EDITOR’S NOTE: This, the third article in AFMC’s year-long look at diabetes, focuses on treatment, medications, lifestyle modifications and specific treatments when blood glucose gets too-high or too-low.
Diabetes has risen dramatically since 2000; the same period the nation has seen obesity levels reach epidemic proportions. While diabetes cannot be cured, many people live long and healthy lives with effective treatment methods that keep their diabetes under control. The importance and value of lifestyle interventions – eating well, getting regular exercise, maintaining a healthy weight and taking medications exactly as prescribed – has been strengthened by recent research.
Spotting it early
More than a third of people with diabetes don’t know they have it; 90 percent of people with prediabetes don’t know it. Early diagnosis and treatment is important to maintain your overall health and maintain control over diabetes. Diabetes is a disease that affects every party of your body. Prediabetics also have an increased risk of developing heart disease and stroke.
Keeping blood glucose levels at a normal level can minimize, delay and even prevent the many health problems and complications that diabetes can cause. The longer your body is exposed to high blood glucose levels, the greater the risk that problems will occur or worsen.
The U.S. Preventive Services Task Force (USPSTF) recommended in 2014 that every American over age 45 be screened for both type 2 diabetes and prediabetes. Additionally, all adults over age 18 with diabetes risk factors such as obesity, family history of diabetes, high blood pressure and/or cholesterol, should also be screened.
In making the recommendation, the USPSTF noted that lifestyle changes can prevent or delay both diabetes and prediabetes. They also noted that if you have prediabetes and you make changes to eat healthier and maintain a healthy weight, you can cut in half your chances of eventually developing type 2 diabetes. In some cases, prediabetics can return their blood glucose levels to normal. The health improvement and cost savings of preventing diabetes are enormous. On an individual level, preventing diabetes could mean preventing blindness, an amputation or never having to take insulin shots.
Ask your doctor if and when you need a blood test to check your blood glucose levels and be sure he or she tracks these changes over time. A 2014 study found that two-thirds of those with undiagnosed diabetes had seen a health care provider two or more times in the past year. Don’t let your doctor overlook an opportunity to prevent or treat diabetes.
Several kinds of medicine can help control blood glucose. It is crucial that you take your medications exactly as your doctors ask you to – every day, on time and even if you feel fine.
- Pills are usually the first treatment for newly diagnosed people with type 2 diabetes. Oral medicines usually work well for type 2 diabetes although they are usually not effective in treating type 1. Medications often change during the course of the disease.
- Insulin, delivered either by a shot or insulin pump, is required by people with type 1 diabetes. Insulin injections are also necessary for some people with type 2 diabetes. If you need insulin, you’ll have to give yourself a shot, either with a syringe or with an insulin pen. Implanted insulin pumps are an option for some people.
- Treating high blood pressure and high cholesterol levels also help control diabetes. There are a variety of oral medications for those problems.
- Stay current with your preventive vaccines such an annual flu shot, tetanus booster every 10 years, shingles and pneumonia shot (s), and others, depending on your age and condition.
Effective lifestyle treatments
Research has found that lifestyle interventions are more cost-effective than medications for diabetes. Be sure to discuss the following with your doctor:
- Diet – ask your doctor about a referral to a nutritionist or registered dietitian to help you develop the most effective meal plan for your health needs and lifestyle. Before you meet with a nutritionist, try keeping a food diary for at least a week. Include everything you eat or drink, the amount and time you consumed it. Myfitnesspal.com is a good online tool that’s free (also available as a phone app) that serves the purpose of a food diary. You can also use it to log in the types and amount of your daily exercise.
- Regular exercise and maintaining a healthy weight are as important as eating healthy. Consult a BMI chart to find what’s a healthy weight for your height and gender. Find a physical activity you enjoy so you’ll stick with it for the long term. Walking is the easiest to incorporate into your day. Start slow and work up to at least 30 minutes a day. Exercise with a friend and track your progress. A large study of people at high risk for diabetes showed that learning about lifestyle interventions to lose weight and increase physical activity reduced the development of type 2 diabetes by 58 percent; 71 percent among people over age 60.
- Education about diabetes can be helpful because the disease affects almost every aspect of your physical and mental health. Diabetes education focuses on self-care, problem-solving and coping skills needed to successfully manage diabetes. A nurse or diabetes educator can show you how to test your blood glucose levels and what to do if they fall too low.
Blood sugar lows and highs
People with diabetes can sometimes have blood glucose that is too low, called hypoglycemia. The symptoms of hypoglycemia include:
- Feeling faint, lightheaded or dizzy
- Feeling shaky, nervous or anxious
- Hunger or weakness
- Loss of consciousness
- Confusion, difficulty speaking or thinking clearly; feeling like you’re in a fog
- Feeling very tired or sleepy; frequent yawning
- Becoming very pale
- Loss of muscle coordination or twitching
Hypoglycemia can also occur as a side effect of some diabetes medications, including insulin. If you’re on insulin or diabetes pills, hypoglycemia can be caused by alcoholic beverages, increased physical activity, or by meals that are too small, delayed or skipped. Hypoglycemia can also happen during sleep. Some signs of hypoglycemia during sleep include crying out or having nightmares, pajamas or sheets are damp from perspiration, and feeling tired, irritable or confused after awakening.
In case of hypoglycemia or an insulin reaction, people with diabetes should have with them at all times at least 15 grams of a fast-acting carbohydrate, such as:
- ½ cup fruit juice
- ½ cup soft drink (not diet drinks)
- 1 cup milk
- 2 tablespoons raisins
- 5 Lifesavers candies
- 3, 5-gram glucose tablets
- 1 tablespoon of sugar or honey
Keep a supply of glucagon on hand. Glucagon comes in a kit with a powder and a liquid that must be mixed together and then given as a shot. It will raise your blood sugar level.
Teach your friends, work colleagues and family members how to treat hypoglycemia, because sometimes you may need their help. If you are unconscious, or you can’t eat or drink, another person can give you a shot of glucagon. This will bring your blood sugar level back to normal.
On the flip side, your blood sugar level can get too high – called hyperglycemia – even when you’re eating properly and taking your medications. Hyperglycemia can be caused by eating too much high-glucose food at a meal, becoming ill, hormonal changes or having a high stress level.
Hyperglycemia can cause you to be extremely thirsty, have blurry vision, feel very tired or have frequent urination. Your doctor will explain what to do if these symptoms occur.
Your treatment team
In addition to your regular doctor or primary care provider, you may have the following in your health care team:
- An endocrinologist for more specialized diabetes care
- Dietitian, nurse or certified diabetes educator to provide information and training to manage diabetes
- Mental health professional or counselor
- Ophthalmologist for eye care
- Podiatrist for foot care