“All I had was a bologna sandwich on white bread and a glass of sweet tea and my glucose is 250!” So went a call from “Sue”, a patient this week who already knew she had impaired glucose tolerance (IGT) or “pre-diabetes”. Now it’s beginning to look like she may actually have full-blown type 2 diabetes. Her only symptoms had been some vision changes – sometimes her vision seemed a bit blurry and other times fine. After seeing her ophthalmologist, she noticed that the change in her glasses hadn’t fixed the problem. Her fasting blood sugar had been 110 (normal is below 100 and diabetic is above 125). Likewise, her HbA1C (the blood test that reflects a person’s average blood sugar over the previous 3 months) had been 6.1 – not yet in the clearly diabetic range (6.5 and up), but already in the IGT range.
Like so many entering into diabetes, Sue had only subtle symptoms and her initial blood work had been fairly unimpressive. Also like so many in the early stages of diabetes, she had little feel for the impact of foods and drinks (like white bread and sweet tea) on her blood sugar. We had actually just had an appointment that morning where we had begun to discuss foods to limit, including “sweets” and “whites” – breads, pastas, potatoes, rice. We had prescribed a glucose meter to check her blood sugar. At this stage it was more as a teaching tool to check her glucose at various times such as fasting in the morning, after a meal, when her vision was blurry, and so on.
So, what now for Sue? She has four choices. One would be to let this diagnosis scare her and just try to ignore it and stick her head in the sand (or sugar bowl). Unfortunately, diabetes is a diagnosis that has a nasty habit of refusing to be ignored. Over time, if ignored, it will bring nerve, eye, heart, kidney, circulation, and brain injury, or, in some cases, put a person into the hospital with a diabetic coma (from extremely high blood sugar). Yah, not a good choice to try to ignore it. I don’t have many patients going this route, but I do have just a few who check things so infrequently and haphazardly that they are close to this. I always hope they’ll change their ways before the bad stuff really starts happening.
The second choice would be to not change her lifestyle but treat with medicines and monitor her sugar along with other important risk factors like blood pressure and cholesterol. This is certainly a better choice, but a bit expensive. It’s a little like trying to put out a fire while sprinkling gas (in this case, flammable sugar) on it.
A third choice would be for her to “tweak” her lifestyle and take medicines to make up for any shortfalls in her efforts. We’re getting better now. If she can perhaps lose 10 or 15 pounds out of the 50 extra that she has on board, that will help substantially. In terms of exercise, a study where the “exercise group” did a 30 minute walk five days a week showed an eleven year delay in the onset of diabetes compared with the “no exercise group” – a rather huge impact. Likewise, cutting out sweets (or substituting Splenda) and limiting whites (and substituting whole-grain alternatives as much as possible) can have a major impact. Even if Sue isn’t perfect in these efforts, it will have a significant effect on her diabetes and allow her to reduce the number of meds needed to control her diabetes well.
The final choice is certainly what I love to see. This is where the person really changes their life. They begin to learn the ins and outs of a healthy diabetic diet. They exercise six days a week and slowly work their way down to their ideal weight and maintain it. These folks, the few, the proud, the diabetic marines, are able to essentially eliminate the risk factors normally associated with diabetes while minimizing the medicines that may be needed. And they feel great. We have a man whose HbA1C was 12 – terrible! He became a “change your life” kind of guy and now has his HbA1C down in the 6’s with no diabetes meds. At our office, we follow people in all four categories, but the more we can encourage into this last category, the better we like it. So if diabetes is raising its ugly sugar-coated head in your life, don’t stick your head in the sugar; change your life – the rewards are sweet.
Andrew Smith, MD is board-certified in Family Medicine and practices at 1503 East Lamar Alexander Parkway, Maryville. Contact him at 982-0835More