Diagnosed With Diabetes: Now What?
By Dr. Stephanie Powers
In my lifetime, the number of adults with diabetes has tripled, from 5.5 million to more than 19 million. Last year alone doctors like me diagnosed 1.9 million new cases.
I’m a family medicine doctor at Wake Forest Baptist Medical Center so I see diabetes in all age groups, from men and women in their 80s to young children, too young, really, to be faced with what was once an adult illness.
Few patients come to me thinking they have diabetes. They usually complain of thirst, frequent urination and fatigue, all telltale signs. A simple blood sugar test confirms the disease.
Some of my patients are depressed by the diagnosis. Others feel overwhelmed by the thought of daily medication and a lifetime spent worrying about their diet. But most people just take it in stride because it’s become so common.
The most important thing for patients to know is that they can control their disease. Diabetes is a life-long diagnosis, but it’s not a hopeless diagnosis. Almost everyone will get better if they eat healthier and exercise. In fact, many people can even get off medicine eventually if they make significant lifestyle changes and lose weight.
There are many frightening complications of diabetes such as kidney failure, heart disease, and circulatory problems, but it is usually the people who don’t control their disease who end up on dialysis, have heart attacks, and lose their limbs.
There’s a lot for patients to learn about diabetes, so I spend a lot of time talking to my patients about their illness during our visits. First, almost every diabetic patient will benefit from losing weight if they do it correctly with regular exercise and a healthy diet. Second, if they smoke, they need to quit. There is no way around it. Smoking makes all of the bad complications much more likely.
Then I explain the disease. Type 1 diabetes occurs in children or adultswhose pancreas stops producing the insulin the need to regulate sugar levels. These patients need insulin. The kind of diabetes that’s on the rise, the type I diagnose every day, is different. With Type 2 diabetes, the pancreas still produces insulin but the body has grown resistant and the normal glucose processing cycle breaks down. Obesity interferes with the way cells process insulin and is the leading cause of Type 2 diabetes.
Once I explain the illness, I tackle the numbers. Patients with diabetes need to keep up with their glucose levels, cholesterol, blood pressure and something called creatinine, which measures kidney function.
Most patients measure their glucose levels at home by pricking their finger once a day. They also see me every three months for a test called an A1C, which measures their glucose levels over time. That figure should be below 7 percent. Their blood pressure should be below 130 over 80, which is lower than the recommended level for someone without diabetes. And they need to keep their LDL (“bad”) cholesterol below 100. Normal creatinine values vary based on your age, weight and ethnicity, but patients should ask their doctor to make sure their kidney function is checked regularly and is normal.
We also talk about regular medical care. They need to see me every three months. Patients with diabetes also need an eye exam every year. They need to check their feet for sores every day and keep them clean and well moisturized. I need to check their feet once a year. And they need to have their urine tested every year to make sure their kidneys are working. I understand why some patients feel overwhelmed.
Most of my patients start off with a medicine called Metformin, which helps regulate the body’s response to insulin. It’s a big pill, which makes it hard to swallow. In some patients, it causes diarrhea for a few weeks, but usually that clears up. If Metformin doesn’t work to reduce glucose levels, I try it in combination with other drugs, which help regulate the way the body metabolizes sugar.
Weight loss, which is important for almost all of my diabetic patients, is probably the hardest part. Most people have to change both the way they eat and their activity level.
Public health officials publish maps every year that show the link between obesity and diabetes. Counties with high obesity rates have high rates of diabetes. In many counties in North Carolina and other parts of the Southeast the obesity rates are as high as 30 percent and diabetes rates exceed 11 percent. Around here, for example, more than 9 percent of adults in Yadkin, Stokes and Davidson counties have diabetes. Obesity rates in those counties hover around 30 percent.
Many of my patients with diabetes are totally sedentary. I tell them to start with five minutes of exercise a day and build up to a goal of 20 to 30 minutes a day. They don’t need to become long-distance runners; a regular walk after dinner will do.
I don’t want my patients to go on crash diet or use any weight-loss pills or shots. They never work. But they need to start eating a healthy diet, with plenty of vegetables and fiber and less sugar, fast food, sodas and other simple carbohydrates. They don’t have to give up everything they like. A piece of cake on their birthday and a dessert once in awhile is okay, but they can’t eat cookies every day and control their disease.
In my practice I think about families, so I also tell my patients with diabetes that almost all the changes they need to make are healthy for everyone. It’s really good for families to eat healthy and exercise together.
Remember, managing diabetes may not be easy but it’s definitely possible.
Dr. Stephanie Powers practices family medicine at Reynolda Family Medicine with Wake Forest Baptist Health.
Diabetes Care at Wake Forest Baptist