Understanding Diabetes

By Sara Hodon

Diabetes is a complicated condition, but a combination of education and self-discipline can make it easier to manage.

“Diabetes Mellitus is a group of diseases in which high blood sugar, or glucose, levels are caused by defects in the body’s ability to produce and/or use insulin. Insulin is a hormone made in the body to convert sugar, starches and food into energy the body needs to live,” explains Justine Fierman, Nurse Practitioner and Diabetes Program Coordinator at St. Luke’s Center for Diabetes and Endocrinology. “When teaching patients, I use the analogy that insulin is the key that lets blood sugar into the cell to feed the cell. If there is no key or the key doesn’t fit, the cells are not fed. The extra sugar builds up in the bloodstream and damages tissues of the body.” According to the Center for Disease Control and Prevention (CDC)’s National Diabetes Fact Sheet, in 2011 diabetes affected 25.8 million people (8.3% of the U.S. population).

Diabetes is diagnosed as Type I – also known as juvenile diabetes – or Type II, the most common form. In Type I, the body doesn’t produce insulin and the body has a difficult time breaking down and processing sugars. Type II diabetics produce insulin, but in small or improperly processed amounts. A third type, gestational diabetes, affects pregnant women in their third trimester. “They may or may not become diabetic after they deliver, but they are at a much higher risk of contracting Type II later on,” explains Dr. Sara Choudry, endocrinologist with St. Luke’s Center for Diabetes and Endocrinology. “It’s very important that the woman’s physician recognize and treat this condition.” One-third of mothers who deliver are later diagnosed as Type II diabetics.

It can be difficult to diagnose diabetes because patients can be asymptomatic for years. According to Dr. Choudry, a patient develops symptoms of Type II once their blood sugars get high; however, their body may have adjusted to their higher sugar levels and may not notice anything out of the ordinary. Type I symptoms include extreme hunger, excessive thirst, frequent urination, unexplained weight loss, and fatigue. Type II can show any of Type I’s symptoms, as well as blurred vision, cuts or bruises that are slow to heal, tingling/numbness in the extremities, and/or frequent infections. Diabetes can be diagnosed by a simple blood test, which will measure the blood’s fasting glucose levels.

Once a patient is diagnosed, he should learn all they can about the condition because of its complicated nature. Diabetes is manageable if the patient follows his treatment plans and makes the necessary adjustments to their lifestyle. “Treating diabetes is a multidisciplinary approach,” says Dr. Choudry. “The cornerstone for treating it is lifestyle modification, including increasing exercise and improving diet.”

Type I diabetics must receive insulin regularly, since their bodies do not produce this hormone.  Insulin can be delivered through a traditional vial and syringe, insulin pen, or insulin pump.  “An insulin pump works more closely with the pancreas to receive insulin in tiny divided doses, so it’s more precise. The pump holds a predetermined amount of insulin and delivers it slowly throughout the day as well as giving them bursts of insulin when eating meals or snacks. With the pump, insulin delivery can be temporarily increased, decreased, or stopped.  It gives the patient more control over their insulin delivery than the pen can provide,” Fierman says. Insulin delivery through the pump can be tailored to meet the patient’s daily needs. The insulin is delivered through either a tiny plastic or metal cannula (tube) and inserted by the patient every 2-3 days.

Type II diabetics need to understand that the disease is progressive, and their treatment plan will change. “People can go from not requiring insulin to requiring insulin, but that doesn’t make you a Type I.  It doesn’t change the diabetes that you have, but all Type II diabetics require insulin over time.  In the first 5-10 years, the disease can be managed with medications – over time as the body produces less insulin, all Type II will require insulin, and this means you’re just an insulin-requiring Type II diabetic,” Dr. Choudry says.

Both types of diabetes carry a long list of risk factors, including eye disease, which can lead to blindness; kidney disease, which can progress to kidney failure and require dialysis or a transplant; nerve damage, which can lead to amputation and cardiovascular disease which can result in a heart attack or stroke. “I can’t stress enough the importance of learning what the disease is about,” Fierman says.  “It’s not just about avoiding sweets. Working with a dietician can help a person understand what they need to do to get their blood glucoses under control. Start with looking at planning your meals throughout the day properly. This involves portion control and having balanced meals with adequate amount of carbs, proteins and fats.” It’s also important to recognize warning signs for imbalanced glucose levels and what to do about them. “Patients need to know that it’s manageable, but learning self-management skills is key to the treatment. It’s something you’ll live with minute to minute, hour to hour, day to day – the better you know how to manage it, the better chance you have of having more control. You don’t want it to control you, you should control it.”

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