As a primary care provider, I see many patients with diabetes. According to the Centers for Disease Control’s national diabetes statistics report of 2020, approximately 34.2 million people had diabetes in 2018 (10.5% of the U.S. population), 1.5 million being new cases among ages 18 and older. Type 2 diabetes is increasingly diagnosed in youth and now accounts for 20% to 50% of new-onset diabetes case patients.
The total direct and indirect estimated cost of diagnosed diabetes in the United States was $327 billion, according to the American Diabetes Association. On average, people with diagnosed diabetes have medical costs approximately 2.3 times higher than what costs would be in the absence of diabetes.
Some of the challenges I face in practice is diagnosing diabetes early enough to where I can prevent some of the long-term complications and reduce the cost burden for my patients.
What is diabetes?
In short, diabetes is a disease process in which the body can no longer maintain blood sugar within a normal range. There are two types of diabetes, Type 1 and Type 2, with Type 2 being the most common.
The human body does a pretty good job regulating blood sugar via an organ called the pancreas. When we ingest a sugar-rich meal, a signal is sent to the pancreas to release a hormone called insulin. Insulin then signals the cells in our body to take in the sugar that’s been absorbed into the blood stream from the gut.
What happens in Type 2 diabetes is that our cells stop responding as well to the signal from insulin and as a result our blood sugar increases. The extra sugar in the blood then starts to wreak havoc on blood vessels. Specifically, the smaller blood vessels that provide blood flow to our nerve endings, which may result in weakness, numbness and pain from nerve damage, usually in the hands and feet.
In addition to the nervous system, diabetes also affects other vital organ systems in the body including the heart, eyes and kidneys. Type 1 diabetes, the less common one, is an autoimmune disease. Your immune system attacks the pancreas and as a result your body can no longer make any insulin at all.
How is it diagnosed?
The diagnosis of diabetes is very easily made. Ideally, your blood sugar right when you wake up in the morning should be below 100. If it is between 100-125 this is considered pre-diabetes or high risk for diabetes. Above 125, the diagnosis of diabetes is made.
An additional screening tool that is used is the Hemoglobin A1c. This test gives us an estimate of what your average blood sugar is over a three-month period and is reported by a single numerical value between one and 14. Hemoglobin A1c is also used by clinicians to monitor your diabetes and is ordered every three months.
If you begin to have symptoms of diabetes like a persistent increase in thirst, urination or hunger you should contact your primary care physician to get screened for diabetes.
How is it treated?
If Type 2 diabetes is caught early enough it can be reversed with affordable oral medications along with diet and lifestyle modifications. There are newer medications approved by the FDA that can be injected once weekly. Ask your health care provider about these newer medications.
More advanced diabetes requires the use of insulin. Insulin is injected with meals and before bed and requires close blood sugar monitoring.
Diet and lifestyle modifications are very important in disease management and prevention. Physical activity can lower your blood sugar for up to 24 hours or more after your workout. Talk to your health care provider if you have insulin-dependent diabetes before starting an exercise regimen to avoid critically low blood sugar levels.
If you don’t have diabetes, you can reduce your risk of developing it by eating a low-fat, low-sugar diet and exercising regularly.
What do I do personally to prevent diabetes?
For me, exercise is a big part of my life and I struggle sometimes trying to maintain an exercise regimen because of responsibilities that I have both at home and at work. As a result of constantly having to adjust my workout routine, it’s opened my eyes to the fact that I don’t necessarily have to be at a gym to exercise. If I can’t make it to the gym, I’ll find a nice scenic nature path to go for a brisk walk. I also try to keep a balanced diet and limit the amount of processed sugars that I take in.
Our Gainesville community has been doing a great job bridging the gaps to diabetes screening, education and management. We must continue this effort to improve the health of our great community.
Dr. Michael Mustafa is a part of the family medicine resident program at Northeast Georgia Health System. Columns publish monthly from residents in the program.