Diabetes Management...by the Numbers

“Evocative” is an adjective that is defined as bringing strong images, memories, or feelings to mind. A diagnosis of diabetes is evocative for many. There is fear of shortened life expectancy and death, surgical amputations, vision loss, kidney disease, and stroke which are all potentially the results of the disease. But because fear of a disease can paralyze us and lead to inaction I try to get my patients to understand the disease, understand how it can be controlled, and take control of their own long and short term prognosis.

Let’s start by a simple description of diabetes. Diabetes describes increased sugar concentration in the blood (or high blood sugar numbers). Normally sugar enters the blood from food that we take in or from the body breaking down stored energy. We need sugar to supply the energy our muscles need to function, but we don’t need too much. Normally, if sugar levels get high, the pancreas releases a hormone called insulin which instructs cells to remove extra sugar from circulation. Some people can’t produce insulin (Type I diabetes) or their cells don’t recognize insulin and remove sugar (Type II diabetes). With either type of diabetes the amount of sugar in the blood raises (high numbers).

A diagnosis of diabetes makes many feel they will never eat sweets again

When there is too much sugar in the blood it tends to interact with (glycate) other components of the blood. I like to describe these glycated molecules as “spikey” molecules circulating through your blood (they don’t actually form spikes, but they can interact with the walls of your blood vessels and cause damage). Imagine damaging molecules inside your blood vessels and how they would cause circulation problems leading to all the complications associated with diabetes.

There are people who have been diagnosed with diabetes who have few symptoms and live long healthy lives and others who quickly begin having complications. A big difference seems to be the amount of glycated molecules in their circulation - caused by the amount of sugar in their blood. Those who control their blood sugar (lower numbers) tend to stay healthier.

Patients are asked to test their blood sugar to see sugar levels each day or go to the doctor and have a 3 month average A1C blood sugar number checked. When you go to see the doctor they are frequently talking to patients about fasting glucose or three month average (A1C) numbers. Good numbers are associated with low sugar and a longer life with fewer complications. Think about fewer of those glycated molecules causing damage – those good numbers are describing a good thing.

Controlling blood sugar numbers is not easy and requires an understanding of what raises and lowers blood sugar. It makes sense that if you eat sugar (or candy, ice cream, or cake) your blood sugar will go up. If you exercise you will “burn” extra sugar and your numbers should go down. The first approach to control diabetes then should be to reduce carbohydrate (sugar and starch) in the diet and increase suitable exercise. I would recommend talking or getting recommendations from a nutritionist (sometimes available through a local grocery store or the American Diabetes Association web site). It is best to get help in starting an exercise program as well by talking to your provider.

At this point of the description I can imagine most patients are tuning me out or maybe getting a little angry. They might want to yell! “It is not that simple” to control blood sugar (I agree). Other things beside diet and exercise increase blood sugar including infections, pain, stress, and medicines. This is a good moment to add an important diabetes control recommendation. Taking good care of teeth and getting regular dental appointments is essential to keeping blood sugar under control.

No matter how vigilant they are most diabetics will require medication to control their blood sugar. There are many different types of medicine which vary in their ability to lower blood sugar, their side effects and how they are taken. We also expect changes to occur over the course of treating diabetes which will change which medications are appropriate. Finally, many people have a hard time paying for diabetes medications and don’t take them as directed because of cost concerns.

Using medications well requires a relationship between patient and provider. The patient needs to follow medical advice, keep track and test blood sugar if advised, and let the doctor know about barriers they are facing. The provider needs to listen and offers help in dealing with any barriers you face. Together and by controlling blood sugar numbers many patients can anticipate long and healthy lives.

With a focus on diet, exercise, and medication many diabetics are living longer and feeling better. A diagnosis of diabetes is never something one wants to hear, however maybe someday it will evoke a much better image.

As with all my recommendations, let me add a caveat here. We are all individuals and your doctor knows you better then anyone else. Do not change your doctors recommendations based on a blog. Also seek medical attention right away if you have any severe problems or reactions. If you need more answers or would like a personal consultation contact me at ashbyrx.com