Talk to your doctor about your current levels and new aggressive goal levels for treatment. The goals are:
Blood glucose should ideally be:
Developing the right approach to diabetes is essential to both preventing its onset and learning to live with it.
The Canadian Diabetes Association (www.diabetes.ca) is an excellent resource for information about preventing or living with diabetes. If you have diabetes, there are many other education resources available. Ask your doctor or pharmacist for recommended classes and programs in your area.
Start a regular routine of physical activity at least five days per week (total 150 minutes or more). This can be as simple as a brisk walk for 30 minutes, five days a week. If you are overweight, losing even two or three pounds a year can help prevent diabetes if you have a pre-diabetes condition. If you have been diagnosed with diabetes, physical activity can greatly improve your control of your diabetes.
A healthy lifestyle, including regular physical activity and a healthy diet, will improve blood pressure, cholesterol levels, and may prevent diabetes. If you already have diabetes, such changes can help you maintain better control. Together with your family doctor and your diabetes education team, you’ll be able to work towards a longer and healthier life.
Diabetes may be present without any symptoms. When present, the symptoms of diabetes are not always specific or obvious. Some people with diabetes may not recognize symptoms as related to the condition. Diabetes can only be diagnosed through appropriate medical testing.
Classic symptoms of diabetes include thirst and a need to urinate often, both day and night. Other symptoms, especially in those over 65, include fatigue, weakness, confusion and weight loss. These are not always related to diabetes. Without testing, diabetes is often not found in seniors until a complication such as heart attack or stroke occurs.
Type 2 diabetes, the most common type, was previously and inaccurately known as non-insulin dependent or adult onset diabetes. Medical guidelines for diagnosing and treating this form become stricter each year. Doctors are able to diagnose type 2 diabetes earlier and begin treatment before complications arise. It is currently recommended that testing for diabetes start at age 40, with a fasting blood glucose check. Repeat the test at least once every three years. Your family doctor will test earlier and more often if you have certain risk factors. These include high blood pressure, high cholesterol, and being overweight.
Insulin is a hormone that helps the body maintain normal blood glucose (sugar) balance. In type 2 diabetes, cells in the pancreas do not produce enough insulin. Body tissue is also unable to properly respond to existing insulin. As a result, the level of glucose in the blood remains high.
Consequences of high blood glucose include kidney disease and hardening of blood vessels throughout the body, including the heart and brain. Related nerve problems can cause reduced foot sensation and problems with erections.
Can recognizing pre-diabetes help prevent the disease from developing?
Medical guidelines are being developed which allow earlier diagnosis of diabetes. It is now possible to detect ‘pre-diabetes’ as impaired fasting glucose (IFG) or impaired glucose tolerance (ITG). Treating pre-diabetes can delay the development of the disease for many years.
In recent years, studies have been done in people with impaired fasting glucose or impaired glucose tolerance. Effects of various therapies, including lifestyle changes and medication, in delaying or preventing diabetes have also been studied.
Does lifestyle matter?
Study participants did activities such as aerobic exercise, walking, jogging, and swimming. They aimed for 150 minutes of physical activity each week, ideally done on at least three days that were not consecutive. Another goal included losing five to seven per cent of body weight.
Hard work and discipline paid off. Those who followed the program of weight loss and physical activity were 50 to 60 per cent less likely to develop diabetes after four years. This occurred even though those in the lifestyle group lost only three to five pounds of weight in the study period. So even a small amount of weight loss, done along with exercise, is a very effective way to protect against developing diabetes. Always talk to your doctor before starting a physical activity program.
What about medications?
Some study participants with pre-diabetes took either acarbose or metformin (drugs that are currently used to treat diabetes). The medications reduced their risk of developing diabetes by 30 per cent, compared to those with pre-diabetes who were not using medication. A recent study with a newer class of diabetes medication (TZDs) showed a 60 per cent success rate over four years in preventing these high risk people from developing diabetes.
If your doctor has said that you may be at high risk for developing diabetes, discuss the pros and cons of new, more intensive approaches. Only certain people are able to take these medications. The cost and possible side effects should be considered beforehand. We also do not yet know the best length of time to take these medications.
Remember that lifestyle change is as powerful or more powerful in preventing diabetes than any medication currently available. Where possible, it is best to succeed with lifestyle changes rather than with medication.
Aggressive treatment involves following tight guidelines for blood glucose, blood pressure and cholesterol. Studies show that achieving these goals can mean living an average of seven to 10 years longer than those whose diabetes is poorly controlled. These numbers are still improving.
Someone with diabetes has a risk of dying of heart or blood vessel disease similar to a person who has already had a heart attack. Excellent control of blood glucose is only part of the solution. Reducing blood pressure to less than 130/80 regularly, lowering cholesterol levels to new, very low targets, and using low-dose ASA (e.g. Aspirin™) daily are now considered essential. With such changes, those with diabetes are now living longer, healthier lives with less disability.