Managing Diabetes: What You Need To Know

Successfully managing diabetes requires knowledge of the disease, an understanding of how your body handles blood sugar and what you can do to help control it.

What Is Diabetes?

Sugar in your bloodstream is a normal and an integral part of your body’s function. It is a fuel that gives your body’s cells the energy to function properly. Blood sugar is produced by your body but also comes from what you eat. The sugar in your blood, often referred to as “blood sugar”, is called glucose.

Simply having glucose in your blood does not mean it will be absorbed into your cells that need it. The ability of cells to absorb glucose is regulated by a hormone created by the pancreas called Insulin. Think of insulin as the key that would be used to open the door of the cell so that glucose could move into the cell. Without sufficient insulin, or if insulin doesn’t function properly, too little glucose will enter your cells. This leaves an excess of glucose in your bloodstream that eventually leads to blood vessel damage that can cause a heart attack, diabetic nerve pain, or a non-healing infection for example.

This oversimplified explanation is a solid starting point for understanding and managing diabetes. In short, diabetes is a disruption of the delicate balance between glucose and insulin. And the requirements to maintain this balance are different for every individual.

Understanding The Types Of Diabetes

Diabetes comes in two major forms, Type 1 and Type 2. Type 1 diabetes occurs when the individual’s immune system has attacked the pancreas and consequently, the pancreas does not produce enough insulin. In type 2 diabetes the individual’s cells are no longer sensitive to the insulin being produced (the door doesn’t accept the key as readily) and blood sugar elevates.

Type 1 diabetes is typically the result of genetics. Type 2 is a combination of genetics and lifestyle. For either type, the goal is to maintain a proper balance between glucose and insulin to keep the body functioning normally.

Type 1 diabetics will always require insulin because their pancreas does not produce enough insulin. The amount of insulin they require is dependent on their level of blood sugar, which is mainly dependent on the amount of carbohydrate and protein that they consume. Type 2 diabetics, depending on the severity of the disease, may be able to control blood sugar with just diet, or diet and very few medications that help lower blood glucose and increase cell sensitivity to insulin.

The Blood Sugar Rollercoaster

The current prevailing thought of the medical community is to guide diabetics to eat starchy vegetables (including potatoes), fruit and low-fat milk in addition to protein and non-starchy vegetables. All carbohydrate (no matter the source) is turned into blood sugar. Beyond these dietary suggestions, the medical community relies on medications to control the blood sugar level.

If you don’t limit your carbohydrates, you will see larger elevations of your blood sugar (hyperglycemia). If you are on insulin and are trying to reach a normal blood sugar you will sometimes use too much and cause low blood sugar (hypoglycemia). Hypoglycemia causes the person to feel sweaty, jittery, nervous and can cause a headache.

To avoid these feelings a diabetic will reach for high-sugar foods such as candy and can easily raise their glucose levels too high. Without a controlled diet, these swings will have a tendency continue and get worse over time. This is the Blood Sugar Roller Coaster.

Managing Diabetes with Diet

Simply eating what you want and relying on medications to keep blood sugar controlled is a reactive approach and will make it difficult to achieve long-term control. This is because the blood sugar will be far from your goal blood sugar level after eating a large load of carbohydrate. You are then requiring the medicine to push your blood sugar down and sometimes your blood sugar will be pushed too low.

An analogy for the difficulty of managing the swinging blood sugar level is the game of golf. How often does a golfer get a hole in one from 290 yards away? Very rarely! It’s not only luck, but how you stand, what club you use, how your club hits the ball, and the strength and direction of the wind. However, it is much easier and predictable to make the “hole in one” if the golf ball is only a couple of feet from the hole. The “hole in one” in diabetes care is taking the right amount of medication in order to get your blood sugar to the goal level.

For the diabetic, the more they can control the consumption of sugar and carbohydrates and understand their bodies production of insulin and their cell’s sensitivity to it, the more achieving the goal blood sugar level becomes like sinking a golf ball that is close to the hole. It’s much easier to predict the amount and kind of medication required, if any, to keep the blood sugar level consistent and successfully manage diabetes when you start off really close to the goal.

Additionally, a low carbohydrate diet usually results in a decreased need for medication and allows the diabetic an opportunity to depend on more affordable medications like Metformin that is a tried and true medication that reduces glucose production and increases a cell’s insulin sensitivity without risking hypoglycemia. An uncontrolled diet and an elevated blood glucose level usually require a number of medications and they can be very expensive, not to mention a potential increase in medication side effects and other complications.

Managing Carbohydrate Intake

Carbohydrate intake has increased since the introduction of the food pyramid. Minimizing carbohydrates in a diet can be hard to do simply because they have been such a staple of the American diet. However, imagine the blood sugar of a diabetic that eats pasta every day! Carbohydrates are not only found in foods that people are aware of like pasta and bread, but they are in many other foods too, such as vegetables and fruits.

As a society, we mainly use carbohydrates, in many forms, to fill ourselves up. So how do you reduce carbohydrates from your diet and still feel full and satisfied? Replace those calories with primarily healthy fats.

There are few cookbooks available with recipes that follow the principle of reducing carbohydrates while remaining satisfied. Additionally, it is important to understand and know that although a certain diet and set of medications may work for one diabetic, they may work less effectively for another.

Everyone’s body handles the glucose/insulin ratio differently and it can be affected by many factors both internal and external. This is one of the reasons why jumping online to self-educate can be confusing and not necessarily helpful. The best thing to do is to work closely with your doctor.

Partnering with an Attentive Doctor

Diabetes is a chronic disease, meaning it is an ongoing issue and something that will always have to be maintained throughout life. Whether a diabetic is newly diagnosed or is experiencing the blood sugar roller coaster, working with your doctor closely is the key to finding a path to successfully managing diabetes and feeling better.

At first, your doctor should work with you almost on a daily or weekly basis to learn about you, your lifestyle, habits, diet and your insulin sensitivity. This may require keeping track of your diet and frequently checking your blood sugar levels. This effort, in turn, will help the doctor understand your needs and better educate you on how your body handles glucose and medication to help you manage diabetes through mostly diet and lifestyle changes. Once your glucose/insulin ratio is balanced, follow up visits are less frequent. However, always remember that diet, lifestyle, your insulin sensitivity and, therefore, the effectiveness of medications can change over time. So, it’s beneficial to have access to your doctor.

Unfortunately, most insurance based doctors are hard-pressed to have the time to work closely with a patient. Although they are caring and capable doctors, the low reimbursement rates from insurance companies have forced their practices to be better suited for acute issues, medical problems that are not ongoing such as a cold, abscess or routine check-ups.

Insurance companies have historically only paid the doctor for face-to-face visits. Because of this, in-office visits have been required even when issues could be resolved without a face-to-face visit. This is true for medical consulting as well as medication refills and labs. These are some of the barriers that have given rise to high quality, low cost, membership-based Direct Primary Care practices like Euphora Health, an Austin primary care clinic.

Direct Primary Care doctors are highly accessible and have extra time to spend with patients. Generally, you can get same-day appointments, have little or no wait time and you can visit with them over the phone, via text, email or even video conference. You get as many visits as you need for one monthly fee and no copays.

Additionally, the cost of glucose tests are included and better management of your diabetes can prevent relying on more costly medications. Direct Primary Care is very beneficial in successfully managing diabetes, keeping you healthy and decreasing your costs long term.