Although there are multiple types of diabetes, most of our CCM patients with a diagnosis of diabetes have type 2 diabetes. With type 2 diabetes your body does not use insulin properly; it is the most common form of diabetes and is often referred to as adult-onset diabetes. Today, one in every 11 people, globally, has diabetes; this is projected to rise to one in every 9 by 2045. Some may be able to manage their diabetes through diet and exercise, while others may need medication or insulin to help manage it. Understanding what diabetes is, what your risks are, and what you can do to help reduce the risks is an essential part of learning to live with diabetes.
Diabetes explained . . .
When we eat, food is digested in the stomach and intestines where it is broken down into glucose and then absorbed into the bloodstream. The body (pancreas) produce insulin which removes sugar from the bloodstream and delivers it to the cells of the body where it is needed for energy, mainly muscle. It also regulates the production of glucose by the liver, turning it off when blood glucose levels are high. In people with type 2 diabetes, the cells don’t respond to the insulin as it should, disrupting blood glucose levels. This leads to insulin resistance and prediabetes which can lead to type 2 diabetes. Type 2 diabetes begins gradually, and results from lifestyle choices. Since it is a gradual onset, it is typically seen in older adults.
Why is it significant . . .
Sustained high blood glucose levels can cause damage to both small and large blood vessels, placing one with a type 2 diabetes diagnosis at higher risk for heart attack, stroke and kidney failure. Excess blood sugar decreases the elasticity of blood vessels causing them to narrow and impede blood flow. This can lead to a reduced supply of blood and oxygen, increasing the risk of high blood pressure and damage to the large and small blood vessels. Damage to the large blood vessels is known as macrovascular disease and damage to the small blood vessels is known as microvascular disease. Diabetes and heart disease often go hand-in-hand and management of cardiovascular disease in diabetic patients has become a great challenge for healthcare providers.
Let’s look a bit further at what can happen . . .
Macrovascular disease is disease of any large blood vessel in the body, including but not limited to coronary arteries, aorta, sizeable arteries in the brain and limbs. Complications from macrovascular disease include heart attack, stroke and peripheral artery disease. Diabetics are more likely to have comorbid conditions which raise the risk for heart attack, stroke and peripheral artery disease – high blood pressure, as well as, elevated LDL and triglycerides.
Microvascular disease is disease which affects the walls and inner lining of the tiny vessels which branch off from the larger coronary arteries. Complications from microvascular disease includes neuropathy, retinopathy, and nephropathy. Those are big words. . . so let me help you understand this further.
Over time, high blood glucose levels and high levels of fats in the blood can damage the nerves, or neuropathy. Peripheral neuropathy is the most common presentation; it generally affects the feet and legs and affects 1/3 to 1/2 of diabetic patients.
The retina is the light-sensitive layer of the tissue in the back of the eye. Retinopathy can lead to macular edema, which is the leading cause of blindness for diabetic adults in the US. Having diabetes also makes one 2-5 times more likely to develop cataracts and nearly doubles their risk for open-angle glaucoma.
The kidneys contain millions of tiny blood vessel clusters called glomeruli that filter waste from the blood. Over time, high blood glucose levels can cause damage to the glomeruli and lead to diabetic nephropathy, decreased kidney function and kidney failure.
Who is at risk . . .
Those who are overweight (BMI >25)
Those over the age of 35
Those who have a family history of diabetes
Those who are not physically active
Those who have high blood pressure
Those who have had gestational diabetes (diabetes during pregnancy)
What you can do to improve your outcomes . . .
It is important to understand that lifestyle changes such as losing weight, eating healthy, and engaging in regular exercise may reduce the progression of insulin resistance, prediabetes and type 2 diabetes. Being consistent about what and how much you eat is important, and healthy food doesn’t always mean boring food! NovoNordisk, a leading manufacturer in a wide range of diabetic medications has a free and helpful web-based resource for patients diagnosed with diabetes. You do not have to be taking a NovoNordisk product to take advantage of their platform and I encourage anyone, whether you have diabetes or not, to visit NovoCare Education and Resources for helpful information on healthy lifestyle tips and recipes, as well as ideas to keep physically active. We also have resources for one-on-one education for patients who need motivation and accountability in working toward productive diabetic self-management. Houston Methodist Hospital, in particular, has diabetic education and medical nutrition therapy for those seeking a more individualized experience. As far as activity, most professional platforms recommend 150 minutes of moderate aerobic activity per week. Aerobic activity is any activity that increases your heart rate and oxygen demand. This allows more oxygen to make it to the muscles to help them burn fuel (calories) and move more efficiently. . . this is what most of us call “cardio” or cardiovascular conditioning. While 150 minutes a week does seem to be very cumbersome, if you are not physically active currently, please start with 20 minutes of aerobic activity 3 days of the week and gradually build up your tolerance. As is the case with your diet, being consistent is important. For some additional and more specific guidelines for staying active and tips on activities which you can benefit from please see American Heart Association’s recommendations for physical activities in adults and Centers for Disease Control and Prevention's recommendations for physical activity. The benefits of aerobic exercise include, but are not limited to reduction of heart rate and blood pressure, elevation of your HDLs or “good” cholesterol, improvement in cardiovascular conditioning, reduction in your risk of heart disease, better management of your blood sugars, weight loss and weight management, improved mood and cognition, slowing of bone mineral loss which leads to osteoporosis, increase of fluid to the joints to relieve pain associated with arthritis.
Living with diabetes can be overwhelming and exhausting, frustrating and confusing and difficult to handle at times. You can live normally with diabetes, and you have a healthcare team who wants to help you to be the best you possible. It is important to understand the impact diabetes can have on your overall well-being and developing a strategy to manage your diabetes and reduce your overall risks can be daunting; talk with your care coordinator today - let’s make sure you understand fully what diabetes is and what your risks are, we understand what your values are, and together we can work on setting small, incremental goals to help you in your journey to defeat diabetes!
Centers for Disease Control and Prevention - Diabetes Basics