Diabetes types, diagnosis and treatment
That pesky little month that is sandwiched in between two of my favorite holidays – Halloween and Christmas.
This is personal preference, because my preschooler loves to dress up and eat candy. He also loves to write long lists to Santa Claus, assist with the holiday baking, and is enthralled with the beauty of Christmas lights. I love to experience all of these with him.
But as a certified diabetes educator (CDE), November is a busy month for me. Why? Because it is Diabetes Awareness Month.
I personally think we should be aware of diabetes all year long – but having an ‘awareness month’ draws attention to the public. It has garnered so much attention that we now have World Diabetes Day, which is November 4. World Diabetes Day is also the birthdate of Dr. Frederick Banting, one of the discoverers of insulin.
As healthcare providers, what are the nuts and bolts of what you should know?
What are the Types of Diabetes?
There are three main types of diabetes:
- Type 1 diabetes. This type of diabetes is an autoimmune disease that occurs when the beta cells (the insulin-producing cells) of the pancreas become damaged, which means that the pancreas makes little to no insulin. This means that insulin is required for survival. Historically, type 1 diabetes has been thought of as “juvenile diabetes” because it most often occurs during childhood, but it can occur at any age.
- Type 2 diabetes. This type of diabetes occurs when the pancreas does not make enough insulin, or the body does not use the insulin properly. This type of diabetes is often thought of as “adult-onset” but it can occur in childhood. It is also the most common form of diabetes, occurring in 9 out of 10 people with diabetes.
- Gestational diabetes. This type of diabetes occurs in women who are pregnant. It occurs due to hormonal changes during pregnancy, which affect how insulin is used in the body. There are certain women who are at greater risk for gestational diabetes, and women who have gestational diabetes are at a greater risk for developing type 2 diabetes later in life. However, blood sugar levels typically normalize shortly after giving birth.
How is Diabetes Diagnosed?
There are several diagnostic tests for diabetes. Your physician may choose to order one of the following tests:
- Fasting blood sugar
- Random blood sugar
- Oral glucose tolerance test
For you to be diagnosed with diabetes, your values must be the following:
- Fasting blood sugar
- Normal: less than 100 mg/dl
- Prediabetes: 100-125 mg/dl
- Diabetes: 126 mg/dl or greater
- Random blood sugar
- Normal: less than 140 mg/dl
- Prediabetes: 140-199 mg/dl
- Diabetes: 200 mg/dl or greater on two separate occasions
- Oral glucose tolerance test: results greater than 200 mg/dl
- Normal: less than 5.7%
- Prediabetes: 5.7-6.4%
- Diabetes: 6.5% or greater on two separate days
How is Diabetes Treated?
Treatment of type 1 diabetes always involves insulin. As we previously discussed, insulin is necessary for survival. Insulin may be administered by injections or an insulin pump. There are several types that may be used, but typically a basal (long-acting or intermediate-acting) is used along with a rapid-acting or short-acting insulin that is used to correct high blood sugar, as well as given with carbohydrate to combat blood sugar elevations.
Cessation of insulin will result in a potentially life-threatening condition called diabetic ketoacidosis.
There is a bit more options when it comes to the treatment of type 2 diabetes. There is no one perfect “plan” that will fit every person with type 2 diabetes; as such, there are many different types of treatment options.
The cornerstone of type diabetes treatment is living a healthy lifestyle. This includes following a healthy diet with balanced carbohydrates, fat, and protein. It also means getting exercise; exercise can reduce blood sugar levels as well as reduce weight.
Typically, with diagnosis, a medication called metformin is prescribed. This is an oral medication that has multiple different functions, but one of the biggest functions is that it helps to reduce the liver’s production of glucose, which reduces blood sugar levels overall.
There are several other oral medications that your physician can prescribe if metformin doesn’t reduce your blood sugar enough, or if you do not tolerate it. The most common drug classes are called sulfonylureas, DPP-4 inhibitors, thiazolidinediones, and SGLT2 inhibitors. GLP-1 receptor agonists can also be prescribed; these are once-daily or once-weekly injectable medications.
Type 2 diabetes is a progressive condition. Sometimes, these medications do not work well enough, as the body does not make enough insulin, or insulin resistance is too great. Insulin must be injected. As with type 1 diabetes, several types of insulin can be used, and it can be used through injections or an insulin pump.
Can Diabetes Be Treated with Diet Alone?
Type 1 diabetes cannot be treated with diet alone. It requires insulin 100% of the time.
For someone with type 2 diabetes, the answer is “it depends.”
There are a lot of variables. It ultimately depends on the person.
We know that for many people, diabetes is progressive – once they’re diagnosed, despite their best efforts, they will progress to requiring insulin.
However, there have been research studies that indicate that a program of healthy eating and exercise can actually lead to diabetes “reversal” – but this depends on how long the person has had diabetes, the severity of diabetes, and genetics.
One study evaluated people with type 2 diabetes who did 175 minutes of exercise weekly. These people also consumed between 1,200 and 1,800 calories per day, in addition to weekly counseling sessions. Approximately one year later, 10% of the participants got off their diabetes medications or were classified as prediabetic.
The Bottom Line…
This month, encourage your patients to become evaluated for diabetes. Encourage them take care of their diabetes. Remind them that although November is Diabetes Awareness Month, their health is everyday.
Cleveland Clinic. (2018, October 2). Diabetes mellitus: an overview. Retrieved from https://my.clevelandclinic.org/health/diseases/7104-diabetes-mellitus-an-overview
Healthline. (2018, Nov 1). November: World Diabetes Day and Diabetes Awareness Month! Retrieved from https://www.healthline.com/diabetesmine/november-world-diabetes-day-and-diabetes-awareness-month#1
WebMD. (2016). Type 2 diabetes treatments. Retrieved from https://www.webmd.com/diabetes/type-2-diabetes-treatments#1
WebMD (2016, January 10). Can you reverse type 2 diabetes? Retrieved from https://www.webmd.com/diabetes/type-2-diabetes-guide/reversing-type-2-diabetes#1