The ABC’s 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, it’s 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 can’t 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’s contribution
Sugar is one of our body’s 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 isn’t working as well due to insulin resistance, sugar can’t 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.

Gobbling frybread
Unfortunately, much of this doesn’t 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. That’s still a hard habit for me to break at age 49. One of my brothers had a stroke at age 46. He can’t use his left arm and has a hard time walking. He is a former welder and a mechanic and can’t 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 changes.

Here’s your quiz.
(Q) How did I know that the glucose tolerance test solution was sticky sweet?
(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. I’m 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. I’ll keep you posted on my progress.

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