An epidemic of obesity and the rising prevalence of diabetes, recently among children, is a definite cause for concern for our society. But who exactly is at risk? If I am not over weight, do I still need to worry?
There are two types of diabetes. Type 1 mostly affects children and young adults. In this condition, the pancreas ceases to produce the hormone Insulin, which lowers the blood sugar. The only way the body survives is to have daily (or even more frequent) Insulin injections. Type 2 used to be called “old age diabetes”, since it used to primarily affect aging adults. In this condition the body does opposite: it produces too much Insulin, necessary in order to fight excessive levels of blood sugar. However, it is poor quality Insulin, and this condition called Insulin Resistance. This type of diabetes is known to be hereditary, and also related to excessive weight and lack of exercise.
Often Type 2 diabetes is present for 3-5 years before being diagnosed. A fasting glucose level of 100 and above is cause for suspicion of diabetes. The test called Hemoglobin A1C (or glycosylated hemoglobin) is more definitive. It measures the average blood sugar for 3 months prior to running a test, thus giving an idea of overall situation with sugar control, not just on the day of the blood test. A normal result with the hemoglobin AIC test is below 5.7; and value above that may be considered diabetes. Clinical studies indicate that HgB A1C levels predict the likelihood of diabetes complications, including heart attack, stroke, poor circulation and risk of leg amputation, kidney failure, blindness, neuropathy, impotence… the list goes on. The American Association of Clinical Endocrinologists, recommends a target HgB A1C level of 7.0 or below, but in my opinion, that is not good enough for an individual patient. Anybody with diabetes should be aiming at 5.7. Only at that level are the risks of complications equal to that of the general population.
Can a thin, even underweight person have type 2 diabetes? Yes, but it is certainly not as common, and usually indicates a genetic predisposition. Because body size and weight are not predictive factors, I have made it a part of my routine practice to test HgbA1C once a year for all my patients.
Treatment of type 2 diabetes always starts with proper diet, exercise, and if overweight, weight loss efforts. It’s worth spending time explaining to the patient what exactly they need to consider and focus on their diet. I make sure my patients know about the Glycemic Index of various foods and try to stick to low Glycemic Index choices. Monitoring blood sugar at home often helps patients understand how their diet effects sugar levels. My typical recommendation is to test twice a day at the beginning of the diagnosis: once before a meal, and again 90-120 minutes after. Rotate testing around different meals to learn what’s happening based on time of day and what’s eaten. I recommend keeping a log of these readings as well as detailed description of the meal. I then review this “homework assignment” in 2-3 weeks.
Daily exercise of at least 30 minutes is a must. It has to become a priority a priority no matter how busy we are with our schedules and responsibilities.
If diet and exercise do not bring desired results, I prescribe oral medication. Nowadays, we are fortunate to have a variety of choices, some of which may help lose weight in addition to controlling blood sugar.
Insulin injections may be needed at later stages of type 2 diabetes. By then the pancreas becomes exhausted and can no longer produce Insulin.
Exercising and eating natural foods go a long way towards increased quality of life – such habits are certainly preferable to needing daily injections! However, preventing diabetes is a more basic goal than life quality, as it is the leading cause of death in the United States, in part due to being an underlying factor of heart disease. Simply put, it is a vital medical issue; beyond quality of life, at its heart is the question of life itself.