Healthy Living

Understanding - and treating - diabetes

Millions of Americans have the disease, others don't know they have it

Regular checks of your blood glucose level and A1C level are important to determine if you may be diabetic or pre-diabet
Regular checks of your blood glucose level and A1C level are important to determine if you may be diabetic or pre-diabetic. Untreated, diabetes can cause damage throughout the body. (Adobe Stock)

November is Diabetes Awareness Month, but for millions of Americans, diabetes is something that is top-of-mind all year long.

“Type 2 diabetes is more common than you think, and it’s increasing in epic proportions,” said Wendy Sanders, a registered nurse practitioner who specializes in diabetes at Mercy Medical Center in Cedar Rapids.

“Approximately 34 million Americans have diabetes. That’s about one in every 10 people in this country,” she said. “Of those, about 90 to 95 percent have Type 2 diabetes. Most of them are above the age of 45, but we’re seeing more and more children and teens who are affected by it as well.”


To understand the disease, start by knowing the difference between Type 1 and Type 2 diabetes:

• Type 1 diabetes: An autoimmune disease in which beta cells in the pancreas don’t give off insulin, “so you rely on injections of insulin to handle carbohydrates as they come into the body,” Sanders said.

• Type 2 diabetes: A preventable disease, “most likely fueled by obesity,” Sanders said. Patients produce insulin, but the body no longer responds to it properly.

“Insulin resistance often develops due to fatty cells in the abdomen and slower gut digestion. You don’t secrete enough insulin from your pancreas,” Sanders said.

Since cells in the body use insulin to absorb glucose, a lack of insulin means an excess of glucose in the body. That’s where high blood sugar comes into play — and identifying high blood sugar is a key factor in diagnosing diabetes.


“We use an A1C test, which takes average sets of blood glucose over a 12-week span. That, along with a fasting blood sugar level, allows us to diagnose diabetes,” Sanders said.

Type 2 diabetes can be hereditary, but other risk factors are taken into consideration, too, said Dr. Prasuna Rao Madhavaram, an endocrinologist at the Diabetes and Kidney Center at UnityPoint Health-St. Luke’s Hospital in Cedar Rapids.

“People who are 45 and above are all at risk,” she said. “Other risk factors are patients who are overweight, obese, physically inactive, have heart disease or blood pressure or cholesterol problems. Women who developed gestational diabetes during pregnancy also are at a higher risk, as are certain ethnicities, including Latinos, African Americans and Native Americans.”


Knowing the basics of the disease is the first step in prevention, Madhavaram said.

“Everyone should look through risk factors and discuss them with their primary care physician to understand whether testing may be a good option for them,” she said.

It’s also important to understand pre-diabetes and discuss it with your doctor.

“If someone is between normal and diabetic ranges, we call it pre-diabetes. It’s very common — one in every three Americans has pre-diabetes,” she said. “Unfortunately, the records show 88 million Americans have pre-diabetes, and many don’t even know it. They are completely asymptomatic, so they don’t seek treatment.”

When someone receives a diagnosis of pre-diabetes or diabetes, they may have no early symptoms. But eventually, if the disease is not controlled, symptoms can escalate.

“Over time, pressurized blood causes vessels to become stiff — then, they start to leak and cause damage to tissue,” Sanders said. “This will often lead to complications with the eyes, kidneys or feet.”


These types of issues also can lead to more negative long-term effects, including damage to the nerves, kidneys, the heart and brain,” Madhavaram said. “Maintaining blood sugar is the key.”


The good news for patients diagnosed with Type 2 diabetes is that there are many ways to prevent, treat and sometimes even reverse the disease.

“For Type 2 diabetes, lifestyle changes are definitely the key. Weight management, diet control and physical activity are crucial,” Madhavaram said. “Every patient who has a new diagnosis will need to go through education to understand what it is, what their goals should be and what kind of chronic complications they may have.”

If, after changes have been made and blood sugar numbers don’t improve, medication can be used to manage the illness.

“We determine medications based on patients’ blood sugars and A1C when they are diagnosed,” Sanders said. “For someone who needs medication, we start them off on a medication that helps with insulin resistance. Another medication would be a synthetic version of a hormone they need to slow down digestion in the gut and tell the brain they’re fuller longer.”

Sanders also noted progress over the past few years in insulin pumps, closed-loop systems and continuous glucose monitors.

“There’s a lot of good technology for those people who are using insulin,” she said. “Even if you don’t have an insulin pump, you can have a continuous glucose monitor that is outside or inside your body. They last from 10 days up to three months, and check your blood sugar up to 288 times a day.

“They use Bluetooth to project the information into your phone and alarm you when your numbers are getting too low or high.”

Sanders said newly diagnosed patients have a good chance to reverse the disease by taking the right steps.


“If you can lose weight and take good care of your health with diet and exercise, you can get off medications,” she said.

Whether you’ve been diagnosed with diabetes or are just learning about the disease, both experts agree that education and awareness are the first step toward healing. “Everyone needs to understand their own risk and understand how common it is. Discussing it with your physician is very important,” Madhavaram said. “Once you know you may have risk factors, you can become a little more physically active or monitor your weight more closely. Small changes can have a big impact.”

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