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November is American Diabetes Month!

“I may have diabetes but diabetes does not have me.”

Unknown

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Overview

If you pick up any health journal in America, I bet that you will find a plethora of information about diabetes. Not to scare you, but I’m going to begin with some startling statistics for diabetes in the U.S.

  • 34.2 million US adults have diabetes, and 1 in 5 of them don’t know they have it.

  • Diabetes is the seventh leading cause of death in the United States.

  • Diabetes is the No. 1 cause of kidney failure, lower-limb amputations, and adult blindness.

  • In the last 20 years, the number of adults diagnosed with diabetes has more than doubled.

Centers for Disease Control and Prevention. (2020, June 11 What is diabetes? Centers for Disease Control and Prevention).


Heart disease, chronic kidney disease, and obesity are all potential by-products of diabetes and greatly impact your health and overall quality of life.

Understanding Diabetes

The Center for Disease Control and Prevention (CDC) defines diabetes as a “chronic condition that affects how your body turns food into energy.”

When you eat foods such as carbohydrates, they are broken down into glucose (sugar) and released into the bloodstream for energy in the body. When your blood sugar is high, your pancreas releases the hormone insulin. Insulin works like a key and unlocks the cell so the sugar can enter the cell and make energy for the body.

If you suffer from diabetes, then your body either does not produce insulin at all or if it does, the insulin is not properly utilized by the cell. This will cause an excess of sugar to hang around the bloodstream instead of heading into the cell. Take a look at the illustration below. This provides a clear picture of what normal and resistant functioning looks like. Over time, high blood sugar can also lead to heart and kidney disease. It can even cause vision loss if diabetes is not controlled.


Kaiser Permanente


You may be familiar with diabetes as a disease but you might not have a clear understanding of the different types of diabetes. Let’s break those down for a clearer picture.

Pre-diabetes

I have known many older adults who have been diagnosed with “Pre-diabetes”. It has come as a shock and a solid warning sign to all of them. This is the time where you have the chance to make the necessary lifestyle and dietary changes needed in order to possibly stave off a diabetes diagnosis. I don’t want to say it’s much easier to prevent this disease when you are still in the “Pre” stage because nothing about this condition is easy. But once you go over that diabetes cliff, it’s much harder, if not impossible to turn the needle back to that “Pre” stage. This is the time to make vital changes which I'll get into a bit more further below.

Signs & Symptoms

There may not be any signs that you are in the pre-diabetic stage but somethings to look out for are:

  • Excessive thirst

  • Frequent urination

  • Feeling hungry even when you have eaten

  • Feeling tired all the time

Type I Diabetes

Type I diabetes is an autoimmune disease. This happens when your body attacks itself and stops the pancreas from producing insulin. Most cases present themselves in childhood, teen years or early adulthood. Insulin will have to be taken everyday to manage and survive this disease.

Signs & Symptoms

  • Excessive thirst

  • Frequent urination

  • Feeling hungry even when you have eaten

  • Feeling tired all the time

  • Unintentional weight loss

UW Health


Type II Diabetes

You may already be familiar with the term “insulin resistance”. If you are unclear as to the meaning, it relates to Type II diabetes. Insulin resistance means that your body may still produce insulin but it does not utilize it well and can’t keep blood sugar levels within the “normal range”. (Please see the chart below.)

Signs & Symptoms

  • Excessive thirst

  • Frequent urination

  • Feeling hungry even when you have eaten

  • Feeling tired all the time

  • Unintentional weight loss

  • Blurred vision

  • Frequent infection

  • Poor wound healing


CDC


Gestational Diabetes

This type of diabetes occurs during pregnancy and develops in women who do not already suffer from either type of diabetes. According to the CDC, about 2-10% of pregnancies in the U.S. are affected by gestational diabetes. Usually testing will occur during weeks 24-28 of pregnancy. This condition will go away, however, it does increase your risk of developing diabetes later in life. Your child is also more likely to suffer from obesity and develop diabetes later in life.


In order to diagnose gestational diabetes, you doctor will perform an Oral Glucose Test. This involves drinking a syrupy solution and getting a blood test one hour after ingestion. If your levels are in the "high" range, additional testing may be needed to confirm a gestational diabetes diagnosis.

Gestational Levels

Normal

140mg/dl

High (Gestational Diabetes)

190mg/dl

Mayo Foundation for Medical Education and Research. (2020, August 26 Gestational diabetes. Mayo Clinic).


Signs & Symptoms

This type can be a bit tricky because if you experience some of the symptoms below, it will most present as regular pregnancy conditions.

  • Excessive thirst

  • Frequent urination

  • Nausea and vomiting

What might be more helpful are a few risk factors for developing gestational diabetes:

  • Being overweight or obese at the time of your pregnancy

  • Sedentary lifestyle

  • Polycystic ovarian syndrome

  • Immediate family member with diabetes

  • Statistically, Black, Hispanic, American Indian and Asian American have a higher risk of developing gestational diabetes

What's the Difference between A1C and Blood Glucose Levels?

These are two important facets of understanding and managing diabetes and although they relate to each other, they are different sides of the coin.

Your hemoglobin A1C levels measure your blood sugar levels over the past 3 months. Hemoglobin is a protein in your red blood cells. When food is broken down into sugar in your system, it attaches to a red blood cell. It’s normal for this to happen but people with more sugar in their bloodstream will have an increased level.

A1C Levels

Normal

​Below 5.7%

Prediabetes

​5.7% to 6.4%

Diabetes

6.5% or above

Centers for Disease Control and Prevention. (2021, August 10. All about your A1C. Centers for Disease Control and Prevention).


Testing Blood Glucose Levels

This test can either be done as a fasting glucose test, meaning no food for at least 8-10 hours. Or you can take a blood test anytime and your doctor will check it against this range below to see which category you fall into.

​Result

Fasting Blood Sugar Test

Random Blood Sugar Test

Normal

Below 100 mg/dL

​N/A

Prediabetes

100 – 125 mg/dL

​N/A

Diabetes

126 mg/dL or above

200 mg/dL or above

American Diabetes Association

How Did I Get Here?

Remember at the top of this post you read that the CDC states that 34.2 million US adults have diabetes, meaning…..you are NOT alone. There is a ton of information out there as well as highly qualified medical and nutrition experts to help you with either preventing a future diabetes diagnosis or to walk you through maintaining and living your best life with diabetes, regardless of the type you have.

If you find yourself wondering…”How did this even happen to me?”...there are a myriad of reasons, including life circumstances/environment and genetic predispositions that come into play. Having a little more information regarding risk factors can be helpful and several are listed below per type.

Type I Risk Factors:

  • Inherited risk factors from both parents

  • Environmental trigger including cold climate and viruses

  • Adapting a poor diet from early in childhood

Type II Risk Factors:

  • Family history of diabetes, heart attack

  • Sedentary lifestyle (little to no exercise or movement)

  • Overweight or obese

  • Smoking

  • High blood pressure

  • Diet of high fat, sugary and processed foods

  • High LDL (bad) cholesterol and low HDL (good) cholesterol (For more information on cholesterol, please see my September blog post)

Preventing/Managing Diabetes

Whether you are trying to prevent a diabetes diagnosis or are managing one, the first steps will most likely be the same…..say it with me “diet and exercise!” I’m sure these are the two most annoying words....in any language. Now I like to think of it in different terms because “diet” feels restrictive and the mere mention of the word leaves me feeling like I have to give up all my favorite foods, and that’s not a great place to start from.

I like to think of “diet” as simply adopting healthier habits. A great start is adding in more fruits and vegetables onto your plate. A good rule of thumb is “make half your plate fruits and veggies.” I feel less confined that way and freer to make my own “healthier” choices. I also don’t have the running chatter of “you can’t eat that” constantly playing in my head if I’m simply swapping out iceberg lettuce for spinach or arugula or white rice for brown rice for example. You don't have to go without but whole grains and dark leafy greens already add more nutrients and vitamins to the meal...so a simple switch like either of those and you are already ahead.

In regards to exercise, I’ve talked about it repeatedly in my posts. Do something you enjoy and for whatever amount of time you can. No time for a full 30 minute workout? No problem. Even a 10 minute walk is great for you and will get your blood circulating. Try and add on time from there and as your schedule allows. Every step counts!

Having a better sense of carbohydrate intake is also helpful. The section below is part of my February blog post to help get you started.


Carbohydrates

Carbohydrates are important because they break down into glucose molecules which is the body’s preferred source of energy. Glucose helps fuel your brain, heart, kidneys and central nervous system BUT not all carbs are created equal. There are Complex Carbs, which are the preferred kind and Simple carbs, which should be limited (and that goes for everyone...even if diabetes doesn’t play a role in your life).


Complex Carbohydrates:

Complex carbs are often referred to as starches and are digested at a slower pace in the body, resulting in steadier blood sugar (glucose) levels. Most of the carbohydrates you eat should preferably be complex, rather than refined.


A few examples of starchy foods are:

  • whole grain/brown rice

  • Whole Grains

  • Pasta

  • Quinoa

  • Barley

  • Beans

A good goal is to try to stay away from “refined grains” such as white flour and sugar (cookies, candy, pastries) due to their lack of nutritional value. “Unrefined” grains have not been stripped of their nutrients by heavy processing, and contain quality nutrients including fiber. Fiber can help stabilize your blood sugar, lower your cholesterol and help you to feel fuller longer which can prevent overeating.


Exception to Simple Carbs:

Simple carbs are also found in more nutritious foods, such as fruit. It's much healthier to reach for a piece of fruit (fresh is preferred but frozen and dried count too) rather than grabbing a cookie or donut because fruit also contains vitamins, minerals, fiber and antioxidants, whereas sugary treats contain empty calories, spike your blood sugar and usually leave you craving more fast energy. Aim to replace the sweet treat at the end of the night with an apple, pear or your favorite piece of fruit. You might also find that your sleep (in addition to your waistline) has improved without that burst of sugar and calories later at night. And Remember….Health starts from the inside out….but also from the ground up!


Resources

This is all a lot to take in but there are hundreds of resources out there to help you build a strong foundation, understand and maintain this disease. Below is an excellent resource for more in-depth information regarding nutrition, kidney and heart health and overall support. The American Diabetes Association


To discuss more detailed information regarding the topics within this blog, or to inquire about customized nutrition plans, please reach out to Cathleen Winter at cathleen@wellnesswithincw.com


A Little About Me

My name is Mary DeBlasio, and I live in Silver Spring, MD. I recently graduated Magna Cum Laude with a Bachelor of Science in Nutrition and Dietetics in May of 2021. I am very interested in mindful eating, and foods that correlate with the seasons. My goal after graduation is to pursue a dietetic internship with a focus on clinical dietetics. I would like to concentrate on patients suffering from gastrointestinal issues. All my information is backed by credible sources cited within the blog.

Sources

Centers for Disease Control and Prevention. (2021, August 10). Monitoring your blood sugar. Centers for Disease Control and Prevention.

Centers for Disease Control and Prevention. (2020, February 11). National Diabetes Statistics Report, 2020. Centers for Disease Control and Prevention.

Centers for Disease Control and Prevention. (2020, June 11). What is diabetes? Centers for Disease Control and Prevention.

Diabetes overview. Diabetes Symptoms, Causes, & Treatment | ADA. (n.d.).

Harvard Health. (n.d.).

Mayo Foundation for Medical Education and Research. (2020, August 26). Gestational diabetes. Mayo Clinic.

Mayo Foundation for Medical Education and Research. (2020, September 22). Prediabetes. Mayo Clinic.

U.S. Department of Health and Human Services. (2020, February 11). Diabetes. National Institutes of Health.



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