Everything you need to know about how diabetes changes over time.
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A diabetes diagnosis is always followed with questions. Everything from how insulin works to wondering about a cure floods your brain. Hopefully, your doctor was able to answer all of your questions in the moment, but then the real hard work began: Living with chronic diabetes management for the rest of your life.
According to the Centers for Disease Control and Prevention (CDC), over 30 million, or nearly one in 10, Americans are now living with diabetes. And that number is only expected to increase, paralleling the epidemic of overweight and obesity in this country. In fact, it is estimated that 20-50 percent of diabetes cases identified under the age of 19 are Type 2 diabetes, going against the traditional thinking that Type 2 diabetes is a disease of adulthood. More people are getting diagnosed with diabetes at a younger age, and it’s more important than ever to learn the skills of life-long diabetes management.
By one estimate, diabetes can shorten a person’s life expectancy by up to 10 years. The good news is that, by controlling diabetes and making important lifestyle modifications, research shows that this prognosis can be significantly improved. Here’s everything you need to know about lifelong diabetes management, including questions you probably never thought to ask.
Can diabetes be cured?
Unfortunately, there is no cure for Type 2 diabetes. Once you have received your diagnosis, you should expect it to remain a part of your medical history forever. Just because diabetes cannot be cured, though, does not mean it can’t be managed. The cornerstone of diabetes treatment is focused on controlling blood sugar levels and keeping an eye out for complications. In some people who have committed to major lifestyle changes, diabetes may be partially reversible. This means that certain patients may become so well-controlled that they no longer need medication. Regardless, they are still at risk for diabetes to worsen again and must stay dedicated to lifelong management.
So, how should I manage my diabetes?
As you’re probably already aware, the management of diabetes can be broken down into two main categories: lifestyle changes and medication.
No matter how long you’ve had diabetes, it is never too late to change your daily habits to improve your health. Losing weight – particularly losing weight around the waist – is one of the most important things you can do to manage your diabetes. Research shows that weight loss of five to 10 percent of body weight can have beneficial effects. Additionally, eating a diet that is focused on whole, unprocessed foods (like vegetables and whole grains) is better than eating sugars or processed foods (like white breads and pastas). Along with this, exercising 30 minutes per day five days per week is the minimum amount of physical activity you should strive for. Quitting smoking — if you’re a smoker — is one last step you can take to improve your overall health status.
Numerous oral and injectable medications have now been approved for the treatment of Type 2 diabetes. These work in many different ways in the body, but overall are intended to decrease blood sugar levels. Medications can be taken alone or in combination with one another.
- Oral medications: The most commonly prescribed oral medication is metformin, which is sometimes even prescribed for those with prediabetes. As your diabetes progresses, you may need to increase your dose of metformin. There are many other classes of oral medications that are intended to be taken daily
- Non-insulin injectable medications: Some medications that help control your blood sugar are injectable. Depending on the specific medication, injections may be daily or can be spaced out more. Some medications can also be used to help combat obesity.
- Insulin: Everybody with Type 1 diabetes requires insulin. You may not require insulin at first if you have Type 2 diabetes. However, since diabetes is a progressive disease, even if you have lived for years without insulin injections, you may still need it in the future.
No matter what you are taking, staying compliant with your medications is paramount to maintaining good control of your disease.
How often should I go to my doctor?
According to the Cleveland Clinic, people who are managing their diabetes with insulin should see their doctor at least every three to four months. Patients only on oral medications or relying on diet and exercise to control their diabetes can space this out a little more, visiting the doctor every four to six months. Of course, if your healthcare provider wants to see you more often, you should follow their recommendations, as closer monitoring may be beneficial for you.
What screening tests will I need in the future?
Diabetes can lead to many issues in the future, including eye damage, kidney damage, and nerve damage. To watch out for these things, there are three main screening tests you should make sure you have done every year. An annual eye exam can look out for issues with the back of the eye, an annual foot exam can test for nerve damage, and an annual urine test can look for protein in your urine, which would be a sign that your kidneys are getting damaged. If unchecked and untreated, these issues can lead to blindness, amputations, and permanent kidney disease requiring dialysis or transplantation.
In addition to these three screening tests, your doctor may also regularly check your blood pressure, your cholesterol, and your hemoglobin A1c level. The hemoglobin A1c is a number that estimates how well your blood sugar has been controlled over time. Management of diabetes is typically focused on achieving a hemoglobin A1c of <7.0. However, as you age with diabetes, it may be more appropriate for your hemoglobin A1c target to be <8.5.
Does diabetes affect other medical conditions?
Type 2 diabetes is a major risk factor for many other diseases, including cardiovascular disease (heart disease) and possibly even cancer. Because of this, there are recommendations specifically for people with Type 2 diabetes that differ from recommendations for the general public. If you have high blood pressure along with diabetes, your healthcare provider may try to achieve stricter blood pressure control (<130/80) than if you didn’t have diabetes. Similarly, if you have high cholesterol along with diabetes, it may be more important for you to take a higher dose of a statin (a cholesterol-lowering medication). These recommendations are updated every few years, so don’t assume you’re already on the correct regimen. Make sure to ask your doctor about the most up to date recommendations.
What’s the future of diabetes care? Will there ever be a cure?
Recent developments surrounding the treatment of diabetes have looked towards the use of stem cell therapy, an artificial pancreas, or pancreas transplant. However, these therapies are more likely to be beneficial for those with Type 1 diabetes (in which the pancreas has stopped producing insulin) instead of Type 2 diabetes (in which the pancreas works but the body is less sensitive to insulin). Regardless, medical breakthroughs are always happening, so remember to ask your doctor about the most recent developments in diabetes care at your next appointment.
What else should I know?
You can never educate yourself too much about the potential complications you may experience. Having both high blood sugar (which can occur when you are noncompliant with medications) and having low blood sugar (which can be a side effect of treatment) can be very dangerous.
Low blood sugar can cause anxiety, headaches, racing heartbeat, shaking, sweating, confusion, vision problems, and loss of consciousness. If you have had diabetes for a long time, you may have a condition called “hypoglycemia unawareness”. This is a state in which you may have low blood sugar but do not experience its typical symptoms. This can be dangerous and, if you think you may have hypoglycemia unawareness, you should check your blood sugar more often and should talk to your healthcare provider about your options. Anybody at risk of having low blood sugar should always keep a sugary snack or drink on hand for when levels get too low and should call 9-1-1 if symptoms worsen, as this is a medical emergency.
High blood sugar can cause frequent urination, thirst, vision changes, breath that smells fruity or like nail polish remover, lethargy, belly pain, and vomiting. When severe, it is also a medical emergency requiring treatment in a healthcare facility.
Living with Type 2 diabetes is difficult, but you don’t have to let it control the rest of your life. If you remember to see your doctor, stay up to date with the latest breakthroughs in diabetes management, engage in regular screening, and stay compliant with your lifestyle modifications and your medications, you can live a long life with Type 2 diabetes.