September Provider Newsletter

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

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.





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:


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:


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:

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!


Another good resource:


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.


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







Image sources:

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.

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