Understanding Diabetes

There’s a new online resource specifically for those with type 2 diabetes, and we thought you should know about it. Type2Diabetes.com provides a combination of educational and practical resource information, and an online community for connecting with other patients. Online communities can be extremely valuable in building a virtual group of friends who understand your challenges.

A great way to introduce yourself to this new resource might be to review the results of their survey of people with type 2 diabetes. The results offer some interesting insights you can compare with your own experiences, and the site offers a new survey question frequently. Toby helped “vet” the main survey, and you’ll find her contributing other content now and then. Enjoy.

Yesterday was “Diabetes Alert Day” which urges people to take a diabetes risk test, and talk to a health care provider when their risk is shown to be high. Diabetes Alert Day looks to address the alarming estimate that more than 25% of diabetes cases have not been diagnosed (therefore, are not being treated). I couldn’t help but think how effective this campaign might be if every television ran the alert similar to a tornado warning- beep, beep, beep- severe diabetes alert!!!

The undiagnosed issue is only one element of the “severe diabetes alert.”  In 2001 the CDC published a report about the rising incidence of diabetes in the U.S. The warning was that diabetes cases in the U.S. would approach 30,000,000 cases by the year 2050. This projection is represented by the dashed blue line above. Guess what? We made it to 30,000,000 cases 37 or 38 years ahead of schedule, as illustrated by the red line based upon the most recent report filed in 2011.

Coming in ahead of schedule may be desirable in some cases, but certainly not this one. And, while there may be some qualification to the data (use of A1C for diagnosis in 2011 numbers), that would only make previous estimates higher- the projection for 2050 looks more like 100,000,000 now, and that should be startling. Diabetes is clearly a public health emergency, and some wise people consider it a national security issue (based upon the economic impact).

We have managed to make remarkable “progress” heading in the wrong direction. The question is, how do we do an about face, and make equally remarkable progress in reducing the incidence of diabetes. Changing lifestyles is the only reasonable answer, and many political and economic interests have created a stiff headwind for sure. National diabetes months and alert days are always celebrated by those of us fighting this battle every day- it’s time those in power took note of these alerts. Sound the alarm.

After 45 years with diabetes, I’ve always been different from my peers. But, that’s never stopped me from experiencing the wonderful things in life.  I’m now on an amazing trip to Paris France with three fellow dietitians.  We came from different parts of the US, and the three of them met in Atlanta to fly together (barely beating the ice storm). I flew solo from Chicago, and we met in Charles DeGaulle Airport at about 2:00 AM Chicago time.

The four of us have been chatting for weeks about all the things we want to see and do while we are in the most awesome and mesmerizing “city of lights.”  In the beginning everyone was talking about packing only a carryon piece of luggage EXCEPT for me.  I knew that I was different because of all my diabetes supplies.  I know I need to bring double extra “just in case.” With extra supplies and ready to eat foods for the many “just in case” moments, I must pack a carry on plus check a piece of luggage.

I’ve talked about planning numerous times- in my book, in my videos, and in my posts on social media.  Planning as much as possible eases the stress when confronted with a situation such as a low blood glucose reading, or the need to test a couple extra times a day because your activity is so very different as you tour a new city……and adjust to a 7 hour time difference…..and eat new food. We can’t predict everything we may encounter, but planning lets us “go with the flow” and enjoy marvelous experiences like this without worry.

I know I’m different, but that’s OK. Giving in to the demands of diabetes just a little bit, by planning ahead and being prepared, lets me relax and enjoy the companionship and the unique culture of Paris.

If you’ve followed me for long you’ll already know I have type 1 diabetes, formerly called “juvenile” or “insulin dependent” diabetes- 45 years and counting. People with type 1 diabetes have a lot in common related to the imposition of this condition into our lives, and as a result the community of people with type 1 diabetes is well organized in social media groups and organizations like the Juvenile Diabetes Research Foundation. The shocking epidemic of type 2 diabetes over the past 20 years has, in many ways, drawn the type 1 community into a tighter group, and some are “resentful” of being lumped into the same “diabetes” category by the uninformed public as that overwhelming number of people with type 2. Personally, I have a soft spot for those with type 2, and here’s why.

The life time game plan for people with type 1 diabetes is clear – not easy or simple, but clear. In general terms we get access to specialized medical care without anyone questioning the need, adequate equipment and instruction to monitor blood glucose levels on a continuing basis, medication that affects blood glucose immediately and noticeable feedback when we go off course. Don’t misunderstand- this is a gigantic pain in the butt, and the noticeable feedback – extreme high and low blood glucose levels- are miserable and even dangerous. But, with type 1 diabetes it’s virtually impossible to misunderstand the consequences for failing to dedicate some attention to diabetes. We go forward in life with our eyes wide open.

Not so with type 2. The onset of type 2 diabetes isn’t an “alarming” event like type 1, tools to monitor and regulate blood glucose levels are restricted by insurers, and the instant feedback from extreme highs and lows isn’t usually part of the picture. I’m convinced that many don’t get a sense of urgency from their doctors, who are often overwhelmed by diabetes patients facing more serious problems too. Ultimately, too many people diagnosed with type 2 diabetes walk forward with their eyes completely closed to the long term consequences of diabetes until the real trouble starts. And, they can honestly say (and often do) “if I had realized what could happen I would’ve tried harder.”

Here’s the bottom line- it’s not diabetes that leads to the real trouble- heart disease, kidney failure, nerve pain, etc. – it’s diabetes that goes unmanaged. Type 1 or type 2, in the long run it’s much the same. I simply think those with type 2 don’t get that message strongly enough, and don’t get the support we all need to thrive.

I think there are very few people in the U.S. that haven’t experienced some shocking winter weather lately – I know I have. I found it interesting that a recently diagnosed diabetes patient described her diagnoses to me in much the same terms as I’ve felt about the weather; shocked, frightened, things coming to a standstill, and overwhelmed by the challenge ahead. In fact, the temptation with horrible winter weather, and with diabetes, is to just hunker down and let it pass.

Since we know the weather will soon change for the better, hunkering down might be a reasonable strategy for winter. But no matter how badly we’d wish it so, diabetes won’t pass if you hunker down and wait. If fact, it’s just the opposite approach that can put diabetes in its rightful place as something that’s a manageable part of your life – you must take diabetes head on.

If that seems impossible to reconcile, think again. There’s a lot you can do in the middle of a blizzard or a “polar vortex” to minimize the effects – keep your windows closed, let your faucets drip, have firewood accessible. There’s also a lot you can’t do until the crisis passes- clear the drive or travel freely. Trying to accomplish everything simply isn’t possible in the middle of a crisis.

It’s the same with diabetes. But, just because you can’t accomplish everything right now doesn’t mean you can’t accomplish anything. Even though diabetes is definitely going to last longer than a blizzard or polar vortex, it won’t always be a crisis. In fact, it’s important to relax and let the crisis pass so that you can clearly focus on thriving in the months and years ahead. Even with a type 1 diagnosis, usually a genuine crisis, it’s important to prioritize what’s essential against what can be absorbed more effectively after the storm.

There is definitely sunshine and warmth ahead weather-wise, and with your diabetes. Just don’t get so hunkered down that you fail to notice Spring is here.

Vitamin D is an interesting compound. First, by strict definition it’s not a vitamin. A vitamin is something that can’t be “manufactured” in your body, and must be acquired in diet. But, you can make vitamin D by exposing your bare skin to sunlight. The questions are how much can you make, and how much is metabolically available. Sunscreen, dark skin, northern climates, and winter make manufacturing lots of vitamin D very challenging. Excess body fat, which can sequester the fat soluble vitamin, may compromise the availability of vitamin D in your metabolism.

Vitamin D deficiency is associated with diabetes in ways that aren’t fully understood. Some evidence hints that inadequate vitamin D is associated with the onset of type 1 diabetes. People with type 2 diabetes, especially women, show higher levels of vitamin D deficiency.

Now a small study suggests that raising vitamin D levels among 100 type 2 diabetes patients by supplementing with vitamin D₃ over an 8 week period significantly lowered fasting blood glucose levels, and the effect was most significant when the blood level of the active form of vitamin D was between 40 and 60 nanograms per milliliter. This level is considerably higher than the recommended minimum level, and supplementation isn’t a “straight line” benefit.

Even without regard for the potential benefit to blood glucose levels, knowing your current level of vitamin D is important. Ask your doctor to authorize the blood test, and discuss supplementation for all the potential benefits.