Diabetes is a serious condition and
it is important people receive the
right care and support to prevent and
manage it. If you have diabetes, you’re
twice as likely to have heart disease
or a stroke as people who do not.
Diabetes can also cause kidney failure, permanent
vision loss and has contributed to a rise in
amputations, according to the Centers for Disease
Control and Prevention (CDC). “People are losing
their limbs and part of that is because their
diabetes is not well controlled,” said board-certified
endocrinologist Dr. Julie O’Keefe.
The statistics show as high as 80% of nontraumatic
lower limb amputations happen due to
diabetic complications. This is of particular concern
locally because the most recent Community Health
Needs Assessment once again revealed diabetes to
be a priority.
The good news is – it’s not too late to get your blood sugar
levels back down. Even people at high risk can cut their risk in
half by eating healthy, exercising regularly, getting to a healthy
weight, reducing stress and stopping smoking.
Recently, we sat down with Dr. O’Keefe to learn more
about diabetes, the life-threatening complications it can
cause, if not controlled, who should be screened and why
eating right and moving more can significantly lower
your risk.
Q: What is diabetes?
It is a group of diseases in which the body’s ability to respond
to the hormone insulin is impaired. It results in abnormal
metabolism or breakdown of carbohydrates, which increases
the levels of glucose or blood sugar in the blood or the urine.
There are different forms of diabetes and what causes them
are different. The most common type is type 2, which has
risen dramatically with the epidemic of obesity.
Q: What causes it?
Genetics plays a role; so does being overweight and people’s
lifestyles – not getting enough exercise and eating poorly. But
the only risk factor you need is age. As you become older, you
become more resistant to insulin.
Q: How serious is diabetes?
Diabetes and heart disease go hand in hand. There is at least
a 10-fold greater risk of a serious coronary event. Whether
it’s a heart attack, congestive heart failure or stroke – the
risk is significantly greater.
Microvascular complications (affecting the small blood
vessels) are vision loss, loss of kidney function that can lead
to dialysis and neuropathy, where the disease affects the
nerves. Once you have neuropathy, especially in the lower
extremities, you are at increased risk of severe infection
or amputation.
Patients who have neuropathy can avoid amputations
if they make it a practice to look at their feet daily. If it is
difficult for you to see your feet, place a mirror on the floor
or ask someone to look at your feet. Any abnormalities
(swelling, redness, lesions) should be evaluated by a
medical provider.
Macrovascular complications of type 2 diabetes include
coronary heart disease where there is a narrowing or
blockage of the coronary arteries usually caused by
atherosclerosis (buildup of plaque inside the coronary
arteries). Diabetes also increases the risk of the heart muscle
not working and congestive heart failure.
Q: What’s the relationship between diabetes and dementia?
A number of studies have shown that diabetes is associated
with a 1.5- to 2-fold increase in the risk of developing cognitive
decline and dementia later in life. This increased risk is
present for vascular dementia and Alzheimer’s disease but the
magnitude of risk is higher for vascular dementia. Vascular
dementia is due to the atherosclerotic changes that occur in
the blood vessels in the brain. Dementia may also occur after
repeated hypoglycemic (low blood glucose) events.
Q: How do you know you have it?
That’s part of the problem. With type 2, there are some people
who have symptoms that are so mild they often go unnoticed.
That is why it is critical to have your blood sugar tested –
early screening may help people avoid the more serious
complications of the disease.
Q: Who should be screened?
Per the American Diabetes Association (ADA), any adult over
45 OR any adult who is overweight (BMI over 25) and has one
additional risk factor such as:
- Hypertension
- High cholesterol
- Smoking
- First-degree relative with diabetes
- History of gestational diabetes
We know certain populations such as African-American,
Hispanic, Asian-American, Pacific Islander and Native
American are at a much higher risk. If you are screened
and it’s negative, you should get screened every
three years. If you are someone who was told you are
prediabetic, you should be screened yearly.
Q: Can type 2 diabetes be prevented?
Yes, it can. First of all, what is important is to know your
risk – talk to your doctor if you don’t know. And make sure
you’re getting screened. Because in truth, as we age our
body becomes more resistant to insulin. That is just reality.
But keeping your weight in check, being active, and eating a
healthy diet can help prevent most cases of type 2 diabetes.
In general, it’s a good idea to load up on vegetables,
especially the less starchy kind such as spinach and other
leafy greens, broccoli, carrots and green beans. Add more
high fiber foods and enjoy fruit in moderation (1-3 servings
per day), choose whole grain foods and avoid bad fats like
bacon, luncheon meats, chips, ice cream and fried foods.
Q: Why is regular physical activity so important?
Becoming more active is one of the best things you can do
to make type 2 diabetes less likely. In fact, inactivity is a
risk factor for developing the disease. Aim for 30 minutes
of aerobic activity five days a week. Find what is going to
keep you engaged and keep doing it. It’s OK to split it into
three 10-minute intervals.
Strength/resistance training should be done at least
twice a week. Muscles are what allows the body to take
the glucose in your bloodstream and use it as energy. The
other thing it does is lower your resistance to insulin.
That’s why your exercise routine needs a strength/
resistance training component. Before beginning any
exercise program or regimen, you should get clearance
from your doctor.