Silent Killers: Diabetes


There are two main types, 1 and 2. While type 1 can occur in adults, it mostly shows up in childhood. I will focus this post on Type 2 Diabetes.

What is diabetes?

Diabetes (DM) is the body’s inability to appropriately utilize glucose, or sugar. Type 2 diabetes is an intrinsic resistance to the body’s own insulin. (Type 1 diabetes is a result of not enough insulin.)

Why is insulin important?

Your cells need glucose to function. Insulin is needed to transport glucose inside the cells to use for energy. Without insulin, as in type 1 DM, or without an appropriate response to insulin, as in type 2 DM, glucose builds up in the blood stream.

What are the risk factors?

Lifestyle plays a very important role, but there is a very strong genetic component as well. There is a 5-10 time risk increase if one of your first degree relatives is diagnosed with DM.

Also, if a woman developed gestational diabetes during pregnancy, she has a significantly increased risk of diabetes compared to the general population.

What are the symptoms?

Common symptoms include extreme thirst, frequent urination, fatigue, and blurry vision.

How do I get tested?

Most insurance plans cover diabetic screening at your yearly wellness exam. We will test a fasting glucose level and normal level will be less than 100. If it is between 100-125, it is considered impaired fasting glucose or “pre-diabetes”. Greater than 126 is concerning for DM.

If you do have elevated fasting glucose, we will test your a1c, which can tell us a 3 month average of your glucose levels. 5.7-6.4% is considered impaired fasting glucose and greater than 6.5% is considered diabetes.

Can I “cure” DM?

Not necessarily, but you may be able control your glucose enough with diet and exercise that you may not need to take medication to manage it. The most important part of controlling or “curing” type 2 diabetes is weight loss.

Why is exercise so important?

Weight loss is very important in improving glucose control. The fat cells in your body play a large part in creating the insulin resistance. Exercise also helps lower blood pressure and cholesterol, which are frequently problems in patients with DM.

Why do I have to diet?

Eating carbohydrates directly impacts the glucose level. If you eat less sugar and carbohydrates, your glucose levels won’t increase dramatically with each meal.

Can’t I just take a pill?

Diabetes is likely to get worse, even if on medication, if you do not change your lifestyle. Most patients who cannot or will not alter their diet and exercise habits, end up progressing to need more and more medications and eventually wind up on insulin.

Common myths about insulin:

Insulin will not make you fat. Insulin does not kill you. Diabetics that have gotten to the point that insulin is required have usually have not been well controlled. These people tend to be sicker and more likely to succumb to the consequences of having uncontrolled glucose levels for a long time. If your physician thinks that you would benefit from insulin, this may not be because you are “sick”, but there are other benefits it insulin as well, such as lowering your triglycerides.

What are the consequences of uncontrolled glucose levels?

The consequences of uncontrolled DM can be devastating. The risk of a heart attack is significantly increased in someone with DM, so much so that it is equal risk to someone who has already had a heart attack. There is also increased risk of stroke.

Other consequences include chronic kidney disease, which may progress to requiring dialysis, neuropathy (which is pain, tingling, and numbness in the extremities), gastroparesis (which is paralysis of the stomach causing persistent abdominal pain, nausea, and vomiting after meals), amputations, increased risk of infection.

When should I see an Endocrinologist?

That depends on the comfort of your physician in his or her ability to treat diabetes as well as the availability of endocrinologists in your community. Many of us internists love treating diabetes and feel very comfortable dosing insulin, both short and long acting. Some of us prefer to send you to the endocrinologist sooner because we may not be as confident in our ability to get your A1c down to goal in the most efficient way.


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