Oh, Sugar, Sugar: Breaking down type 2 diabetes mellitus

Diabetes mellitus is a major cause of blindness, heart attacks, strokes, and kidney failure. In the United States, one in 10 people have diabetes mellitus, with 90-95 % of them having type 2 diabetes.  Join me in discussing how our body normally responds to sugar, where things go wrong, and the risk factors, symptoms, complications and treatment options for type 2 diabetes mellitus.

This episode's show notes:   Season 1, Episode 4 Show Notes

We also have an animated version of this episode for our fellow visual learners as well!
 Season 1, Episode 4 YouTube Short 

Check out our website for show notes, articles referenced, resources and more.

https://www.rhoadtopa.com/podcast

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Transcript

S1E4

“Oh, Sugar, Sugar: Breaking down diabetes mellitus”

Erin Layman Rhoads

[00:00:00]

Hello, and welcome to Medicine in Layman’s Terms. 

Whether you are a patient looking to understand more about your health, a student looking to brush up on common medical terms, or a provider wanting ideas to explain diagnoses to your patients, I invite you to join me every week as we break down basic medicine into layman’s terms. I am your host, Erin Layman Rhoads, a certified physician assistant, and let's get started.

[00:00:25]

Meet Isabella. Isabella is a 58 yo female presenting to her primary care doctor for her annual physical. Her annual physical goes well, and her provider orders some basic lab work. A few days later, however, her doctor calls her and tells her that the labs showed that she has type 2 diabetes. She would like Isabella to return to the office to discuss more about her new diagnosis and to start her on an oral medication. At the follow up appointment, Isabella brings a list of questions to ask her physician including why she doesn’t have any symptoms, if she will have to be on medication forever, and how she even got diabetes?

[00:00:57]

This week we will be diving into diabetes mellitus. Before though, I wanted to encourage everyone to check out our website, in layman’s terms. L-A-Y-M-A-N.  Not only are there links for the show notes and animated YouTube videos for each episode, but there is also a new blog post up for PA students and new graduates so, please, check it out and, if you haven’t already, subscribe to our email group to get notifications. Moving on!

[00:01:18]

What is diabetes mellitus?

Diabetes mellitus refers to a group of diseases that affect how the body uses and responds to blood sugar.  Today we are going to primarily focus on type 2 diabetes as this is the more common type. In the United States, 1 in 10 people (approximately 37 million Americans) have diabetes, and 90-95% of them have type 2 diabetes. I do want to discuss type 1 diabetes in the future, and I will briefly summarize the differences between type 1 and 2 today. However, the management, risk factors, prevention, etc. can vary drastically between the two so we will cover them in different episodes. 

[00:01:54]

What is insulin?

To understand diabetes, there are a few concepts we should cover first, specifically how your body normally uses and responds to sugar, also known as glucose. Glucose is an important source of energy for the cells in our bodies, especially those in our brain and our muscles. Insulin is a hormone released by your pancreas which helps bring that glucose, or sugar, floating around in your bloodstream, into the cells. We can think of insulin like a key that unlocks the cells and allows the sugar to enter. 

As an example, you eat your sandwich at lunch. The bread, for instance, starts getting broken down into its basic components, including carbohydrates, which are further broken down in the digestive tract into sugars like glucose. Glucose is then absorbed into your bloodstream and kind of floats around. Insulin comes and shuffles the glucose into the cell where they can be “magically”…it’s really not magic, but it’s been a while since I’ve touched on biochemistry and, also, we don’t have unlimited time so *voila* magic!... and it’s turned into energy to help fuel the body. 

In patients with type 1 diabetes, the body does not produce insulin. This is compared to patients with type 2 diabetes, where the body does not use or respond to insulin properly. 

[00:03:05]

What causes type 2 diabetes and what are the risk factors?

The exact cause of diabetes is often unknown, however in all cases sugar builds up in the bloodstream because the pancreas can’t make enough insulin. This is likely due to a combination of genetic and environmental factors. As mentioned, in people with type 2 diabetes their cells do not respond normally to insulin. As the blood sugars continue to rise, your pancreas works harder and harder to keep up, and it cranks out more and more insulin until eventually it can’t keep up since your cells are not responding properly. 

Type 2 diabetes typically develops over many years and is usually diagnosed in adults over the age of 45. Other risk factors include being overweight or obese and having a family history of type 2 diabetes. Research shows that structured lifestyle changes, including a focus on diet and exercise, can cut the risk of type 2 diabetes in half. 

[00:03:56]

Symptoms 

Symptoms often develop gradually over many years and, sometimes, people may not notice symptoms at all. This is why attending annual checkups with your primary care provider and knowing the risk factors are so important because testing can catch the disease early, especially if there aren’t symptoms. 

If people do experience symptoms, they may complain of feeling more thirsty than usual, frequent urination, weight loss without trying, feeling more tired or weak, blurry vision, and/or having problems with slow-healing wounds and sores, especially on their legs. And we’ll touch more on that in a little bit. 

[00:04:27]

How is type 2 diagnosed?

Most commonly, simple blood tests are used to screen for and diagnose diabetes. There are several different tests and multiple of these types may be used to properly diagnose diabetes. 

If you or a family member have diabetes, or levels that are concerning that you may develop it (sometimes referred to as prediabetes), then you have likely heard of an “A1c” before. An A1c is a way of testing your average blood sugar for the past few months. Sometimes if you eat a bowl of fruit loops, drink two orange juices and a vanilla latte before your appointment, a simple blood glucose test that sees what your sugar is at that exact moment can be reactive to wait you ate and give really high readings. Looking at an A1c is a way to see what the average has been for the past two to three months. Values less than 5.7% are considered normal. An A1c value of 6.5% or greater indicates diabetes. 

Fasting plasma glucose tests your blood sugar values at the exact moment. To avoid the possible spikes that come with eating and drinking, as mentioned above, this test is performed while fasting. It is most commonly done before breakfast without having anything to eat or drink for at least 8 hours prior. A fasting blood glucose level greater than 126 indicates diabetes. 

On the other hand, a non-fasting blood glucose test, also known as a “random blood sugar test”, with a level of 200 or higher indicates diabetes. 

Finally, an oral glucose tolerance test is a 2-hour test that checks your body’s glucose levels and how they respond to sugar. Your levels are tested before then again two hours after drinking a sugary, sweet drink. At the two-hour mark, a blood glucose level of 200 or higher indicates diabetes. 

[00:06:08]

What is prediabetes?

Briefly, let’s touch on this. 96 million adults, more than 1 in 3, have prediabetes. More than 8 in 10 of these individuals do not know that they have it. The same blood tests that we use for diagnosing diabetes can also tell us if someone has prediabetes. Basically, your glucose levels are higher than normal but not quite to the diabetes levels. For example, I mentioned that the normal A1c is less than 5.7% and an A1c of 6.5% or greater indicates diabetes. Therefore, values between those numbers fall into the range of “prediabetes”. 

I like to explain prediabetes versus diabetes measurements like you are approaching a stoplight when talking to patients. If your glucose levels are normal, then you are pulling up at a green light. We encourage keeping a healthy, balanced diet and have ya keep on keepin’ on. If you have levels that indicate prediabetes, we see this as a yellow light. We have patients slow down to focus on specific ways to improve diet and exercise, and then perhaps monitor your levels a little bit closer, trying to avoid developing into diabetes. If your levels show diabetes then we are ow at a red light, so we stop completely, talk more in depth about monitoring your blood sugar, adjusting diet and exercise, and will often start medications as well. 

Having prediabetes does not always lead to diabetes. Early treatment, including focus on diet modifications, exercising more frequently and losing weight can bring your blood glucose levels down to the normal range.  

[00:07:37]

Treatment

A huge part of managing type 2 diabetes is a healthy diet, which I understand is redundant because I think I’ve said it at least ten times, but it really is something that I can’t stress enough when managing diabetes. I always recommend patients meet with a registered dietician or nutritionist. These people are amazing and can help tailor eating plans to maximize your health while also setting you up for success with foods that you enjoy. Fitness is huge but this can also vary from person to person and is very dependent on the individual. 

People may be able to manage their diabetes with diet, exercise, and lifestyle modifications, however sometimes you may need medication. This may include oral medications to manage blood sugars and injected insulin if your pancreas can’t make enough of it. You and your doctor will find a target level for your blood sugar. People then test themselves regularly, generally with a simple finger stick, and can adjust medications to keep their blood sugar level in that target range. 

[00:08:31]

Complications 

Finally, let’s talk about complications of diabetes since sometimes I don’t think we fully realize how big of a deal this can be. Diabetes is a major cause of blindness, heart attacks, strokes, and kidney failure. Long-term complications tend to develop gradually. The longer you have diabetes, especially if it remains uncontrolled, the higher the risk of complications. Over time, type 2 diabetes can cause serious damage to the body, especially to nerves and blood vessels.  

Let’s break this down a little.

First, your heart. Having diabetes increases the risk of many heart problems including heart attacks and strokes. Nerve damage- also known as diabetic neuropathy. Having too much sugar can injure the walls of the tiny blood vessels that nourish the nerves, especially those in the legs. This can cause tingling, numbness, burning or pain especially in the tips of the toes that gradually spreads upwards. 

Your digestive system is heavily regulated with nerves so uncontrolled diabetes can lead to things like nausea, vomiting, diarrhea as these nerves become damaged.  The kidneys hold millions of tiny blood vessels and filter waste from the blood. This system can become damaged, and people may develop kidney disease, known as diabetic nephropathy. The eye vessels can be damaged leading to blurry vision and blindness known as diabetic retinopathy. 

In 2019, per the World Health Organization, diabetes and kidney disease due to diabetes caused an estimated 2 million deaths. And that is why it is important to have regular visits and conversations with your doctor and, if you do get diagnosed with type 2 diabetes or prediabetes, learn how to control your sugars. 

[00:10:10]

And that, my friends, is a grand overview of type 2 diabetes. Visit our Instagram page or website to vote for which topic you would like to hear next time!   

[00:10:19]

If you have any questions, like wanting clarification on something, suggestions or constructive criticism, feel free to reach out via social media. My Instagram handle is rhoadtopa, R H O A D T O P A. You may also email me at rhoadtopa@gmail.com, again the same spelling as the Instagram handle, R H O A D T O P A. Finally, feel free to hit the subscribe button and have a beautiful rest of your week. 

Thank you.