Consistent Treatment Helps Manage Diabetes

By Dr. Christopher Iorio

Over the past 20 years there has been a dramatic increase in the number of people with diabetes around the world.  The vast majority of those cases are type 2 diabetes, which is often related to diet and lifestyle.  If not treated aggressively and properly, type 2 diabetes has the potential to lead to heart attacks, strokes, kidney failure and blindness, as well as a host of other serious and life threatening complications.

Type 2 diabetes, also called diabetes mellitus, refers to a disease in which the body’s blood sugar is elevated.  The elevation of blood sugar above normal limits leads to inflammation and permanent damage in several body parts, most notably the blood vessels and nerves.  It is damage to these two body parts that leads to the most serious complications.  People rarely have any symptoms early in the disease, so the diagnosis is most commonly made by routine blood work. 

Type 2 diabetes is by far the most common form of diabetes, and it is the form that most adults develop.  The biggest risk factor for type 2 diabetes development is obesity.  Other risk factors include family history (due to genetic inheritance of how the pancreas works) and progressive age.  Recently several other risk factors have aroused concern, such as trans-fats (partially hydrogenated oils) which are used in fast food preparation and processed foods, and high consumption of simple sugars and high fructose corn syrup.

In type 2 diabetes, several derangements of normal body function occur.  The pancreas fails to make enough insulin, which is the hormone that pushes sugar from the blood into body organs.   The body’s organs, mainly the muscles, fail to use insulin properly due to “insulin resistance” and this leaves extra sugar in the blood stream.  The liver compounds these problems by continuously producing extra sugars, despite sugar levels that may already be elevated.   

Many people are terrified of the diagnosis of diabetes, and rightfully so, given the potential for life threatening complications.  The good news is that it appears to take 5-7 years of persistently elevated blood sugars to cause permanent damage, and aggressive therapy of diabetes can completely halt or reverse any damage. 

When I treat someone with diabetes there are two areas of focus -- the patient role, and the physician role.

THE PATIENT’S ROLE

Good health is largely dependent on three things -- healthy eating habits, exercise and avoidance of smoking.  People who develop diabetes have often been missing at least one of these components.  Once the diagnosis of diabetes is made, these components become even more important to good health.

For an overweight diabetic, losing 15% of body weight may be enough to cure diabetes.  Eating habits are important in reaching this goal.  I think many people approach eating habits in a way that is overly complicated.  One should follow some general principles such as drinking zero-calorie drinks, and eating lots of fruits and vegetables.  Focus on lean sources of protein (ex., chicken breasts, fish, cottage cheese, egg whites, lean pork chops, and lean cuts of red meat such as skirt steaks or 8% fat ground meat).  Although diabetics need to watch out for added sugar, people shouldn’t be overly concerned about the sugars in fruits.  Occasionally, some fruits will increase blood sugars, but, long term, fruit has been shown to be very beneficial in reducing diabetic complications, and fruit are essential components to losing weight.

Try and avoid unnecessary starches that don’t give you much nutrition and are easily digested.  White rice, regular pasta and white potatoes cause rapid elevations of blood sugars, and often leave an individual hungry again in a few hours.  Whole grains, which are high in fiber, are much healthier options.  Many diabetics have success with diets that limit carbohydrates altogether, such as the Atkins, South Beach and Mediterranean style diets.  Recent studies have found that all of these diets are very safe and may lead to even greater health benefits in diabetic patients when compared to non-diabetics. 

Exercise activates the body’s muscles to use sugar and will increase the efficiency of insulin.  Exercise is different from “activity.”  Many patients will tell me that they garden or walk at work, and while this may make them tired, it may not activate the muscles enough to lose weight or lower sugars.  While higher intensity and longer periods of exercise may be needed to help with weight loss, only a small amount of exercise is needed to lower blood sugars.  Walking, for as little as 15-20 minutes every single day, is an effective way to help stabilize sugars, particularly after meals. 

Smoking is detrimental for your health, and when combined with diabetes, it is especially deadly.  There are now many medications available to help with smoking cessation.  Talk to your doctor.  There is nothing better that you can do for your health than to stop smoking, so use everything at your disposal to help you stop, such as wellness programs, hypnosis, etc.

THE PHYSICIAN’S ROLE

If you develop diabetes, you will probably require a lot of medications and have frequent doctor’s visits and blood draws.  These things are not fun, but remember that the inconvenience of medications and vaccines are necessary to lower your risk of serious complications.

The ideal blood sugar is now thought to be an average below 140.  Short term fluctuations above and below this are not worrisome.  Sugars are controlled to prevent certain complications, such as blindness, renal failure, and nerve damage, that can cause numbness and tingling in the feet.  A combination of eating habits, exercise and medications can help with blood sugar control.

Both diabetics and pre-diabetics have the same risk of heart attacks and strokes, and up to 80% of patients will eventually die from these complications.  Three therapies can dramatically decrease this risk -- smoking avoidance, cholesterol medication and blood pressure control.  Every diabetic and pre-diabetic needs a cholesterol medication, even if sugars are controlled and the levels of cholesterol are “normal.”  The cholesterol in diabetics is much more toxic than non-diabetic cholesterol and creates more damage in the blood vessel.  This damage can be prevented by cholesterol medications.  Blood pressures control should ideally keep the top number (systolic blood pressure) below the 120 range (Both the top and bottom numbers are important, but I find it easier for patients to remember one number).

Flu shots are essential every year, as are periodic pneumonia vaccines.  Even minimally elevated sugars will adversely affect the immune system, so diabetics acquire these two illnesses with greater frequency and severity.  Yearly eye exams can identify complications that may lead to blindness.  Aspirin is required if a diabetic has a known blood vessel blockage, such as a prior heart attack or stroke.  There is accumulating evidence that daily fish oil supplementation is especially beneficial for the diabetic patient (the dose should be 2000 mg of over the counter fish oil).

As mentioned earlier, if patients can lose enough weight, many can be cured of diabetes.  However, losing weight by changing eating and exercise habits that people have had for 20-40 years can be very frustrating and unsuccessful.  Bariatric surgery is a life saving procedure for many patients and the only realistic way that most people can lose 100-150 pounds.

Diabetes can lead to many deadly complications, but if it is treated aggressively by a coordinated effort between the patient and physician, then those complications can be avoided and the patient can live a long and healthy life.  The most important therapies for diabetes includes healthy eating habits, exercise, and smoking cessation, but certain medications, such a cholesterol therapy, are also essential parts of a comprehensive diabetic regimen.  Remember that life is sweet, but your blood shouldn’t be.