Category: Endocrinology

Diabetes is a condition where there is too much sugar in the body for long periods of time. There are strong genetic factors related to some forms of diabetes, while other forms are attributed to weight gain and lack of exercise. The pancreas makes insulin, which helps the body use consumed sugars.  Diabetes is caused by either the pancreas not producing enough insulin, or the cells of the body are unable to respond to the insulin produced.  There are 4 main types of diabetes:

1. Type 1 = the body’s failure to produce enough insulin. This was previously known as “insulin-dependent” diabetes mellitus (IDDM), or “juvenile diabetes.”
2. Type 2 = this starts with “insulin resistance,” where the cells fail to use the insulin produced properly, but can progress to a lack of insulin over time. This was previously known as “non-insulin-dependent” diabetes mellitus (NIDDM), or “adult onset” diabetes.
3. Gestational Diabetes = when pregnant women without a previous history of diabetes develop high blood sugars during pregnancy requiring close monitoring. Many of these patients may convert back without diabetes after delivery, while others may continue to have diabetes.
4. Secondary Diabetes = when a patient without previous history of diabetes develops high blood sugars, usually as a result of: (a) an underlying condition, such as Cushing’s syndrome or pancreatitis, (b) a drug or chemical, such as steroidal use, or (c) a surgical procedure, such as a pancreatectomy. A wide range of health problems that damage, injure, interfere with, or destroy the pancreas can cause secondary diabetes. If the underlying cause of secondary diabetes can be successfully treated, insulin production may improve or return to normal. Common causes include:
   • Chronic pancreatitis occurs when digestive enzymes attack and destroy the pancreas. The main causes of chronic pancreatitis are alcoholism, blocked or narrow pancreatic duct due to some form of trauma or cyst, and heredity.
   • Cushing’s disease is a hormonal disorder caused by prolonged exposure of the body’s tissues to high levels of the hormone cortisol spontaneously produced by the adrenals, or by excessive use of cortisol or other similar steroid hormones (i.e., steroids used to treat life threatening diseases such as asthma, rheumatoid arthritis, systemic lupus, inflammatory bowel disease, chronic allergies, etc.).
   • Cystic fibrosis is a genetic disease that causes the incapacitation of the pancreas by fibrosis and can lead to the development of Type 2 Diabetes.
   • Adenocarcinomas are cancers that begin in cells that line the inside of organs. Almost all pancreatic cancers are of this type.
   • Drugs (chemically induced diabetes).

The importance of insulin is that it enables the body to use consumed sugars as energy. In fact, most diabetic complications arise from the inability to use these sugars. When left roaming in various areas of the body, the excess unused sugars can cause very serious complications. In type two diabetes, which tends to be more common than type one, the patient either does not make enough insulin or is unable to use the insulin the body makes for various reasons. These patients may be placed on an oral medication, an insulin supplement, or a combination to help regulate blood sugar levels.

There are some ethnic groups who are at a higher risk for developing diabetes, which include American Indians, African Americans, Latinos, Asian Americans, and Pacific Islanders. An important factor in controlling diabetes is through diet and exercise. However, even the best-intention patient may find difficulty navigating the ingredient labels of some foods as sugars can come in a variety of types which may be unnoticed by the novice patient. Economically, it is also more difficult for diabetics as their health food lifestyle is typically much more expensive.

While diabetics often check their blood sugars between one to four times a day, the ultimate blood sugar test is the hemoglobin A1C, which is often referred to as A1C. While regular blood sugar readings report current blood sugar levels, the A1C gives a blood sugar average for the past three months. This test is the gold standard used by physicians to monitor the control of the diabetic’s blood sugar. Typically, anyone with an A1C of seven or less is considered to be controlled and those who are over seven will often have changes made to the medications or insulin dosing or both.

Low vs. High Blood Sugar Readings : Slight fluctuations in blood sugar levels are completely normal and also happen on a daily basis in people who do not have diabetes. Between around 60 and 140 milligrams of sugar per deciliter of blood (mg/dL) is considered to be healthy. This is equivalent to blood sugar concentrations between 3.3 and 7.8 mmol/L. “Millimole per liter” (mmol/L) is the international unit for measuring blood sugar. It indicates the concentration of a certain substance per liter.

Checking Blood Sugar Levels : People with type 2 diabetes should take a blood sugar reading at least once a day. Some may need to test as frequently as seven times a day. Doctors recommend that people who need insulin to treat their type 2 diabetes perform three or more blood sugar tests throughout the day, especially if they take multiple daily doses or are using an insulin pump. Most people use a small glucometer machine to check their blood sugars regularly, and it is important to track these readings so that your healthcare providers can get a better idea of how your body is responding to your daily activities to include foods. It is important to keep a food diary, along with a record of what you were doing throughout the day (sitting long periods vs. working out or running, etc.) so that a treatment plan can better be customized to your situation. There are many phone apps that provide easy to use trackers for tracking foods eaten, activity levels and blood sugar readings.

Blood Tests Used

• Random blood sugar test. Blood sugar values are expressed in milligrams per deciliter (mg/dL) or millimoles per liter (mmol/L). Regardless of when you last ate, a blood sample showing that your blood sugar level is 200 mg/dL (11.1 mmol/L) or higher suggests diabetes, especially if you also have signs and symptoms of diabetes, such as frequent urination and extreme thirst.
• Fasting blood sugar test. A blood sample is taken after an overnight fast. A reading of less than 100 mg/dL (5.6 mmol/L) is normal. A level from 100 to 125 mg/dL (5.6 to 6.9 mmol/L) is considered prediabetes.If your fasting blood sugar is 126 mg/dL (7 mmol/L) or higher on two separate tests, you have diabetes.
• Oral glucose tolerance test. This test is less commonly used than the others, except during pregnancy. You’ll need to fast overnight and then drink a sugary liquid at the doctor’s office. Blood sugar levels are tested periodically for the next two hours.A blood sugar level less than 140 mg/dL (7.8 mmol/L) is normal. A reading between 140 and 199 mg/dL (7.8 mmol/L and 11.0 mmol/L) indicates prediabetes. A reading of 200 mg/dL (11.1 mmol/L) or higher after two hours suggests diabetes.

Glycated hemoglobin (A1C) test. This blood test indicates your average blood sugar level for the past two to three months. Normal levels are below 5.7 percent, and a result between 5.7 and 6.4 percent is considered prediabetes. An A1C level of 6.5 percent or higher on two separate tests means you have diabetes.

A1C levels need to be checked between two and four times a year. Discuss your target A1C goal with your doctor, as it may vary depending on your age and other factors. For most people, the American Diabetes Association recommends an A1C level below 7 percent.

An elevated A1C level may signal the need for a change in your medication, meal plan or activity level.

In addition to the A1C test, it is important to also monitor your blood pressure and take blood and urine samples periodically to check your cholesterol levels, thyroid function, liver function and kidney function. Regular eye and foot exams also are important.

Symptoms of Hyperglycemia: (High Blood Sugar)

Signs of very high blood sugar levels may include the following:

• Extreme thirst, drinking a lot and then urinating frequently as a result
• Unintentionally losing a lot of weight within a few weeks
• Noticeable loss of energy with muscle weakness, tiredness and generally feeling quite unwell
• Nausea and stomach ache
• Trouble seeing
• Poor concentration
• Frequent infections (cystitis, thrush)
• Confusion and drowsiness, or even coma

Symptoms of Hypoglycemia: (Low Blood Sugar)

Signs that your blood sugar is too low may include:

• Racing pulse
• Cold sweats
• Pale face
• Headache
• Feeling incredibly hungry
• Shivering, feeling weak in the knees
• Feeling restless, nervous or anxious
• Difficulty concentrating, confusion

Diabetes affects many other health conditions and can make a patient more susceptible to getting other new health problems to include most commonly: Neuropathy (damage to the nerves in the extremities), Retinopathy (damage to the retina of the eyes), Chronic Kidney Disease (CKD) (damage to the kidneys), Heart Disease (0ver time sugars can harm blood vessels and arteries), and Erectile Dysfunction (ED) in men (damage to the nerves and vessels supplying blood to the penis).