If you’ve been diagnosed with diabetes and find yourself wondering what the diagnosis means to you, you are far from alone. Over 30 million Americans carry a diagnosis of diabetes, with nearly 1.5 million new cases diagnosed each year. Diabetes can be frightening, as it can be associated with many other conditions such as heart disease, stroke, kidney disease, vision and foot problems, and many others. The good news is that with proper control of diabetes, many of its complications can be minimized or even avoided altogether.
What is diabetes? Diabetes is a disease in which blood glucose is high. Glucose is the main source of energy for the body and comes from the food we eat. In order for glucose to be used as fuel it needs to be taken from the blood and moved into the cells of the body. The hormone that does this is insulin, which is produced by the pancreas. In people with diabetes, the body’s ability to produce or respond to insulin is impaired, leading to elevated blood glucose levels. These elevated blood glucose levels might not cause symptoms right away, but over time can lead to the complications commonly associated with diabetes.
There are two main types of diabetes, type 1 and type 2. Type 1 diabetes is characterized by destruction of the insulin-producing cells of the pancreas, leading to a complete lack of insulin production in the body. Type 1 diabetes is usually diagnosed in childhood or young adulthood. The more common type of diabetes is type 2 diabetes, accounting for over 95 percent of cases. People with type 2 diabetes usually still produce insulin but do not respond to it well and are so-called “insulin resistant.” Type 2 diabetes is most often diagnosed in adulthood, although it continues to be diagnosed in younger and younger patients. Risk factors for the development of type 2 diabetes include a family history of diabetes, being overweight and age greater than 45.
Physicians diagnose and monitor diabetes using a blood test called the hemoglobin A1C, which reflects the average blood glucose over the previous three months. Diabetes is diagnosed when the A1C is 6.5 percent or greater. Once diabetes is diagnosed we create an individualized A1C goal for each patient. For patients recently diagnosed with diabetes, research strongly suggests that aggressive lowering of the A1C has been linked to avoidance of many complications of diabetes, and we will therefore aim for an A1C of 7 percent or lower. For older patients or those with other medical issues, the benefits of lowering the A1C to less than 7 percent may be more limited, and an A1C target of 7 to 8 percent would be warranted instead.
A major treatment goal in diabetes is to lower the A1C, which is accomplished with both lifestyle changes and medications. The treatment of type 1 diabetes is beyond the scope of this article. For people with type 2 diabetes, achieving weight loss by lowering caloric intake and increasing physical activity may be enough to achieve adequate control of diabetes. For others, however, medications are needed to control blood glucose adequately.
There are many medications available to treat diabetes and help lower the A1C. While not too long ago there were limited options to choose from, there are now a wide range of treatment choices, thus allowing physicians to individualize a treatment program for each particular patient. There are now treatment options that can assist with weight loss or even reduce cardiovascular risk in high-risk patients. There are both oral and injectable options, some of which are even available in weekly formulations.
If you haven’t had a “big-picture” conversation with your doctor about your individual diabetes treatment goals and treatment options, now is a great time to do so. A diabetes treatment plan tailored to your specific health needs can go a long way in helping you take control of your diabetes.
By Ari Geliebter
Dr. Ari Geliebter is a board-certified endocrinologist who provides complete endocrine care including the management of diabetes, thyroid disease, osteoporosis, obesity and more at Comprehensive Endocrinology, PC in Hackensack, NJ. He is affiliated with Hackensack University Medical Center and Holy Name Medical Center. To schedule an appointment with Dr. Geliebter, please call 201-903-0070 or visit www.comprehensiveendo.com.
