Avoiding and Controlling Diabetes May Be Simpler Than You Think

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Diabetes can be a silent killer – and an invisible one.

Eventually, it can cost you your vision or your feet; it can make your kidneys or your heart fail, and trigger several other serious medical issues.

The fact that Type 2 diabetes is more and more common shouldn't make anyone think it's not a major concern, says internal medicine specialist Abi Sundaramoorthy, MD.

“Because of the prevalence of diabetes, I don't think people take it nearly as seriously as they should," says Dr. Abi, as she prefers to be called. “It's hard to see how dangerous it is unless – or until – you suffer the consequences. It's something you perhaps can't see until you have a heart attack, stroke, infection, amputation or vision problems."

Know Your Numbers

You can avoid those severe medical consequences.

This means seeing your primary care doctor yearly for a check-up, and getting tested to see where your “numbers" are.

Diabetes is measured in two ways: through blood glucose, or A1C.  The A1C test is better, Dr. Abi says, because it determines an average number over three to six months, whereas glucose is more of a snapshot. A blood glucose test might be affected by stress, for example, so if the number is high, your doctor will likely follow up with an AIC for accuracy.

If your blood sugar is elevated, that means doing what you can to make lifestyle changes, and not simply “accepting" diabetes and counting on medication to treat it– because all medications have side effects, Dr. Abi says.

If your A1C number is under 5.7, you do not have diabetes. Between 5.7 and 6.5, you have pre-diabetes. Over 6.5 means you have diabetes.

Setting Goals

“The goal is to keep the diabetic patient under 7," Dr. Abi says. “At that point, we can manage it with lifestyle changes.

“If the number is between 7 and 10, the patient will need some kind of oral medication. Over 10 is when the patient will have to inject insulin – this might also happen if the oral medication was not effective for the patient."

Dr. Abi tells patients not to panic.

“Some of them think, 'Oh my gosh, I'll never have a doughnut again.' Diabetes is never about cutting out, it's about cutting down,” she says. “Whatever you are doing, take it down a notch."

And what is 'lifestyle management'? It's about empowering patients. Dr. Abi tells them about:

  • Exercising. Walking at a moderate or brisk pace for about 30 minutes, at least three days a week to start
  • Diet. Your doctor will give you specifics, but it means cutting back on sugar, artificial sweeteners, and reducing carbohydrates, both simple (usually packaged) and complex carbohydrates. Quantity and quality of carbs must both be considered.
  • Food portions. The vegetable portion should take up half your plate; protein about ¼, and carbs ¼ or less.

Exercise and weight loss work very well to lower blood glucose and A1C numbers, Dr. Abi says.

“I've seen patients with an A1C of 13 or 14, I put them on medication and with perseverance and good lifestyle management, they've lowered their number to below 7," she says. “The more empowered the patient feels, the better the outcomes."

As a physician, she says, it's not enough to tell patients their blood sugar is high, or that they are pre-diabetic or diabetic.

“You have to warn them about exactly what that means, and what will happen," she says. “And then you assure them that they do have some control over this."

Related links

UH's Division of Clinical & Molecular Endocrinology provides a full range of treatments for Type 1 and Type 2 diabetes – with a strong emphasis on self-management. Learn more about diabetes services at University Hospitals.

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