September Provider Newsletter

Did you know that according to the Center for Disease Control:

• More than 34 million people in the United States (that's roughly 10%) have diabetes
  • 1 in 5 don’t know that they have it
  • Prevalence increases with age: approximately 26.8% of those 65years + have diabetes
• More than 88 million US adults meet criteria for prediabetes
  • More than 80% don’t know
• Diabetes is the 7^th leading cause of death in the United States
  • #1 cause of adult blindness, lower limb amputation, and kidney failure
• Medical costs and lost work ages for those with diabetes is estimated at $327 billion YEARLY

And these numbers are increasing! Over the past 20 years, the number of adults diagnosed has more than doubled.

So What is Diabetes?

There are several “types” of diabetes- but for this “crash course” we’re specifically interested in the two most common types of diabetes mellitus: Type 1 diabetes and Type 2 diabetes.

To understand diabetes, it is important to know how the body gets and uses sugar- and so it is important to know a few key terms.

Carbohydrate:

• Macronutrient (along with fat and protein) found in many foods and beverages – that (predominantly) is broken down into glucose for use by the body (one of the body’s main fuel sources!)
• Three main types: sugar, starch, fiber
  • Sugar: simplest form. Occurs naturally in some food (fruits, vegetables, milks) – but also often added for flavor
  • Starch: complex carbohydrates (two or more simple carbs added together) – found naturally in some vegetables/grains (potatoes, rice, etc) and beans.
  • Fiber: complex carbohydrates found naturally in fruits, vegetables, grains
• Make up approximately 45-65% daily calorie intake in a balanced diet
  • Considered an essential part of a healthy diet- but NOT ALL CARBS ARE CREATED EQUALLY (see lifestyle section below)

Insulin:

• Hormone produced by the pancreas that allows the body to use glucose for energy

Pancreas:

• Gland that lies behind the stomach and produces digestive enzymes/hormones- including insulin

So…

When we eat carbohydrates, they are broken down into sugars (including glucose) and this glucose is released into the blood stream. The pancreas notices blood glucose levels rising and releases insulin. Insulin then acts like a “key” and helps glucose move from the blood stream into the cells so that cells can use it for energy. But some people don’t make insulin (Type 1 diabetics) and some people can’t use the insulin they make as well as they should—either because they don’t make enough, or the cells are resistant (Type 2 diabetics).

If the body cannot get glucose into the cells to use it for energy, then levels of glucose in the blood rise. When, over time, blood glucose remains elevated- this is referred to as diabetes.

Type 1 Diabetes:

                Prevalence: 1.6 million Americans

Type 1 diabetes occurs when the body stops producing insulin. Most often, this happens because the body mistakenly attacks its own insulin producing cells (autoimmune reaction). Because the body completely stops making insulin, symptoms of type 1 diabetes usually onset quickly and include increased thirst, increased hunger, increased urination, and unintended weight loss. These symptoms are a result of the body both trying to get rid of extra glucose and breaking down fat for energy (because it can’t use the sugar). If left uncontrolled, this can become fatal quickly.

Type 1 diabetics require insulin (injection or via an insulin pump) for survival. Most commonly, their care is managed by a specialist (endocrinologist).

Type 1 diabetes is usually diagnosed any time between young childhood and young adulthood (which is why it was previously referred to as juvenile diabetes).  It can, however, onset at any age.

Type 2 Diabetes:

                Prevalence: 90-95% of people with diabetes

Type 2 diabetes is the result of the body not using insulin properly. The body either makes insulin- but not enough – or more commonly the cells become resistant to insulin. There are both genetic and environmental influences on the development of type 2 diabetes. Being overweight is a leading risk factor, and so lifestyle modification is exceedingly important in prevention and management. 

                Additional risk factors include:

• Having prediabetes
• Age (45+)
• First degree relative with Type 2 diabetes
• Being physically active less than 3x/week
• History of gestational diabetes or having a child with birth weight >9 pounds
• African America, Hispanic/Latino American, American Indian, or Alaska Native
• Having non-alcohol fatty liver disease

TAKE THE RISK TEST: https://www.diabetes.org/risk-test

Type 2 diabetes often develops over many years and affects predominantly adults, be we are seeing increased prevalence in children and teenagers (as obesity rates rise). Because it develops slowly, many people have no symptoms at time of diagnosis.

Of note, prediabetes is a state in which glucose levels are elevated, but not to a degree that meets criteria for diabetes Type 2 diagnosis. It does increase your risk for Type 2 diabetes and in turn, heart disease and stroke.

Diagnosis: Know Your Numbers

You certainly should see your provider if you have symptoms that could suggest diabetes, including:

• Frequent urination or new onset bedwetting
• Excessive, unquenchable thirst
• Unintended weight loss
• Excessive hunger
• Changes in vision/blurred vision
• Numbness/toplining in hands or feet
• Excessive fatigue, especially after meals
• Slow healing wounds
• Frequent infections

However, as mentioned above, Type 2 diabetes can either be present for a long time without causing symptoms- or not cause symptoms at all. Even without symptoms, uncontrolled type 2 diabetes can cause damage to the heart, eyes, blood vessels, kidneys, etc and increase your risk of heart attack and stroke. For this reason, it is important that you go for annual wellness exams and have regular screenings.

Screening includes:

• Fasting blood glucose (most popular)
  • NORMAL: <100mg/dL
  • PRE-DIABETES RANGE: 100-125mg/dL
  • DIABETES RANGE: 126mg/dL +
• A1C (gives idea of average glucose over past 3 months)
  • Often checked if you have risk factors OR if fasting glucose is abnormal
  • NORMAL: below 5.7%
  • PRE-DIABETES: 5.7%-6.4%
  • DIABETSES: 6.5%
• If you are diagnosed with diabetes, you should also have the blood vessels in your eyes checked by an eye doctor at least once per year and have your kidney function and feet checked regularly by your PCP.

Lifestyle Modification

With Type 2 diabetes especially, lifestyle modification is very important in both prevention and management. Did you know that you CAN, especially if identified early, bring diabetes range blood glucose values back to normal range WITHOUT medication!

KEYS TO MANAGEMENT:

• Weight optimization
• Well-balanced diet:
  • YOU DO NOT NEED TO CUT OUT CARBS COMPLETELY!
    • Carbohydrates play an important role in protecting against disease and in weight management. The key is CHOOSING THE RIGHT CARBS!
      • Good: fresh fruits, fresh vegetables, whole grains
      • Avoid: concentrated sugars (full sugar sodas, fruit juices, candies, cookies, cakes, etc) and foods with high glycemic index (white bread, white rice, pasta, potatoes, chips, corn, etc).
    • Good resource: https://www.diabetes.org/nutrition/understanding-carbs/get-to-know-carbs
  • Ask your provider about meeting with a nutritionist!
• Regular physical activity
  • At least 150 minutes of aerobic exercise (brisk walking or more) per week

Another good resource:

https://www.cdc.gov/diabetes/prevent-type-2/guide-prevent-type2-diabetes.html

Medication

Medication is ALWAYS used in the treatment of Type 1 diabetes (insulin) and is OFTEN used in the treatment of Type 2 diabetes.

In the recent past, the FDA has approved many new and very effective medications for the management of Type 2 diabetes.

Most people have heard of METFORMIN. Metformin continues to be the recommended first line treatment for most people with diabetes- assuming there are no contraindications. It is recommended that treatment be initiated early in the course of diabetes- as this can help slow progression of disease. If treatment with lifestyle medication and Metformin does not achieve desired results (generally considered to be an A1C <7%), then a second agent is often added (oral, injectable, or insulin).

Discuss with your provider which medications options are the best for you.

COVID-19:

People with diabetes do have increased risk of having serious complications should they be diagnosed with COVID-19. Continue to follow your providers recommendations in protecting yourself- including limiting exposures as much as possible, wearing a mask, and practicing excellent hand hygiene.

What diabetes is NOT:

My hope is that the above may serve as a conversation starter between you and your provider at your next wellness visit. We are here to help and to answer any questions you may have!

Stay well,

Kristine Izzi, FNP-C

Resources:

CDC:

https://www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf

https://www.cdc.gov/diabetes/basics/quick-facts.html

https://www.cdc.gov/diabetes/basics/diabetes.html

https://www.cdc.gov/nchs/fastats/diabetes.htm

https://www.cdc.gov/diabetes/basics/getting-tested.html

https://www.cdc.gov/diabetes/basics/risk-factors.html

https://www.cdc.gov/diabetes/basics/symptoms.html

ADA:

https://www.diabetes.org/coronavirus-covid-19/planning-for-coronavirus

https://www.diabetes.org/diabetes

UP TO DATE:

https://www.uptodate.com/contents/initial-management-of-blood-glucose-in-adults-with-type-2-diabetes-mellitus?search=Diabetes%20facts&topicRef=1750&source=see_link

https://www.uptodate.com/contents/overview-of-general-medical-care-in-nonpregnant-adults-with-diabetes-mellitus?search=Diabetes%20facts&source=search_result&selectedTitle=2~150&usage_type=default&display_rank=1#H15054419

Image sources:

1. https://www.istockphoto.com/illustrations/insulin?mediatype=illustration&phrase=insulin&sort=mostpopular
2. https://www.t1international.com/type-1-diabetes/
3. https://me.me/i/math-test-bob-has-36-candy-bars-he-eats-29-2129213

Author

Kristine Izzi, FNP-C Kristine grew up in Brentwood, Tennessee. She graduated summa cum laude with her Bachelor of Science in Nursing from Belmont University. She then worked as a registered nurse in Labor and Delivery at Vanderbilt Medical Center prior to becoming a nurse practitioner. Kristine earned her Master’s degree from Vanderbilt University and is a certified Family Nurse Practitioner. She is a member of Sigma Theta Tau and the Tennessee Nurses Association. Kristine is passionate about optimizing health and wellness, treating illness, and building relationships with patients of all ages.