A diabetes diagnosis can affect every decision you make – from what to wear and eat, to your health regimen and how you take care of yourself. Many often misunderstand or are unaware of the high level of care needed to manage the disease. For people diagnosed with diabetes, effectively managing the condition is a daily task requiring many decisions and lifestyle changes.
Dr. Carmen Echols, a board-certified family medicine physician, practices at Emory at Stonecrest Primary Care and has a special interest in helping patients manage chronic illnesses like diabetes, high cholesterol and high blood pressure. On an episode of The Weekly Checkup, she discussed common questions about diabetes in order to help listeners understand the condition and clear up common misconceptions.
What is diabetes?
Echols: Diabetes is not just a medical condition, it is a lifestyle as well. There are two types of diabetes.
Type 1 diabetes is the type that people are born with. If a patient is diagnosed as a child, they are highly likely to have type 1 diabetes. It is an autoimmune condition; the body recognizes the cells in the pancreas as being foreign and begins to attack them. Therefore, the body will not produce enough insulin. Type 1 diabetes must be managed exogenous insulin, which means outside insulin. That is why the insulin pump is provided to patients with type 1 diabetes – so they can adjust their insulin levels based on their meal. It cannot be solely managed through diet, exercise and lifestyle modifications.
On the other hand, type 2 diabetes can be impacted by lifestyle. When an excessive number of sugary foods, like sweets and cakes, are consumed, and sometimes when combined with genes as well, your healthy pancreas produces insulin to lower the blood glucose naturally. After a while, your pancreas starts pumping out more insulin, and it is not enough to lower the blood glucose as your pancreas gets tired. Therefore, the blood sugars wind up getting higher and higher. Ultimately, those levels get to a point where we have a diagnosis of diabetes.
When should you talk to your doctor?
Echols: The most common symptoms to indicate if your sugar is exceedingly high are that you may have dry mouth, and excessive thirst and urination. You may even taste sugar. For example, you may just be eating something like broccoli, which is not sweet at all, but it can taste very sugary. Sometimes, you may even smell sugar in your urine, which means that the blood sugar is extremely high. Those are the main symptoms that people have. However, it is also recommended to ask patients if they have any family history of type 2 diabetes or if anybody in their family is diabetic. If the answer is yes, then we do further tests to see if they may be pre-diabetic.
How is diabetes diagnosed?
Echols: Fasting glucose is measured for the diagnosis. This means you will fast – nothing to eat or drink, except water with nothing added – for at least six to eight hours and then we check your sugar. Normal glucose readings are 70 to 90. If my patients come to me with high readings, I recommend they follow up in six months for Hemoglobin A1C, which is a simple blood test that measures average blood sugar over a two and a half to three-month period and lets us know where they fall on a spectrum. Normal would be considered anything under a 5.7, and abnormal, or prediabetes in this case, would be considered 5.7 and higher. Anything 6.5 and above is diabetes. After an A1C, I recommend getting a second fasting glucose test and then talking to your doctor or your provider about your elevated numbers to see what they recommend you do next.
What diet is recommended for patients with diabetes?
Echols: Typically, if a person has one parent that has type 2 diabetes, there is a 50% chance they become type 2 themselves. But, of course, lifestyle modifications can help with this. I always tell my patients that diet is inherited as well. Similarly, if a person has both parents diagnosed with type 2 diabetes, their chances increase to 80%. I recommend visiting diabetes.org, the official website of the American Diabetes Association, for healthy cooking recipes. I always suggest reduced carbs, reduced saturated fat and an anti-inflammatory diet. Personally speaking, if there is one specific diet which encompasses all those elements, it would be the Mediterranean diet. And if you are not partial to some specific foods in the Mediterranean diet, consume culturally relevant foods that fit within the aforementioned guidelines. Oldways is a good source for these guidelines.
What else does diabetes affect?
Echols: Diabetes complications can often cause impaired vision. Retinopathy, which is when the blood vessels in the retina are damaged by those high-circulating sugars, is the most common eye condition for diabetics. There is also a link between elevated eye pressure and blood sugar, where glaucoma – damage to the optic nerve – can occur. Also, diabetes is a cardiovascular disease equivalent, which means there is a possibility for every organ system in the body to be affected—from the digestive system to the kidneys, and even the sexual organs of both men and women.
What is dialysis and how can it be prevented?
Echols: Over time, blood vessels are damaged because of the high-circulating blood sugars, which can eventually lead a diabetic to be on dialysis. You can either never be on dialysis at all, or you can get there very quickly depending on how well you manage your blood sugar level. Good management of blood sugars is a good way to prevent having to get on dialysis. Being responsible and doing what you can to manage your blood sugar level, and just being consistent with knowing the right way to eat and treat your body, can sometimes prevent you from getting to the point where dialysis is needed. And make sure you keep regularly scheduled follow up visits with your trusted clinician.
What is integrative medicine?
Echols: Integrative medicine is a combination of using prescription drugs to help manage conditions and getting a better understanding of supplements and their appropriate use to treat medical conditions. My interest in integrative medicine started because a lot of my patients were coming in to let me know that they did not want just medication, they also wanted to use supplements. So, I let them know the benefits of the prescription drugs but still respected the fact that they were looking for something other than a pharmaceutical drug to help manage their conditions.
Emory Healthcare’s Diabetes Management Program
Emory’s Diabetes Management Program includes two comprehensive patient-centered care program modules developed to improve clinical care and reduce acute and chronic complications in people affected by type 2 diabetes.
Diabetes Management Program
The Management Program is designed to provide patients with high blood sugar levels the knowledge, skill, and ability they need to better manage their diabetes. The patients are recommended to participate for one full year to help them reach their long-term healthy blood sugar level goals. Emory’s goal is for patients to live their life to its fullest and healthiest.
For more information, or to schedule your visit with the Emory Diabetes Management Program, please call 404-251-0083.
Diabetes Self-Management Training Program
The Self-Management Training Program is recognized by the American Diabetes Association. The American Diabetes Association has developed a three-session program that focuses on seven key areas. The group classes include education and discussions about healthy eating, problem solving, reducing health risks, healthy coping, taking medication, being active, and monitoring blood sugar.
For more information about the Emory Diabetes Self-Management Training Program, please call 404-778-4991.
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Emory Healthcare offers a wide range of primary care services. With the variety of backgrounds, interests and experiences our providers have, you’re sure to find one who’s a good match for you.