Diabetes Management: Our Tips to Thrive with Diabetes

According to the U.S. Centers for Disease Control and Prevention, over 38.4 million Americans have diabetes. But according to Dr. Cecilia Lozier, Chief of the Division of Endocrinology and Diabetes at Baystate Medical Center, while over 38 million people have diabetes, the disease is not the same for everyone.

She explains, “Diabetes looks different in every individual. From what causes the disease to develop to how it’s experienced, everyone's diabetes journey is different. Which is why understanding the causes and symptoms as well as having a personalized plan for managing the disease is so critical.”

Understanding Diabetes: Causes, Symptoms and Diagnosis

Simply put, diabetes is a disease that occurs when the amount of sugar in your blood is too high. Often referred to as glucose, sugar is an important source of energy for your body.

“The sugar in our blood comes from one of two sources,” says Lozier, “Either it comes from what we eat or drink, or it’s produced by the liver. Normally, the level of sugar in the blood is controlled by a substance called insulin that’s released by the pancreas. Insulin is what makes it possible for sugar to move from the bloodstream to the cells where it’s needed. When something interferes with the process and sugar stays in the bloodstream instead of going into the cells, that’s considered diabetes.”

Dr. Lozier further explains that there are two types of diabetes, the difference between the two being what’s happening with the insulin in the body.

“Type 1 diabetes occurs when the pancreas stops producing insulin,” she says, “while type 2 diabetes occurs when the body develops a resistance to insulin. Even though the causes of each type are different, the resulting high blood sugar levels lead to the same symptoms.”

Another major difference between type 1 and type 2 diabetes is the risk of diabetic ketoacidosis, also known as DKA. DKA is a life-threatening condition more commonly seen in patients with type 1 diabetes. "It occurs when the body starts breaking down fat at a rate that is much too fast. The liver processes the fat into a fuel called ketones, which causes the blood to become acidic,” according to the National Library of Medicine.

Symptoms of Diabetes

Common symptoms of diabetes include:

• Fatigue
• Increased urination and thirst
• Increased hunger
• Weight loss
• Blurry vision
• Numbness or tingling

Other signs may include an increased number of skin tags on the body, a velvet-like rash on the back of the neck or under the arms, and slow-healing sores or infections.

However, Dr. Lozier is quick to point out that in many cases, patients experience no symptoms or signs of diabetes and only learn of it from a routine blood screening.

“If a standard blood screening, like you might have at an annual exam, shows a high level of sugar in your blood,” says Dr. Lozier, “a diagnosis of diabetes typically needs to be confirmed. Your primary care doctor can guide you through the next steps. The findings of these tests will confirm a diagnosis of diabetes, or a condition referred to as prediabetes.” In the case of prediabetes, blood sugar levels are above normal but not so high as to indicate diabetes.

“A prediabetes result,” says Dr. Lozier, “is a signal that the body is having trouble handling sugar. The good news is that at this stage you can take steps to delay developing full blown diabetes and limit the damage the disease can cause.”

Ways to Manage Diabetes

Untreated, elevated sugar levels associated with diabetes can damage blood vessels, both large and small, throughout the body.

Dr. Lozier explains, “It helps to think of granulated sugar, like you might put in your coffee, tumbling through very fragile, and often very narrow, blood vessels. The sharp edges of the sugar can damage tiny blood vessels, like those in your eye, as well as harm larger vessels like those that carry blood to your heart and brain. Over time, that damage can lead to complications including heart attack, stroke, kidney disease, skin conditions, poor vision or even blindness, circulation issues, and nerve damage, most notably in the feet, which, in some cases, may require amputation. Type 2 diabetes has also been linked to dementia and Alzheimer’s.

“Fortunately,” she adds, “There are several ways to effectively manage diabetes. These include lifestyle changes, medication, and careful monitoring of sugar levels.”

Managing Diabetes Through Lifestyle Changes

Both type 1 and type 2 diabetes can be effectively managed through changes to daily routine.

With type 1 diabetes there is an absolute need for insulin. Type 1 diabetes cannot be managed without medication. However, with being thoughtful about diet and exercise, type 1 diabetes can be easier to manage. With type 2 diabetes, focused, consistent and thoughtful efforts towards healthy lifestyle changes can change the way your body uses insulin to the point that no medication may be necessary. Some folks with type 2 diabetes may end up requiring some support from medications even with really powerful lifestyle changes. Your care team can help you understand the roles medications may play. The earlier diabetes is caught the more likely you may be able to overcome diabetes without medications!

When we think about what lifestyle changes are helpful for diabetes, there are three: moderating carbohydrates, increased physical activity and modest weight loss. To begin with, moderating the amount of carbohydrates (which convert to sugar in the body) can go a long way to keeping levels in check. Of course, the first step is educating yourself on what foods contain carbohydrates. Common sources include:

• Potatoes
• Pasta
• White bread
• Grains
• White rice
• Beans
• Corn
• Cereal
• Cookies
• Cakes
• Soda
• Chips
• White or brown sugar

Dr. Lozier notes that even just reducing portions of carbohydrates can be helpful.

“However,” says Dr. Lozier, “the challenge is that not everybody processes food the same way. For one person, potatoes can really spike their blood sugar while rice does very little to it. But for the next person it can be the complete opposite.”

She adds that many of her patients find success with what’s called the Plate Method of portion control. This involves filling half your plate with non-starchy vegetables, a quarter with protein, and the remaining quarter with carbohydrate or starch.

She also encourages patients to work with a Certified Diabetes Care and Education Specialist (CDCES) or a nutritionist or dietician to develop an eating plan that works for them.

The second helpful lifestyle change for managing type 1 and type 2 diabetes is exercise and physical activity.

“When you exercise, you engage your muscles which pull sugar out of the bloodstream to create energy,” explains Dr. Lozier. “Combining regular exercise with a moderate carbohydrate intake can be very effective at keeping diabetes in check.”

For individuals looking to manage their diabetes through exercise, Dr. Lozier strongly encourages working with an exercise physiologist to develop a program that supports your goals and aligns with your abilities.

Managing Diabetes Through Medication and Insulin

Today, there are multiple classes of drugs as well as insulin to help you effectively bring down blood sugar levels. The challenge is that some are rather costly—even with insurance—and some can have unpleasant side effects. There are effective treatments that come in pill and injection form. Matching the right medication to you is essential. You should work with your physician, advanced practitioner (diabetes specialist), and even your pharmacist to evaluate your options.

“In some cases, certain medications may not be recommended based on other medical conditions a patient may have. The good news is there are plenty of options to bring your diabetes under control and prevent further damage to your body.”

Managing Diabetes Through Blood Sugar Monitoring

Regardless of what lifestyle changes you make or what medications or insulin you take, monitoring your blood sugar levels is essential.

“Monitoring is the only way to know where your blood sugar stands at any given moment as well as to determine what’s working and not working to keep it in check,” says Dr. Lozier.

The absolute minimum of monitoring for anyone with diabetes is a hemoglobin A1C test. A blood test ordered by your provider, an A1C test tracks your average blood sugar level over the course of a red blood cell lifespan, roughly three months. Depending upon your levels, your provider may adjust your medication.

In addition, it’s important to track your blood sugar levels on your own. Dr. Lozier notes that how often levels should be monitored varies from person to person: “Some people may only need to self-monitor once or twice a week while others may need to do it several times a day.”

You can monitor your sugar levels using a glucometer or a continuous glucose monitor (CGM).

A glucometer requires you to, first, insert a test strip in the glucometer. You then capture a drop of blood from your fingertip on a test strip. The glucometer then reads the sample and displays your blood glucose level.

A CGM is a sensor that adheres to your skin and reads your sugar level every 5 minutes and displays the findings on your phone. The CGM stays on your body for 10-14 days and is perfectly safe to shower or bathe with it on.

“What makes a CGM so powerful,” says Dr. Lozier, “is that you can see in almost real time how your body responds to different foods. You may learn that you can eat all the watermelon you want, and your blood sugar level doesn’t budge but if you eat one grape, you may see your level soar. That kind of insight is extremely useful in making choices to keep your level in check.”

As for where you want your levels to be, Dr. Lozier recommends targeting the following:

• Fasting blood sugar: 80-130 mg/dl
• Blood sugar 2 hours post-meal: less than 180 mg/dl
• Time in Range with a CGM: More than 70% of time in range
• Hemoglobin A1C: Under 7%