps you spot patterns.

Target Ranges

Ideal blood sugar targets are:

• Fasting (before breakfast): 80-130 mg/dL
• Before meals: 80-130 mg/dL
• 1-2 hours after meals: Less than 180 mg/dL

Work with your doctor to determine personalized targets based on your age, medications, risk of hypoglycemia, and overall health.

Logging

Keeping a detailed log of your blood sugar readings, food intake, medication doses, and activity helps you spot trends and determine how different factors impact your levels. There are paper logs, spreadsheet templates, and apps that make logging easy. Review your records regularly and bring them to doctor appointments to inform treatment adjustments. Consistent logging leads to better control.

Diet and Nutrition

Eating healthy is critical for managing diabetes. The focus should be on eating a balanced diet full of nutrient-dense foods. Some key diet tips include:

• Follow a consistent carb counting plan. Carb counting involves tracking the amount of carbohydrates you eat and drink. This helps maintain better blood sugar control. Work with a dietitian to determine your daily carb target.

• Plan meals ahead of time. Meal planning prevents last minute food choices that can spike blood sugar. Make a weekly meal plan that incorporates healthy mixed meals with lean proteins, high fiber foods, fruits, vegetables and healthy fats.

• Eat smaller, frequent meals. Eating smaller meals more often helps keep blood sugar stable versus letting yourself get overly hungry. Aim for eating every 3-4 hours.

• Choose high fiber foods. Foods high in fiber like vegetables, fruits, whole grains, beans and lentils help control blood sugar spikes after meals.

• Limit added sugar. Foods with added sugars can cause blood sugar spikes and crashes. Limit sweets, soda, juices and instead choose whole fruits, nuts, yogurt and other unsweetened options.

• Read nutrition labels. Get in the habit of reading nutrition labels to look at the total carbs, fiber, added sugars and serving sizes.

• Stay hydrated. Drink water as your primary beverage. Staying hydrated helps stabilize blood sugar.

Following a balanced diabetic diet takes commitment but is essential for maintaining healthy blood sugar levels. Work closely with your doctor or dietitian to develop the right meal plan for your needs.

Exercise

Getting regular exercise is essential for people with diabetes. Exercise helps lower blood sugar levels by making your body more sensitive to insulin. It also burns fat, helps maintain a healthy body weight, and reduces cardiovascular risk factors.

The American Diabetes Association recommends getting at least 150 minutes per week of moderate-intensity physical activity, such as brisk walking. For even greater health benefits, aim for 300 minutes per week. Spread out your activity over at least 3 days per week, with no more than 2 consecutive days without exercise.

Aerobic exercise like walking, swimming, or cycling is excellent for diabetes management. Strength training with weights or resistance bands at least 2 times per week is also encouraged, as it builds muscle mass which helps regulate blood sugars.

Before beginning a new workout routine, discuss an exercise plan with your doctor. They can help identify any precautions needed based on your health status. Be sure to check blood sugar levels before, during, and after exercise. Carry quick-acting carbohydrates in case blood sugar drops too low. Wear proper footwear and keep feet dry to prevent injury. Drink plenty of water before, during and after exercise to stay hydrated.

The benefits of regular exercise are immense for those with diabetes. An active lifestyle helps control blood sugar, reduces risks, aids weight management, and improves overall fitness. Just be sure to get medical guidance, take safety precautions, and monitor blood sugar levels. With a thoughtful approach, an exercise regimen can be life-changing for any diabetic.

Foot Care

Keeping your feet healthy is crucial for people with diabetes. Due to nerve damage and poor circulation, even small cuts or blisters can lead to serious infections if left untreated. Make sure to inspect your feet daily and follow proper hygiene and circulation steps.

Inspection

• Check your feet every day for cuts, blisters, redness, swelling or nail problems. Be sure to look between the toes and the bottoms of your feet too.

• If your eyesight is poor, use a mirror or ask someone else to check your feet for you.

• Call your doctor immediately if you see any signs of infection like redness, pus, swollen areas or red streaks.

Hygiene

• Wash your feet daily in lukewarm water. Make sure to dry them carefully, especially between the toes.

• Avoid very hot water as it can burn your skin. Check bath water with your hands or thermometer first.

• Use a mild soap and moisturize after washing. Avoid putting lotion between the toes as moisture can cause infection.

• File corns and calluses gently with an emery board or pumice stone. Don't cut corns or calluses yourself.

Circulation

• Keep blood flowing to your feet by wiggling your toes and doing foot exercises several times a day.

• Don't cross your legs or ankles for long periods when sitting.

• Put your feet up when sitting to improve blood flow.

• Avoid wearing tight socks, elastic, or anything constricting. Wear clean, dry socks daily.

• Don't use hot water bottles or heating pads on your feet.

Following these simple foot care tips can help prevent serious foot problems for diabetics. Be vigilant about inspection and contacting your doctor right away if you have any concerns. Healthy feet are vital for mobility and quality of life.

Eye Care

People with diabetes are at risk of various eye problems, especially diabetic retinopathy. Diabetic retinopathy occurs when high blood sugar levels damage the blood vessels in the retina. Symptoms often don't appear until the damage has progressed. However, it's important to have regular comprehensive eye exams to check for early signs.

Some tips for eye health:

• Get a dilated eye exam at least once a year. The optometrist will put drops in your eyes to widen the pupils and check the retina and optic nerve for signs of damage.

• Control your blood sugar, blood pressure, and cholesterol levels. Keeping these levels close to target range lowers your risk of diabetic retinopathy worsening.

• Quit smoking. Smoking increases the risk of damage to blood vessels.

• See your eye doctor right away if you notice any vision changes like blurriness, floaters, or shadows. These could indicate retinopathy or a retinal detachment, which needs prompt treatment.

• Get laser surgery or an injection if retinopathy is caught early. Laser therapy can stop abnormal blood vessels from leaking. Injections of medication into the eye can slow the formation of new vessels. Both treatments may prevent further vision loss.

• Have surgery to repair a detached retina or remove blood if retinopathy reaches an advanced stage. If extensive bleeding distorts the retina, a vitrectomy removes the hazy vitreous gel and replaces it with a clear solution.

Protecting your vision is an essential part of managing diabetes. Regular eye exams and timely treatment can prevent unnecessary vision loss.

Conclusion

Managing diabetes requires dedication but it is very possible to live a full, active life. The key is to work closely with your doctor, follow prescribed treatments, and make lifestyle adjustments. Focus on keeping blood sugars in your target range through healthy eating, regular exercise, and proper medication. Monitor blood sugars and get regular exams to catch any complications early.

With the right attitude and commitment, many people find they can gain control over their diabetes. The rewards are well worth the extra effort - preventing complications, feeling better day-to-day, and enjoying life to the fullest. Though challenging, managing diabetes is very achievable through knowledge, discipline and self-care. By partnering with your doctor and making smart choices every day, you can continue thriving while keeping diabetes in check. Stay positive and know that you have the power to live the happy, healthy life you deserve.