November is National Diabetes Awareness Month. Give us some facts on diabetes and why is it important to increase our awareness of diabetes?

We all need to be aware of diabetes.  In the United States, there are more than 29 million people with diabetes – more than 8 million of those people are undiagnosed. To quantify that in a different way, that is 9.3% of the U.S. population.  Incredibly, every 19 seconds, someone in our country is diagnosed with diabetes.  What we’ve seen in our country over the last 30 years is a twin epidemic of obesity and diabetes. As the weight of the American population has increased, so has the incidence of diabetes. With respect to long-term consequences of this disease, mortality rates for persons with diabetes are 2-4 times greater than for individuals of the same age without diabetes. Diabetes is the seventh-leading cause of death in the United States. It’s also the leading cause of new cases of blindness, chronic kidney disease and non-traumatic lower limb amputation.  Every year we spend about $245 billion on the direct and indirect costs of this disease.

What are risk factors or symptoms I should be aware of and discuss with my health care provider?

There are multiple risk factors for developing diabetes, especially type 2 diabetes: age, weight, a sedentary lifestyle, family history of diabetes, a personal history of having gestational diabetes (diabetes that occurs during pregnancy) and belonging to certain ethic groups, such as African-Americans, Hispanic, Latinos, Native Americans and Asian-Americans are all risk factors for having diabetes.

There are two main types of diabetes: type 1, which used to be called juvenile diabetes, and type 2, which is the preponderance of people with diabetes – about 90 percent of people with diabetes have type 2.  With type 1, individuals do not make insulin. With type 2, there is more of an insulin resistance – individuals make insulin, but the insulin in the body isn’t working correctly.  What happens with both cases is that the sugar builds up in the bloodstream and you end up with high blood sugar, or hyperglycemia.  The symptoms of hyperglycemia can be insidious, and often overlooked.  If you notice any of the symptoms, it’s important to have a discussion with your health care provider.  The symptoms are:

• Increased thirst
• Increased urination
• Increased hunger
• Fatigue
• Blurred vision
• Weight loss
• Slower-healing cuts
• Dry skin
• Frequent vaginal infections for women
• Frequent urinary tract infections
• Feeling of sleepiness after eating a high-fat, high-carbohydrate meal

Are there multiple options for diabetes treatment?

Yes, there are multiple options.  This is an exciting time to be in the diabetes field.  Diet and exercise are the cornerstones of therapy for both type 1 and type 2 diabetes.  Those lifestyle changes are very important.  Individuals with type 1 diabetes always require insulin to control their blood sugar because their body does not produce the hormone.  Individuals with type 2 diabetes have many other options with respect to medication for treatment.  They’ll have diet, exercise and weight loss which may help normalize blood sugars in someone with type 2 diabetes.  If that doesn’t work, there’s a multitude of oral diabetes medications, there’s insulin and now there’s a new class of non-insulin injectable medications that can actually help to improve blood sugar control and in some cases, help people with diabetes lose weight.

How does our lifestyle affect diabetes management?

I can’t emphasize enough the importance of diet and exercise on blood sugar control. Research has shown that you can lower your risk for type 2 diabetes by 58% if you lose 7% of your body weight.  For example, that would be losing just 15 pounds if you weighed 200 pounds.  Exercising moderately, like brisk walking 30 minutes a day, 5 days a week, can also lower your risk for type 2 diabetes.  Even if you can’t get to your ideal body weight, losing 10-15 pounds can make a huge difference in your glycemic control.

Persons with type 1 diabetes require insulin for blood sugar control because their pancreas does not make insulin. Management of type 1 diabetes can be complex; the insulin doses need to be matched to the carbohydrate intake and activity level of the individual. Management of type 1 diabetes often requires multiple daily injections of insulin, or sometimes use of an insulin pump, as well as frequent blood glucose monitoring. What we’ve seen in the last few years is the advent of continuous blood glucose monitoring, and also the improvement in insulin pump therapy, so that these two systems are on the verge of being able to talk to each other.  Individuals can actually have a system where their sugars are being monitored and an insulin pump is delivering insulin to keep the blood sugar levels normalized. It’s cutting-edge – it hasn’t become available yet in the U.S., but it will be here in the next few years. 

What is your role in diabetes care, and how can people get in touch with you?

They can get in touch with me and set up an appointment or consultation– my office is at Barnes-Jewish St. Peters Hospital. 

Diabetes is a disease that requires ongoing education of the individual and the family affected by this disorder.  It’s paramount that the person diagnosed with diabetes receive education and nutritional counseling to learn how to manage all of the components of care.  I function in a dual role as an adult nurse practitioner and certified diabetes educator. My role in diabetes care is to provide the counsel and resources necessary to help our patients with diabetes incorporate all the components of care, diet, exercise, medication, glucose-monitoring, into their lifestyle, so that diabetes becomes simply a part of their life, and doesn’t run their life.

I function as a team member with physicians, nutritionists, physical therapists – I work with patients to help optimize their health and minimize the risk and chronic complications of diabetes. That’s our goal.