Diabetes is a chronic disease characterized by a disruption of the body’s ability to turn the sugar in the blood (glucose) into fuel for the body’s cells.
It’s normal to have sugar in the blood. In fact, it’s integral to a body’s function, because cells need the energy provided by glucose. Insulin is the hormone responsible for “unlocking” the door to muscle, liver, and fat cells so that glucose molecules can enter. It’s produced in the pancreas of healthy individuals. The two main types of diabetes, Type 1 and Type 2, differ chiefly in regards to insulin.
In Type 1 diabetes, the immune system attacks the pancreas and compromises its ability to produce insulin. As the disease progresses, the pancreas no longer produces any insulin at all. Type 1 diabetes is typically a disease that emerges earlier in life – many are diagnosed in their teen years. Treatment always includes supplemental insulin and likely includes lifestyle changes as well.
Type 2 diabetes results when a person’s muscle, liver, and fat cells become less sensitive to insulin. This results from a combination of genetics and lifestyle. Type 2 diabetes has a later average age of onset. There’s a broad range of severity of the disease that guides treatment options. For individuals who are still fairly sensitive to insulin, diabetes may even be controlled by diet and/or exercise alone.
Latent Autoimmune Diabetes in Adults (LADA) is a slowly-progressive disease sometimes known as Type 1.5 diabetes. Like Type 1 diabetes, LADA involves the pancreas ceasing to produce adequate insulin, but it takes months or even years from diagnosis to needing supplemental insulin. Because of this – and because most people diagnosed with Type 1.5 diabetes are adults rather than children or teenagers – LADA is sometimes initially misdiagnosed as Type 2 diabetes.
Diabetes is widespread in the United States. The 2020 CDC report found that 10.5% of U.S. adults have diabetes. An additional 34.5% of adults have prediabetes, a condition where blood sugars are above the healthy range, but not quite high enough to lead to a diabetes diagnosis. That means that nearly half of all adults in the country are coping with an impaired ability to process glucose and the risks of serious long-term effects – including complications that are life-threatening.
Diabetes was the seventh-leading cause of death in the U.S. in 2019, according to the CDC, resulting in 87,647 deaths.
Both nationally and locally and for virtually all age groups, diabetes rates are on the rise. It is predicted that one out of every three Americans will have Type 2 diabetes by 2050 if the current trend continues.
As the COVID pandemic has shown, calculating the true impact of diabetes on public health is complex. In addition to being deadly on its own, diabetes is a major risk factor for experiencing serious complications, hospitalization, and death due to COVID-19 (and any other virus like influenza).
Prediabetes is a serious and typically undiagnosed health condition in which the patient has impaired insulin sensitivity. It is defined as having blood sugar levels that are elevated above normal but not yet in the diabetic range.
The CDC estimates that 84% of the 88 million American adults who have prediabetes do not know that they have it. This is due to the fact that most people with prediabetes experience few, if any, symptoms.
Almost everyone who develops Type 2 diabetes develops prediabetes first. However, prediabetes does not have to lead to diabetes.
Regular contact with a primary care physician and regular lab work are essential to diagnosing and beginning to address prediabetes. At this stage, lifestyle changes are the most impactful. Even moderate changes in diet and physical activity can help prevent or delay the onset of Type 2 diabetes.
Metabolic Changes that Lead to Type 2 Diabetes
Some people are genetically predisposed to developing Type 2 diabetes. Genetics includes both first-degree family history and long-term ancestry, as studies show that people belonging to certain ancestral DNA groups are more prone to the disease.
However, unlike with Type 1 diabetes, lifestyle plays a key role in setting off the metabolic changes that lead to Type 2 diabetes.
Every time someone eats something that raises the blood sugar level, the pancreas responds by releasing insulin. Insulin plays the role of “unlocking” body cells so that glucose molecules can enter. Enough insulin is produced to unlock a sufficient number of “doors” for glucose to leave the bloodstream so that the blood sugar decreases and levels return to normal.
If a cell is habitually flooded with glucose, it becomes less sensitive to insulin over time. That is, it gradually removes its “doors” so that the insulin has fewer and fewer to “unlock.” With nowhere to go, glucose stays in the bloodstream and starts damaging the body. This is commonly called insulin resistance.
Elevated blood sugar after a meal is often the first sign of metabolic changes that lead to Type 2 diabetes.
At a more advanced stage of diabetes, even fasting glucose is affected. Eventually, elevated blood sugar reduces the pancreas’ ability to make insulin.
Signs that someone may have diabetes include:
- Unusual hunger or thirst
- Frequent urination, especially at night
- Dry mouth
- Dry and/or itchy skin
- Blurred vision
With Type 1 diabetes, the onset of symptoms happens swiftly and they are much more severe.
With Type 2 diabetes, the effects may be mild or not noticeable at all at first. Unfortunately, people tend not to realize they may have diabetes until the disease has already damaged their body for some time. Nerve damage caused by Type 2 diabetes can lead to numbness in the legs or feet and decreased efficiency of the immune system can lead to slow-healing wounds or infections. Because yeast feed on glucose, people with Type 2 diabetes are also more prone to yeast infections.
How to Diagnose and Monitor Diabetes
When it comes to diagnosing and monitoring diabetes, the important lab tests to understand are the Oral Glucose Tolerance Test (OGTT), fasting plasma glucose test, fructosamine test, and hemoglobin A1C test.
The OGTT looks for insulin resistance – how well your body is able to process glucose after it’s introduced into your body. People taking the test are asked to fast for at least eight hours prior to taking the test. At the testing site, they consume a standardized oral dose of glucose and then have their blood drawn a few times over a couple of hours. The level of blood sugar after a waiting period is interpreted to indicate the patients’ current metabolic functioning:
- Normal range: <140 mg/dL
- Prediabetes: 140-199 mg/dL
- Diabetes: >199 mg/dL
Introducing a quantity of glucose into the body tests the body’s ability to process it, just like driving a car uphill tests the capability of its engine. That’s why the OGTT is a good first indicator of diabetes. In contrast, the fasting plasma glucose test is akin to testing a car going downhill – it helps determine the point when a known issue has really developed into something serious.
The fasting plasma glucose test requires people being tested to fast for at least eight hours and then get their blood drawn. It’s utilized both to diagnose and to monitor a case of diabetes or prediabetes that’s already known. The interpretation of readings are as follows:
- Normal range: 70-99 mg/dL
- Prediabetes/controlled diabetes: 100-125 mg/dL
- Diabetes: >125 mg/dL
The hemoglobin A1C test measures the percentage of red blood cells that have blood sugar molecules attached to hemoglobin, another protein. It determines the average blood glucose level over the past two or three months:
- Normal: <5.7%
- Prediabetes: 5.7-6.4%
- Diabetes: >6.4%
Less commonly used, the fructosamine test measures the average blood glucose level over the past two or three weeks via the presence of glucose, which binds to proteins like albumin. It’s an option for patients who have a condition that affects hemoglobin A1C reliability, such as sickle cell amenia, kidney failure, liver disease, or HIV infection. There is no consensus on target ranges for glycemic control or for diagnosis of diabetes.
It’s important to realize that there are multiple tests and relatively subjective thresholds for determining that someone is diabetic. Taking any metabolic disorder revealed in lab results seriously is prudent. It’s best to begin addressing prediabetes before it develops into Type 2 diabetes, because treatments at an earlier stage tend to be less aggressive and more likely to stave off tissue damage and long-term health complications.
Diabetes Treatment Options
There is no one-size-fits-all treatment plan for diabetes. What’s best for an individual depends on their current level of insulin resistance, health history, finances, and diet and lifestyle, as well as their priorities as they manage their diabetes.
Working with a knowledgeable, attentive primary care doctor is critical to fully exploring the treatment options and deciding on a plan that’s best for each person. This may include a combination of prescription pharmaceuticals, lifestyle changes, and non-prescription supplements. A doctor will help monitor the disease and adjust the treatments as needed.
How to Control Diabetes Without Medication
To better manage diabetes, a person needs to commit to making lifestyle changes. Ideally, this would include both a better diet and more movement of the body. It is, however, less realistic for individuals with busy schedules to incorporate regular exercise. One of the most important tasks of a doctor is to coach the patient to lifestyle changes that are both impactful and sustainable over time.
A diabetic-friendly diet and exercise regimen can equal the effects of oral diabetes medications. For people whose diabetes is still mild, the disease can often be halted or even reversed through dietary changes alone.
Even with high insulin resistance, however, lifestyle changes can dramatically reduce the need for prescriptions. Over time, it’s possible for people who depend on medications to control their diabetes and reduce the amounts of medications they need, or they may have no need for medication at all.
The Best Diet for Diabetes
Given that consuming food that raises blood sugar too much is one of the main causes of diabetes, it’s logical that modifying diet should be a key part of a diabetes treatment plan. A diet for managing the disease varies from person to person, but often the most physiologically appropriate option combines the Low-Carb High-Fat (LCHF) Diet with intermittent Fasting (IF).
LCHF is actually an umbrella term that encompasses a variety of diets that aim to swap carbohydrates for fats, including the Keto Diet and the Atkins Diet. While several of them require very specific macronutrient profiles – the ratio of fat, carbs, and protein – any high-fat, low-carb combination is beneficial to someone with diabetes.
To follow an LCHF plan, one should avoid pasta, rice, baked goods, starchy vegetables, fruits, and sweeteners. Instead, one should eat plenty of high-fat fish, eggs, avocado, nuts, full-fat dairy, and healthy oils.
Another beneficial dietary strategy is Intermittent Fasting (IF). As the name implies, it’s an eating pattern that calls for cycling between periods of eating and fasting. There are a variety of popular options, including:
- The 16/8 method: Restricting the daily eating period to eight hours (such as noon to 8pm) and fasting for the 16 hours in between
- The 5/2 method: Consuming only 500-600 calories on two nonconsecutive days and eating normally the other five days of the week
- Eat-Stop-Eat: Fasting for 24 hours once or twice a week
IF is an excellent tool for managing diabetes because it improves insulin sensitivity (bringing back the cellular “doors” that insulin can unlock), allowing sugar to be cleared from the bloodstream. It also contributes indirectly by leading to weight loss.
In many cases, a diabetic patient would combine an LCHF diet with IF by fasting between high-fat meals. However, every person should speak with their doctor before starting a new diet to make sure that it’s the best diet tailored to their individual situation.
Exercise and Diabetes
When people exercise, their muscles need extra energy. During some types of exercise, blood sugar is lower during and after exercise because insulin resistance decreases in the moment to meet this need and muscles take glucose from the bloodstream. In fact, contracting muscles are even able to take up glucose for energy when there is no insulin to unlock the cellular “doors.”
Physical activity is not only beneficial for people with diabetes in the short term, but also decreases insulin resistance and blood sugar levels in the long term if done regularly.
Hypoglycemia – an uncomfortable and potentially dangerous dip in blood sugar – is the most common negative effect of exercise in diabetic patients. The risk is higher for people taking insulin or prescription medications that increase the production of insulin.
Many people living with diabetes avoid exercise because of their fear of hypoglycemia or negate its benefits by preemptively eating high-carb snacks to avoid a hypoglycemic episode while working out.
Continuous Glucose Monitoring (CGM) appears to offer the best solution to this predicament. Available since the 1990s, a CGM device affixes to the abdomen or arm and gives the patient a near-real time blood glucose reading. Modern versions show upward or downward trends in blood sugar and even send an alert when the wearer is approaching the hypoglycemic range.
Using CGM, patients can become more aware of how their bodies react to the complex factors that influence blood sugar. CGM allows them to avoid hypoglycemia and unnecessary corrections that drive blood sugar levels up and enjoy the positive effects of living an active lifestyle.
As with having a diabetic-friendly diet, regular exercise also contributes indirectly to diabetes management. It leads to weight loss and increases muscle mass. Physical activity also relieves stress, promotes better sleep, and boosts general well-being.
Workouts that a person with diabetes might consider include walking/hiking, dancing, swimming, biking, and strength training.
Natural Treatments for Diabetes
There are many reasons that people turn to supplements to manage their diabetes. They may experience side effects from prescription drugs, or simply find the idea of a “natural” treatment appealing. Unfortunately, there is very little evidence from clinical trials that supplements can improve diabetes outcomes.
The non-prescription treatment with the most evidence behind it is berberine. Found naturally in goldenseal, goldthread, European barberry, and phellondon, berberine is a yellow, bitter-tasting chemical. Although research has been limited, there have been studies that suggest that it can help regulate how the body uses glucose.
There is even more limited evidence in favor of cinnamon as a non-prescription treatment for diabetes. Although it may not increase insulin sensitivity as advertised, cinnamon is a common and relatively innocuous spice, and typically will cause no harm to people with diabetes.
Apple cider vinegar, barley, aloe vera, fenugreek, and nopales are other popular supplements touted as natural cures. While they probably won’t help manage diabetes, they are also most likely harmless if consumed in moderate quantities. A doctor familiar with the patient’s health history can determine possible interactions and contraindications.
Controlling diabetes with pharmaceuticals is typically at least part of the treatment plan for diabetic patients. This can be a relatively inexpensive or a costly endeavor, depending on the drugs prescribed by the doctor.
Time-tested, more affordable drugs include Metformin and Sulfonylureas, which work by increasing insulin sensitivity (bringing back the “doors” of cells) and increasing insulin production, respectively. They can be obtained for only $5 to $10 a month.
Discount coupons from GoodRx and discount pharmacies like https://www.manifestrx.com/ and https://costplusdrugs.com/ are also helpful in keeping costs down.
Without discounts or subsidies, insulin can cost upwards of $900 a month – a prohibitive price tag for many diabetic patients. This is the case for newer insulin. Also known as analogues, newer insulins have been engineered to make them more available to the body. Newer pharmaceuticals such as Victoza and Trulicity can cost $400 a month.
Certain discount pharmacies such as Walmart also offer a monthly supply of older insulin for about $25.
Many patients and physicians prefer these newer pharmaceuticals because they’re so powerful that they theoretically allow someone with diabetes to “eat whatever they want.” However, when you depend on these powerful drugs to lower blood glucose, you increase your risk of causing your blood sugar to fall too low. This condition of low blood sugar, known as hypoglycemia, causes uncomfortable symptoms that include sweating, nervousness, and headaches.
The Long-Term Outlook for Diabetes
The bad news is that the long-term prognosis for uncontrolled diabetes is fairly bleak. Uncontrolled diabetes is a progressive disease that reduces quality of life and can ultimately be life- and limb-threatening. High blood glucose causes injury to the tissues and organs of the body that can’t be undone.
The long-term complications of diabetes can be grouped into microvascular (affecting small blood vessels) and macrovascular (affecting large blood vessels) complications.
Diabetic retinopathy is the most common microvascular effect of diabetes. It involves loss of vision that may eventually lead to blindness. Diabetic neuropathy, or nerve damage, is another microvascular effect that leads to tingling, pain, and loss of feeling in the extremities. If left untreated, the patient may need an amputation.
Inflammation of the blood vessels due to high blood sugar causes atherosclerosis, or the narrowing or arterial walls. Most people with long-term, uncontrolled diabetes experience macrovascular damage and develop high blood pressure. This leaves them at an elevated risk for heart attacks and strokes. Atherosclerosis in the blood vessels of the kidneys combined with high blood pressure result in a condition known as diabetic kidney disease. Kidney failure is kidney disease at such an advanced stage that dialysis or a kidney transplant is necessary.
The good news is that people with diabetes don’t have to lose their quality of life (or their lives) to the disease. Regular health screenings make early diagnosis possible. Affordable medications, lifestyle changes, and, above all, an attentive primary care doctor allow patients to successfully manage their diabetes.
Direct Primary Care and Diabetes
For a variety of reasons, conventional, insurance-based healthcare is problematic for managing a chronic disease like diabetes. Doctors who operate under the insurance-based model are reimbursed at a very low rate by the health insurance company, and are incentivized to squeeze in as many patient visits as possible in order to make a living. Because they often aren’t reimbursed for virtual visits, a diabetic patient would have to make an in-person appointment to discuss a lab result or to give feedback on a diet change.
Fortunately, Euphora Health is a Direct Primary Care (DPC) clinic. Direct Primary Care is an alternative to insurance-based healthcare. Our patients pay a monthly membership that includes unlimited, unrushed visits, virtual appointments, and 24/7 virtual access to their doctor. We take the time to learn each person’s full health history and give personalized recommendations for care that are updated as often as needed.
Not only that, but Euphora Health’s DPC model allows us to offer patients access to low-cost labs and prescriptions, such as those used to monitor and treat diabetes.
We’re extremely gratified that we’ve been able to help many of our patients successfully control and even reverse diabetes. And we’ve done it in a way that’s minimally interruptive to their busy lives and never makes them feel like they’re just a number.
Diabetes can be debilitating and even life-threatening chronic condition. Many people feel like they’ve been thrown a curveball when they get their diagnosis. Managing diabetes without guidance from a caring primary care doctor can feel overwhelming, like the disease is taking over and restricting every area of life – physical, social, and financial.
Are you ready to regain control?