‘You have diabetes’

There are many things we do not want to hear when we go to a medical appointment, and the three words, “You have diabetes” are among them. The diabetes diagnosis is based on lab numbers, but the impact of the diagnosis means major changes to the person who hears those words. Better understanding of the disease itself helps in improving outcomes by decreasing complications of diabetes. I believe that if a person knows why they need to make a change, they will be more interested in how to make those changes. Below, I briefly describe what diabetes is, the different types, possible complications, and three aspects of treatment.

Diabetes develops when a person’s pancreas does not make enough insulin to get their blood sugar (the body’s fuel) into their cells to do all the work of the body. Before diagnosis, a person may be eating more because their cells are not being fueled to do their work. They feel very tired. In Type 1 diabetes, the pancreas stops making insulin altogether. In Type 2 diabetes, the pancreas does not make enough insulin and the person becomes more resistant to the insulin they make. Prediabetes occurs when the blood sugar levels are rising, but are not high enough to be diagnosed with diabetes. Prediabetes is a “Golden Opportunity” as lifestyle changes alone are quite effective in stopping or slowing the progression to diabetes.

When first diagnosed, many thoughts arise. Will I go blind? Will I lose my toes, my foot, and then my leg like my grandpa? There is a lot of grief in coping with the diagnosis both in parents of children diagnosed, and in children or adults with the disease. Regarding the complications of diabetes, the sooner your blood sugars come down and the lower you keep your blood sugar levels, the lower your risk of complications. Picture the blood sugar inside your arteries, stuck there and unable to cross into your cells because there isn’t enough insulin. This high concentration of sugar is what damages the walls of the arteries, especially the smallest arteries in the eyes, brain, heart, kidneys and nerves of the feet. This damage is what increases the risk of blindness, stroke, heart disease, kidney failure, and neuropathy or numbness of the feet. These complications are caused by long term high blood sugars of diabetes, but hopefully they are not a part of your future.

After the initial shock of the diagnosis, there are many questions and concerns. Do I ever get to eat bread or candy or Thanksgiving dinner? Do I have to give myself shots? I don’t have time to give myself medication at work. I don’t know what foods I can eat. I can’t afford healthy food. What will my life be like? What can I do so that I don’t have diabetes anymore? In my job, I work to sort out these things with patients. The Diabetes Center is also an awesome local resource to help provide support and education. Treatment consists of focusing on three things: a food plan, daily exercise, and frequently, medications.

Developing a food plan will help you learn what foods you can eat that will help keep your blood sugars at target. Foods that contain carbohydrates become blood sugar. They include foods like bread, pasta, rice, corn, peas, potatoes, chips, fruits, milk, yogurt, and sweets including cakes, candies, cookies, and ice cream. Beverages with sugar, like soda or fruit juice, raise blood sugars very quickly. People with diabetes can continue to eat these foods, but in smaller amounts and with less frequency. Learning to read a food label will help you identify which foods contain carbohydrates. If you eat fewer foods with carbohydrates, you will have lower blood sugars.

Exercise is the second part of treatment. The stronger your muscles are, the more calories they will burn. When a person exercises, insulin resistance goes down. Exercising every day is equal to taking one additional diabetes pill. Exercise is an inexpensive therapy. You do not need a gym membership to exercise. All you need is a pair of comfortable shoes and a commitment to making exercise a priority. Use walking trails or simply walk around your neighborhood. Do as much as you can to keep moving.

The third aspect of treatment for diabetes is medication management. There are many categories of diabetes medications, each working in different ways to lower blood sugars. Your medical provider can work with you to develop the best plan for you personally. It is important that you take your medications regularly, and follow up with your provider to monitor whether the dose is right, whether you are having side effects, or whether you need additional treatment. There is not a cure for diabetes at this time. We also cannot give you enough of any medication that will allow you to eat unlimited carbohydrates. Working closely with a provider, a diabetes educator, and a dietician will help you to figure out the balance of food, exercise, and medications that can lower your blood sugars to normal.

If you have diabetes, it will be OK. Ask questions. Develop a food plan and an exercise plan. Take action now to improve your blood sugars so that you will live a long life with diabetes. At UnityPoint, you matter to us. Let us know how we can help you with your diabetes.

Darlene A. Turner, ARNP, CDE, is affiliated with UnityPoint Clinic Nephrology.