Diabetes

What is Diabetes?

Diabetes is a disorder which results in the body being unable to properly handle glucose (sugar).  There are two types of diabetes.

Type I  - Type I diabetes is also known as Juvenile Diabetes because it is usually first diagnosed in children and young adults. This type of diabetes is thought to occur when the immune system incorrectly attacks the cells of the pancreas that make insulin and destroys them. The body is no longer able to make enough insulin, and cannot control glucose levels properly. Patients with this type of diabetes usually need to take insulin injections.

Type II  - Type II diabetes is also known as Adult Onset Diabetes because in the past it was mostly found in adults. This has begun to change in recent years as we are seeing more cases of this type of diabetes in children. Type II diabetes is usually preceded by a condition called pre-diabetes ( Click here for more info)  which may exist for years or decades before the onset of diabetes. Type II diabetes is responsible for nearly all of the increase in diabetes in recent years. In the early stages of type II diabetes the pancreas is still making enough insulin but the body has become resistant to it and no longer reacts the way it should. The development of type II diabetes is determined partly by genetics ( you inherit the tendency) but is strongly affected by factors such as poor diet, obesity, and inactivity. We believe the increased incidence of these factors in our society is the reason so many adults and even children are starting to develop type II diabetes.

Risk Factors for Type II Diabetes


  • Age 45 years or older
  • Being overweight ( Body Mass Index greater than 24)
  • Having a parent, brother, or sister with diabetes
  • Being of African-American, American Indian, Asian-American, Pacific Islander, or Hispanic-American/Latino descent
  • Having had diabetes that developed during pregnancy (called gestational diabetes) or giving birth to at least one baby weighing more than nine pounds
  • Having high blood pressure
  • Having abnormal cholesterol levels -- either HDL "good" cholesterol of 35 or lower or triglyceride levels of 250 or higher
  • Exercising fewer than three times a week

How is Diabetes Diagnosed?

Diabetes is diagnosed using one of two methods, either a standard fasting blood sugar level or a 3 hr glucose tolerance test. Most often the fasting blood sugar level is done because it is much more convenient for the patient. The table below shows how the fasting blood sugar is interpreted.

Fasting Sugar level

Diagnosis

100 or less Normal
100-124 Pre-diabetic
125 and above Diabetic

Treatment and Management of Diabetes

Patients in the normal category obviously need no treatment. Those in the pre-diabetic category are usually advised to follow "Lifestyle Modification" recommendations.
  • ​Exercise regularly
  • Keep weight within guidelines - Keep your BMI ( Body Mass Index - see calculator above) less than 25. Men should keep their waist size below 40 inches and women below 35 inches. Waist size is NOT the same as pant waist size. The waist should be measured around the belly button with the stomach relaxed. This will usually be several inches larger than your pant waist size.
  • Eat a diet that has a low glycemic index and low glycemic load (Click here for an explanation of the difference).  Foods with a glycemic load under 10 are considered low glycemic load, 10-20 is medium, and above 20 is a high glycemic load food.  The resources in the right column of this page will provide a lot of information to help you improve your diet. In general you want to reduce your intake of sugars and starches and increase your intake of protein and healthy fats.
For diabetic patients on medication, regular monitoring is important to ensure good control and reduction of complications. Patients on oral medications can usually be monitored on a quarterly basis or less frequently with a test called a hemoglobin A1c ( Hgb A1c).  This test is more useful than a random blood sugar level because it tells your doctor how you have been doing over the past 90 days.  Patients who are taking insulin injections may also benefit from home glucose monitoring in addition to periodic HgdA1c levels.

This table summarizes how the HgbA1c is interpreted and what the approximate average sugar level is for each HgbA1c level. For example, if you were to have a HgbA1c level of 8.0 that would mean your average blood sugar over the past 90 days was approximately 188.

Medications - When lifestyle changes are not enough.

Lifestyle changes are always an important part of every diabetics treatment plan but when diet and exercise alone don't bring blood sugar into an acceptable range medications are often needed. There are many different kinds of medications used for this purpose many of which are summarized below. most people are familiar with insulin. Unlike in the past insulin is now available in many different forms. Some are very long acting and others are short acting. The type used depends a lot on the individual patients and their needs.

In addition to insulin we also have many oral medications that can be used to control blood sugar. Oral medications can be used as single drug, in combination with other oral drugs, or in combination with insulin so we can customize care for each patient.

Click Here for a list of the currently available oral diabetes drugs.

Click Here for a list of the currently available insulin preparations.

Diabetes Check List

Additional items that every diabetic should put on their "to do list"

Cholesterol Medications
Most people are familiar with drugs like Zocor, Crestor, and Lipitor. These drugs are members of a class of medications commonly referred to as "statins".

It is common knowledge that statins reduce bad cholesterol levels but what is less well known is that statins reduce inflammation in the walls of our arteries and this may be the main mechanism by which they reduce the risk of heart attacks rather then their effect on cholesterol. This is important to understand because diabetes is one of the strongerst risk factors for the development of cardiovascular diseases like heart attack and stroke. It is thought that diabetes increases the risk of cardiovascular disease by increasing inflammation in the arteries ( see "How do heart Attacks Happen?") and since statin drugs are so effective at reducing this type of inflammation it is now recommended that diabetics be treated with a statin even if their cholesterol numbers are within a range that would otherwise be considered normal.

ACE inhibitors
ACE inhibitors are drugs that were originally developed to treat high blood pressure but it was discovered that they also seem to have a protective effect on the kidneys in diabetic patients. Diabetes is one of the leading causes of chronic kidney disease in the U.S. and with the growing prevalence of diabetes this will only become more common. The best protection for the kidneys is to control diabetes and to prevent its development but for those who have diabetes ACE inhibitors can significantly reduce the risk of kidney disease. For this reason ACE inhibitors are often used in diabetic patients especially those with high blood pressure unless there is a contraindication.  Your doctor may do a test called a microalbumin level. If this is elevated it could indicate that you are increased risk of diabetes related kidney disease and if so you may be a candidate for an ACE inhibitor.

Prevnar 13 - "Pneumonia Vaccine"
Diabetic patients have a reduced ability to fight infections.  The Prevnar 13 vaccine protects patients against a specific bacteria called pneumococcus which can cause some forms of pneumonia as well as sinus and ear infections. For those over 65 of age the vaccine is given once.  If the vaccine is given before age 65 a booster is usually recommended again when the patient turns 65. The term "Pneumonia Vaccine" is not entirely accurate since Prevnar 13 will not protect against forms of pneumonia caused by viruses or bacteria other than pneumococcus, but it does offer significant protection from pneumococcal pneumonia which can be a serious infection in diabetics and older patients.

Flu Vaccine
As mentioned above, diabetics are more susceptible to a number of infections and more likely to develop complications from those infections. For this reason it is also important to vaccinate against influenza every year.

Eye Care
Diabetes is one of the leading causes of blindness in the developed world. The good news is that with good preventive care and annual eye exams much of this can be prevented. Diabetic patients should make every effort to have their eyes examined once a year by a ophthalmologist so that any changes in their eyes can be detected early and vision can be preserved.

Foot Care
Due to loss of sensation and decreased immunity that can accompany diabetes, daibetic patients should take care to examine their feet each night before they go to bed and see a podiatrist if there are any ususual finding including breaks in the skin, redness, swelling, or pain. Toe nails should be trimmed with care and if this is difficult a podiatrist can perform this function.

Diabetes Incidence in the U.S.

Diabetes has reached epidemic proportions in the U.S. over the past 10 years. This graph from the CDC web site shows the increase in cases in this country over the past 2 decades. From 1989 through 2002 the number of diabetic cases nearly doubled. 

The incidence of diabetes is even more prevalent among Blacks, Hispanics and older individuals. Among those over 65, nearly 17% are diabetic or one in six people and the numbers are increasing.

Further Information

If you've been diagnosed with diabetes, are at risk for diabetes, or know someone who is, there is a lot you can do. Educating yourself about the disease is the first step. A great resource for information concerning diabetes is the American Diabetes Association web site.  The booklets below are also filled with helpful advice and information.

Downloadable Booklets

Glycemic Index

Home Blood Sugar Testing

Should all diabetics test their sugar??

Many diabetics use a sugar monitor to check their blood sugars at home. This is called Self Monitoring of Blood Glucose or SMBG. Click here to learn why you may NOT necessarily want to do this.

Glucose Log Book

If you have a type of diabetes that requires insulin and you need to do home blood sugar testing this GLUCOSE LOG BOOK can be downloaded and printed out to help you keep track of your numbers.

Useful Diabetes Apps

Use this app to track your blood sugar level, glucose, hemoglobin a1c, insulin, blood pressure, carbs counting, calories, weight, and more



C4C Diabetes Tracker