November is National Diabetes Awareness Month and I thought it was appropriate to highlight this topic as it affects millions of people in the United States, including many in our own community. Diabetes mellitus is a medical condition where our body has trouble regulating the sugar in our blood. Once food is broken down through digestion, carbohydrates are converted into glucose. This molecular form of sugar is used as fuel to the many cells of our body, especially our brain. Scientific research has helped us learn what healthy and unhealthy levels of blood glucose (blood sugar) are and how to measure it. Also, we now understand why some people have difficulty controlling their blood sugar and others don’t.

Under normal conditions the pancreas will excrete insulin into the blood stream when the body detects an elevation of blood sugar levels. In diabetic cases, the body will encounter high levels of sugar in the blood, known as hyperglycemia, because there is a problem with insulin.

There are a few types of diabetes we can refer to: type 1, type 2, and gestational. Type 1 diabetes occurs when the pancreas can’t produce enough or any insulin. This may be due to an autoimmune condition in which the body attacks the pancreas and damages its insulin production source. Type 2 diabetes occurs when the pancreas makes insulin but the body doesn’t use it effectively. Finally, gestational diabetes occurs when a woman is pregnant and some of the other hormones in circulation make the body’s cells resistant to insulin. The pancreas will produce more insulin in response, but if it still isn’t enough, then the condition comes about. It is usually reversed after the pregnancy. 

Unfortunately, type 1 and type 2 diabetes doesn’t just go away. Type 1 diabetes requires blood sugar management with supplemental insulin. Nowadays, people can carry an auto-delivery system the size of cell phone that connects to the belly by a thin tube. In other cases, people may give themselves regular insulin injections to prevent blood sugar from getting too high. For those who have Type 2 diabetes, management may still include use of insulin but usually other medications can be taken orally to lower glucose levels in the blood, boost insulin production or promote the body’s response to insulin function.

Everyone who has diabetes needs to manage their blood sugar levels by testing their blood on a regular basis. If diabetes goes uncontrolled, the results to the body can be devastating. When blood sugar levels are above the normal range over a long period of time, tiny blood vessels become damaged. This can lead to kidney disease, loss of vision, loss of sensation in the hands and feet, poor healing, muscle weakness, balance problems and stroke. In some cases, blood sugar levels can become so high it results in what is known as diabetic coma which can be fatal if not treated immediately.

Living with diabetes is about being attentive to your blood sugar levels. Type 1 diabetes usually is diagnosed in childhood and management becomes a lifelong activity. Type 2 diabetes, which accounts for 90% of diabetic cases in the country, is diagnosed mostly in adults, but more children are being diagnosed with type 2 in recent years. Unfortunately, type 2 diabetes rates are increasing. The good news (finally), both types of diabetes can be better managed with proper nutrition, healthy eating habits, and regular activity. In some people, type 2 diabetes can be reversed and also may be preventable.

You might be wondering “how do I know if I have diabetes?” The main symptoms of too much sugar in the blood are increased thirst, increased urination, and increased hunger. Sometimes a person will feel tired, weak, or have blurred vision. Diabetes is one or many medical conditions that cause hyperglycemia. A physician would need to perform blood tests to identify the cause so the appropriate treatment can be ordered.

When you see your doctor, a 12 hour fasting blood glucose reading is commonly tested. Another blood test called, A1C, can be ordered to measure the average concentration of glucose in the blood over the last 2-3 months. The higher the number, the more sugar coated oxygen carrying proteins will be found in your blood. So you can’t “cram” a quick healthy diet for a day or two and think you’ll be fooling your doctor. These tests are indicators of a healthy lifestyle and you’ll want to pass every time.

Diabetes research happens all over the world. A couple headlines I found were fascinating and worth sharing. According to an article on www.bbc.com/news/health, the NHS Blood and Transplant is testing special stem cell injections on individuals who are at high risk for kidney disease caused by diabetes. The cells are expected to reduce kidney inflammation and tissue damage which hopefully reduces the need for patient dialysis treatment or kidney transplants. This is important because 3 out of 4 diabetics develop kidney disease.

Lastly, a study published in the 2015 Journal of American Medical Association Surgery describes how weight loss surgery in people who are obese and have Type 2 Diabetes resulted in a greater chance of remission from diabetes. Test subjects who had gastric bypass surgery were 43 times more likely to reverse diabetes compared to those who didn’t have surgery (that’s not a typo, 43!). Other bariatric procedures were also highly successful. This study doesn’t mean everyone who has diabetes needs to have surgery. There are plenty of risks involved with having surgery but this may be an option for some who struggle to manage their weight and diabetes with non-invasive options.

 Dr. Thomas Naro, MSPT, DPT is a doctor of physical therapy and partner/manager of Coppola Physical Therapy Farmington located at 395 NH Route 11.