What You Need to Know About Diabetes

I am Doctor Jennifer Williamson, a new resident internal medicine physician at the Brookings Avera Clinic. I recently moved here from New York. Prior to that, I lived in the Caribbean, in the Bahamas and Jamaica where my roots are.

What is Type 2 diabetes? 

The insulin is there, but for some reasons, there is some resistance to the insulin. What I mean, at the cellular level when the insulin circulates and goes around and it tries to act on the cells to get them "Knock, knock open, take up this sugar from the bloodstream," and nothing is happening there. So it's just like you have a bloodstream full of sugar, floating around in the body and for some reason, it's not getting into the cells where you need it to be for energy and for all the different processes that the cell participates in.

How can patients treat diabetes?

Good glucose control. The diabetic patient should work along with his or her doctor, dietitian and diabetes educator to ensure that he or she attains normal weight, normal blood pressure, and normal cholesterol levels.

What is a diabetic diet?
 
There are no foods that are barred for a diabetic patient, and I wanna be clear because many diabetic patients are frustrated thinking that, "I cannot eat this." Or, "I cannot eat that." It's really...it's based on your calorie requirements for the day, and each person, it's very highly individualized requirement. It's based on your height, your weight, and your activity level. So, in conjunction with your dietitian then, you would sit down and tell them what are kind of foods you have in your cupboard at home, what kinds of food you like and you would work out for the day, how many calories you are entitled to and then you eat within that limit. So we call it...it's like a calorie control diet. This is not a restricted diet. It's just that you eat within the limits of your diet.
 
Of course, I want to encourage diabetics to avoid too much of refined starches like the processed foods, too much of the cookies and the cakes and all of that. Try to limit your intake of those because those are refined starches that require a higher burst of insulin in order for them to be absorbed and also to...the goal of controlling your cholesterol and having normal cholesterol. Also, choose foods low in saturated fats, and these are the things that your dietitian will help you.
 
So it’s important when you are a diabetic that you have meetings with your dietitian to learn how to read labels and to learn how to understand all this phraseology. What are they saying? What do they mean? So it would become just a regular thing for you to know or to check when you're shopping, "Okay let me avoid... Let me pick this one over this one, and let me know how to mix and match my diet to stay within my requirements."

What physical activity can help control diabetes? 

Exercise should be a cardiovascular exercise meaning, when you work out, your muscles should not just be, "Oh, I walked all over today and my muscles and my legs are tired." You should work out till you feel that your heart is pumping and moving. You could actually feel your heart pumping. But of course, before you participate in an exercise program, please discuss your plans and have yourself assessed by your physician.
 
On average, 150 minutes of regular cardiovascular exercise per week and you could split this into like 5 days, 30 minutes each time, not just walking, although walking is good. But if you're walking, it shouldn't be at a leisurely, romantic peace. Although, if you have other comorbidities such as degenerative joints and that's all you can do, then fine. It's doing something. But if you are well and able and capable of walking fast to the level where you could feel your heart actually pounding, then that is better than doing nothing at all.

How can patients check blood glucose levels? 

There are two ways of monitoring. There is at home monitoring which patients do with their glucometers and there are so many brands of glucometers on the market. So, the blood glucose is checked at home. We recommend that you check the fasting in the morning. So you wake up in the morning, the first thing you do before you have breakfast is check the fasting levels. And on average, the ranges that we are looking for is 80 to, say, 130. Two hours after each meal in addition to the fasting sugar is what we are looking at because we have, again, target for those postprandial, as we said, after eating. Postprandial value should be in the range of 180.
 
And then, to tell us how well you're doing over a three to four month period, we utilize the hemoglobin A1c. We can tell what percentage of sugar or glucose was attached to your blood cells over the past three to four months. And target values for the diabetic patient no more that 7% of your red blood cells should have glucose attached to them. So if you get a HbA1c number greater than 7%, it means that your diabetes has not been controlled.

Is medication required to treat diabetes?
 
By large and by far, most patients will require either insulin if you are a type one diabetic or if you're a type two diabetic whose insulin stores have run out. In other words, if you're insulin deficient or insulin-depleted or have no insulin at all, you will require insulin. And patients who have insulin but they are insulin resistant, which is a larger percentage of the type two population, then we have medication that are insulin sensitizers to help the cell. Whenever the insulin go around and say, "Knock, knock, please let in the sugar," then we have medications that will help the cells to open their doors and let in the glucose so that the glucose can go where they are needed, where it is needed, which is inside the cells and no floating around in your bloodstream causing havoc. 

What would you say to encourage diabetic patients? 
 
So just by doing those basic measures, following up with your healthcare professionals, taking charge of your life by such as exercising, sticking within the limits or within the constraint of your calorie requirements for the day, keeping your blood pressure normal, keeping your cholesterol normal. It sounds like a lot, but in the end, it's rewarding. I've seen people very happy with the results that they were able to accomplish just by being empowered. So if you need encouragement and you need support, work along with your physician, work along with your diabetes educator, work along with people who are positive if you have positive family members, work along with other diabetics who have done it before. And be empowered to know that, yes, it's a chronic condition but, yes, most of the control resides in your hands. And it's very rewarding once you are doing what you need to do and the results that you achieve. You'll be very empowered.