Diagnosis Diabetes Part 2: I’m a Type-2 diabetic … now what?

Editor’s note: This is the second in a two-part series on Type-2 diabetes. Check out the first part by clicking here.

The blood glucose test is complete. The results have returned — and the numbers are consistently over the 126-threshold that indicates a diagnosis that can be hard to accept.

“It is never easy to tell someone they have (Type 2) diabetes,” said Dr. Michael Adler, endocrinologist with Evangelical Community Hospital. “We try to take away some of the misconceptions — and honestly, if someone makes the effort to take care of themselves and their blood sugar from the start, they will fare much better.”

That effort involves a series of life changes, Adler added, including introduction of a healthier diet, improving exercise, supplementing with proper medication and looking — in some cases — at procedures such as bariatric surgery.

“The first step is gaining an education — the more you know, the better prepared you will be to manage the condition,” said Dr. Brian Jameson, endocrinologist with Geisinger Medical Center. “Here, everyone who is newly diagnosed with diabetes has a certain bank of time set up to meet with an educator and learn all the basics — such as why they developed diabetes, how the body works in terms of sugar metabolism and different drug agents that can be used to treat diabetes and confront the issues that lead to its development.”

 

Identifying habits

That education looks at lifestyle habits, including the diet patterns that led to diagnosis.

“People sometimes don’t realize the habits they have that allowed them to consume large quantities of carbohydrates, such as drinking sugar-sweetened beverages,” Jameson said. “They can make it really easy to consume a lot of carbohydrates and empty calories.”

A Type 2 diabetes diagnosis and the deep dive into factors that led to the condition can be hard to accept for many patients who feel guilt for their situation — but a diagnosis can be a valuable wake-up call, according to Kate Patetta, program coordinator of UPMC Susquehanna’s diabetes and nutrition center.

“As depressing and down as people can get, there is definitely a blessing in disguise — it can offer a warning and a call to action that can be life-saving,” she said. “Ultimately, as things change, weight goes down and sugars get better, then cholesterol numbers, lipids and blood pressure all typically improve, too. It leads to a better quality of life, leaving patients feeling more themselves and more in control of their situations.”

Myriad of medications

Part of the equation to a healthier life involves starting a medication regimen that improves the body systems affiliated with blood sugar.

“Over the past decade, there has been an explosion into research looking at taking something that is failing — the pancreas (which produces insulin which helps regulate blood sugars) — and squeezing some extra life out of it,” said Jameson. “

Patetta agreed.

“In 1998, there were three different pills for diabetes that each worked differently. Now, there are 11 different classes of medications for diabetes, and on top of that, countless combinations of those different types,” she said. “There are meds that help decrease insulin resistance, some that help the pancreas to produce more insulin and even injectable medications that help with insulin while helping the patient with weight loss. Some newer injectable meds only need to be taken once a week, which makes it more user-friendly for patients.”

According to Adler, the gold standard of diabetes medications continues to be Metformin.

“If you look at most of the algorithms, Metformin is still the cornerstone of diabetes care,” he said. “It has been out for decades, does not cause weight gain and seems to be OK with the heart while offering nearly no rush of low blood sugars.”

Deadly if untreated

Diabetes affects numerous areas of the body and the damage can multiply quickly if not treated early and taken seriously.

“The biggest concern is cardiovascular disease — people with diabetes have twice the risk of developing heart disease than those who don’t have diabetes,” Patetta said. “There can also be a variety of issues involving the veins, including the big ones out of the heart all the way down to the smaller veins. This can lead to eye problems, retinopathy and nerve damage in the extremities.”

Diabetes can also directly impact the kidneys, according to Jameson.

“The kidneys are a filter, and as the blood sugars increase, it becomes like rocks over a screen. The more rocks you put over, the harder it is to filter and the more damage happens to the screen,” he said. “Kidney damage increases over time and can lead to failure.”

Diabetes can also affect healing of wounds — which when combined with nerve damage in the extremities — can lead to small abrasions on the toes and feet becoming major concerns that can lead to amputation if not addressed.

Avoid complications

The best way to avoid complications, according to Adler, is to adhere to the standards of care developed by the American Diabetes Association.

“Make sure to get your eyes checked, feet checked and manage not only your sugars, but also cholesterol and blood pressure,” he said. “It is important to be mindful of the entire body and do what you can to keep healthy.”

That sometimes can be very challenging, Jameson admitted.

“With any chronic disease, it can be easy to fall out of good habits. Life comes at you fast, and you can slide into comfort zones that can lead to bad decisions,” he said. “We are doing all we can to find new ways to help keep people on track — including connecting them with others who may be struggling with diabetes management. Sometimes patients get more out of the camaraderie with others with the same challenges than they do from a health care provider.”

For more information about Type 2 diabetes and tips for better management, visit the American Diabetes Association website (www.diabetes.org) and make an appointment with your health care provider.

“Early and aggressive intervention will lead to the best outcomes,” Jameson said. “The take-home here is to not ignore things, but to follow up right away and that will serve you well.”