Part Three
Welcome
back! This is the final part of
the “Stethoscopes to the Streets” article series about everything you (never)
wanted to know about diabetes but were afraid to ask. We still need to discuss how diabetes is treated and most
importantly, how it is prevented!
Finding patients with
diabetes
In
article two, I outlined the diagnostic criteria with all the fancy numbers and
tests, but how do doctors find the patients to test? There is a group called the US Preventative Service Task Force
who reviews a lot of the literature for all kinds of disorders and makes
concrete recommendations for clinicians on who to test for disease. They have really good guidelines that
make good use of health care resources, but they didn’t really find great
evidence that screening all adults for type 2 diabetes would be worth it. They did recommend screening adults
with blood pressures over 135/80, using a fasting blood glucose reading.
Also,
most clinicians order a fasting glucose test on their patients with metabolic
syndrome, or even just components of it, like those with high lipids or obese
patients. The interval that clinicians
use varies, but every three years seems to be a common one. Obviously, if a patient were to come to
the office complaining of symptoms of diabetes like increased thirst and
urination, fatigue, multiple infections, etc, a doctor should check their
fasting blood sugar immediately.
Treatment and
monitoring for complications
As
we talked about in the previous articles, the problem with diabetes is the
long-term high blood sugar that the insulin from the pancreas is no longer able
to get into muscle and fat cells.
That high blood sugar causes all kinds of problems to blood vessels and
nerves, leading to those serious complications. So, the obvious treatment goal would be to tightly control
blood glucose, mainly in the range of 80-120 mg/dl. Easier said than done, but we have some tips and medications
that make that goal an attainable one.
Lifestyle
modifications: yeah, yeah, yeah, we all know what this means. Diet changes and exercise, leading to
that all-important weight loss. A
lot of people hear this recommendation from the doctor but don’t do much with
it. I totally get it, changing
what you do on a daily basis is really hard, but like anything, consistency is
key. Once habits are changed, a
new routine takes shape. Let’s be
a bit more specific though: “diet” usually means reduced carbohydrates (less
processed foods), more fruits, vegetables, and lean proteins, and lower
fat. It gets tricky for diabetics
though, as fruits can cause blood sugar to increase. The diabetic diet can be hard to navigate alone, and I find
patients do better when they work with a dietitian, who can take the time
clinicians might not have, to explain the ins-and-outs of the proper way to eat
and make a concrete plan. Let’s
face it; just saying “eat better” is really not clear enough. A brief word on exercise: it’s
fantastic for diabetes. Exercising
actually increases muscle and fat cell’s sensitivity to insulin (this means
they are more receptive to the signal insulin is giving them to let blood
glucose through those doors into the cell to be converted into energy). Everyone should aim for at least 30
minutes of activity most days of the week, but again, your doctor should make
individual recommendations based on whatever other conditions you might have.
For
most people, medications are necessary, at least in the beginning of
treatment. The effects of high
blood glucose are concerning enough that most doctors don’t want to rely
completely on a patient’s willpower to make lifestyle changes because we
understand that these things take time, but your kidneys might not have that
much time. In Type 2 diabetes (at
least before the severe end stage), the pancreas is still able to produce
insulin, the body just isn’t responding to its signals. So, we have medications that can help
increase muscle and fat cells’ responsiveness to insulin (that’s pretty cool,
right?). We also have medications
that make the pancreas secrete more insulin to help reduce blood glucose
levels. If these measures don’t
work to control blood sugar, giving insulin injections might become necessary. Remember, the important thing is to
keep blood sugar down, and all these drugs can help do that.
We
really can’t effectively control blood glucose levels if we don’t know what
they are. Therefore, it is super
important (and often overlooked by patients) to monitor their blood sugar using
a simple finger prick at home. The
frequency and timing may vary from person to person, but generally glucose
should be checked in the morning before breakfast and a few hours after dinner.
Remember
all those complications of diabetes we talked about? Most doctors want to start treating and preventing those
right away too. This means in
addition to any blood glucose-regulating medications a patient might need,
there’s a good chance they will be started on a blood pressure medication, even
if their blood pressure isn’t high in order to protect those kidneys. Also, since diabetics have a heart
attack and stroke risk equivalent to those who have already had one of those,
their cholesterol levels need to be even more tightly controlled than before
their diagnosis of diabetes, often needing a medication like Lipitor (a statin)
to help. Aspirin will likely be
prescribed as well to stop platelets from sticking together and forming
clots. Lets count up the meds: a few to control blood sugar, blood
pressure medication, and lipid medication plus aspirin. Whew. Aside from more medications, regular doctors appointments
(every few months) are needed to monitor for foot sores, blood pressure, and
eye changes. Blood will need to be
drawn more often so that lab tests can be done. Patients will need to visit an eye doctor yearly to monitor
for those changes to the retina that might cost them their vision.
Most
of my patients tell me they “don’t like to take medications.” Who does? It’s a lot to remember, especially if some need to be taken
at different times or multiple times during the day. Also no drug is free of side effects! Newly diagnosed diabetics may go from
taking no meds at all to suddenly needing to juggle five or more. The good news, though, is that if
patients really get serious about changing those lifestyle factors we talked
about, it’s possible to get their blood sugar under control and maybe, just
maybe, “cure” their diabetes altogether.
Of course, this requires constant and continued vigilance and a pretty
significant weight loss if the patient is obese, but it is possible. We can then shave down or completely
eliminate some or all of those medications. How cool is that!
Prevention
Don’t
you think the best way to deal with a problem is to never have the problem in
the first place? There are many
things you can do to prevent the development of metabolic syndrome or diabetes,
and most of them are “lifestyle” related.
Like most diseases, there is a strong genetic component to diabetes, but
everyone has control over how much they move and what they put in their
mouth. Prevention strategies
include the common sense things we all know about:
·
Exercising at least 30 minutes daily, even more
if you can
·
If you are overweight, lose weight.
o Even
a 5-7% weight loss can decrease the risk of developing Type 2 diabetes by as
much as 50%!
·
Limiting refined carbohydrates
o These
include products made with white flours, added sugar, sweets, and other
starches.
o As
you might suspect, I love to bake, and yes, most of my favorite recipes are
included in the “naughty” category.
But like most things in life, moderation is the key. You can bake and enjoy an occasional
treat, just share what you make, and try to treat yourself on special occasions
only.
·
Watch fat and cholesterol intake
·
Eat more whole grains, fruits and vegetables
o A
high fiber diet (found in these types of foods) helps regulate blood sugar by
preventing frequent spikes and dips in blood glucose that make you hungry.
·
Don’t smoke
o There
are just a million reasons not to smoke.
Prevention of diabetes is another one.
·
Limit alcohol intake
o Alcoholic
drinks are full of carbohydrates (alcohol itself is a carb, and all the juice
and soda mixed in don’t help either).
All these suggestions are not new
ideas, and I do realize they aren’t easy to implement either. I’m a creature of habit, and if I have
a behavior I want to change, I know it will take at least 2 weeks of consistent
change before it will start to become a new “habit” for me. In other words, don’t start a healthy
eating and exercise program all at once, and don’t quit after two days of it
either. Small changes tend to
stick, and they are better than no changes at all!
Wrap-Up
Well
there you have it. We took a
pretty big journey into the world of diabetes in a short amount of time! Hopefully now you understand a bit more
about how insulin and glucose work in your body, what diabetes actually is, how
it affects it’s sufferers, and some ways to treat and prevent it’s
occurrence. Now go out there and
take one small step for yourself in the right direction of healthy!
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