The ABCís of diabetes
(and why you want to avoid this nasty disease at all costs)
I went to a two-day diabetes conference in Minneapolis in October. At our
clinic, we treat many patients with diabetes with the help of a diabetes
team that really cares about our patients and keeps us up to date on new
medicines and therapies.
Still, the conference was valuable. In the day-to-day care of diabetes I
see foot ulcers, infections, hypertension (high blood pressure), kidney and
heart disease, diabetic retinopathy (eye damage due to diabetes) and high
cholesterol. These are independent disease states, but diabetes is a common
link to all of them. Managing heart disease, kidney disease, or foot ulcers
is a major undertaking and many clinic appointments are devoted to these
complications of diabetes. Sometimes in the middle of the battle, itís easy
to miss the big picture.
The big picture is diabetes itself.
Diabetes is a disease that has hit our people especially hard. The type we
see most is Diabetes Type II. In this type, the pancreas is still able to
produce insulin, but eventually canít keep up with the level needed to keep
blood sugars in the normal range. Native Americans seem to have a higher
level of insulin resistance than other people, for some reason. Obesity in
itself also causes insulin resistance. Insulin resistance means that a
higher level of insulin is needed to allow sugar to move into our cells.
Sugar is one of our bodyís primary fuels and our digestive system can
convert many foods into sugar, even if the foods do not contain sugar. If
not enough insulin is present, or if the digestive system isnít working as
well due to insulin resistance, sugar canít get into our cells (muscle,
brain, heart). Even if the blood sugar is high, the cells send a signal that
more sugar is needed. As the blood sugar climbs, the kidneys try to get rid
of sugar. Water follows the sugar which leads to frequent urination. That
leads to thirst, and a need for more liquids. Unfortunately, at this point
the thirst is for sugary liquids which worsens the spiral. Sound
complicated? It is. Pay attention! There will be a quiz at the end of this
article. When the blood sugar is too high over a long period, it damages
structures and the blood vessels themselves take much of the abuse. This is
when the heart, kidney, eye and other organ damage takes place.
Unfortunately, much of this doesnít show up until lots of damage is already
done. The foods we grew up with (frybread, bacon grease, white rice, fried
eggs, fried hamburger, macaroni and other high fat or sugary foods) are not
helping. I grew up eating those foods and eating that way reminds me of my
childhood. Lots of these foods come from generations of poverty and eating
whatever we could get the cheapest. My mom raised seven kids by herself and
we ate that way out of necessity. With all those brothers and sisters,
whoever ate the fastest got the most. Thatís still a hard habit for me to
break at age 49. One of my brothers had a stroke at age 46. He canít use his
left arm and has a hard time walking. He is a former welder and a mechanic
and canít work anymore. His diabetes was totally out of control when he had
his stroke. Back to the conference. New studies are revealing things about
how our bodies work. We can put out huge amounts of insulin for years before
blood sugars climb. By the time diabetes is diagnosed, it may have been
present for five years or more. This is a long time to overwork a pancreas.
When it eventually gives out, lots of function has been lost. This is the
reason we screen for diabetes whenever we get a chance.
Screenings: what happens
The first screening test is a casual (random) blood sugar and can be
done at anytime. Any blood sugar of 100 or over warrants a two-hour fasting
glucose tolerance test. This means you come in fasting, after nothing to eat
or drink for 12 hours. The first of three blood draws is the fasting sugar.
Then you drink a bottle of sticky sweet pop with exactly 75 grams of glucose
(table sugar). Then the blood sugar is drawn at one hour and two hours
afterward. There are three possible outcomes. The first is a diagnosis of
diabetes. With a new diagnosis, diet and exercise may be enough to keep
blood sugars normal. This is not always the case, sometimes medicines are
prescribed. Another outcome: no diabetes. Remember, this test was done for
an elevated blood sugar, so yearly screening is still recommended. Diet and
exercise are very important here. A third outcome: Pre-diabetes. This is
increasingly common. It means that without intervention, you may develop
diabetes. However, it can be prevented, but it requires work and lifestyle
Hereís your quiz.
(Q) How did I know that the glucose tolerance test solution was sticky
(A) I went through a screening. My random glucose test was elevated at 107.
The two-hour glucose test was normal, but I was still diagnosed with
pre-diabetes. Iím now in the 16-week Fond du Lac Diabetes Prevention Program
as a participant, not an instructor. I need to lose seven percent of my
total body weight. Iíll keep you posted on my progress.