What is diabetes?By definition, diabetes mellitus is a disorder that causes blood sugar (glucose) to rise because the body either isn’t producing enough insulin or isn’t using the insulin it’s making to process glucose effectively.
“Glucose is our primary energy source. If it just sits in the bloodstream, it may cause thicker, stickier blood that doesn’t flow through the body well, leaving organs and tissues deprived of the oxygen or nutrients they need,” says Ellen Wallace, clinical program coordinator for the Geckle Diabetes and Nutrition Center at the Greater Baltimore Medical Center (GBMC).
Diabetes is classified into several types, each requiring different approaches to treatment. Type 1 diabetes is an autoimmune condition in which the body produces little to no insulin. These patients must take daily insulin and closely monitor their diet to manage their blood sugar levels. Type 2 diabetes is much more common, affecting 90% to 95% of those with the disease. In this case, the body does produce some insulin, but not enough to regulate blood sugar without support.
Other less-common types of diabetes include gestational diabetes during pregnancy, genetically attributable monogenetic diabetes of the young, and more rarely, latent autoimmune diabetes in adults.
Who’s most at risk?While heredity, illness, autoimmunity and environmental influences can play a part, the risk factors for type 1 diabetes aren’t fully understood. It’s much easier to pinpoint the risks for developing type 2 diabetes, including genetics, being overweight, high blood pressure, abnormal cholesterol levels, sedentary lifestyle and depression.
“The symptoms of type 2 diabetes may be absent or develop gradually at the onset of disease,” says Nancy Glaser, a registered dietitian and certified diabetes educator at the Geckle Center. “Type 1 diabetes symptoms usually develop rapidly and can be dramatic.”
For both type 1 and type 2, patients may experience increased thirst, frequent urination, weakness and fatigue, blurred vision and infections that are slow to heal. If left untreated, symptoms may progress to nausea, vomiting, abdominal pain and dehydration.
Diagnosis and treatmentDiabetes is diagnosed through one of several blood tests that measure glucose levels over a specific period of time.
“Management always includes a personalized carbohydrate-controlled, calorie-appropriate meal plan, which should be developed with a certified diabetes educator to allow flexibility and provide a healthy, sustainable strategy,” Glaser says.
Exercise is another important aspect of diabetes management. Patients should aim to get 150 minutes of moderately vigorous activity each week.
“People over age 40 or anyone with a history of heart disease should be cleared by their doctor before engaging in a vigorous activity,” Wallace adds.
Keeping a close eye on blood glucose is critical to managing diabetes and can usually be done at home through continuous monitoring or a finger-stick glucose meter. Results determine the amount of insulin needed to maintain the appropriate blood sugar levels, administered either by injection or in pill form.
Recent advances and technologies including longer-lasting insulin and insulin pumps worn under the skin, and a new class of medication called SGLT2 inhibitors are making it much easier to manage diabetes, especially in younger patients.
“Continuous glucose monitoring has revolutionized home monitoring, taking the place of inconvenient finger sticks,” Wallace says. “It provides either real-time or intermittent scanning so patients can see changes in their glucose levels every five minutes.”
How to lower your risksGetting regular exercise and watching what you eat are two of the best ways to prevent diabetes, although these goals can be particularly challenging around the holidays. Wallace and Glaser suggest keeping these tips in mind:
- Stick with your exercise plan, even if it’s just taking a walk after a meal.
- Don’t go to parties hungry.
- Fill your plate with non-starchy veggies first, then add spoon-sized portions of other higher-calorie dishes.
- Move away from the buffet while eating and don’t go back for seconds.
- Avoid the punch bowl and sugary drinks, and limit your alcohol intake. Opt for seltzers, tea, coffee or water instead.