Keeping your diabetes under control can mean making some big lifestyle changes. Piedmont Healthcare Endocrinologist N. Spencer Welch, MD, answers common questions he hears from his patients about treating diabetes.
A: Type 1 diabetes develops in folks who are born with a genetic predisposition to the disease, who also have experienced some type of environmental trigger – what we call a precipitating event – that sets the wheels in motion. Often, the trigger will be a run-of-the-mill virus that adversely affects the immune system. For some reason, the damaged immune system will start making antibodies to fight against the insulin-producing beta cells of the pancreas. After a while, those antibodies destroy the omega cells, causing insulin production to slow and then completely stop.
A: Whereas type 1 diabetes is solely due to an insulin deficiency because the insulin-producing cells have been destroyed, the causes for type 2 diabetes are multi-factorial. The biggest metabolic defects that we see in folks with type 2 diabetes are:
- They’re not making enough insulin to meet their daily needs
- Their bodies are resistant to insulin so they’re not using insulin effectively
- Their livers are making extra glucose, raising blood sugar levels
- Their bodies may have a shortage of hormones called incretins, which release insulin after eating to decrease blood sugar levels. They might also be slightly resistant to incretins.
- Their kidneys reabsorb more glucose from their urine, which elevates their blood sugar
I always tell patents they need to know their ABCs. A is for A1C and we like to see that below 7. B is for blood pressure; we like to see that below 140/90. And C is for cholesterol—we like to see their LDL (bad cholesterol) below 100.
People with diabetes should have pre-meal blood sugars between 80 and 130 and post-meal blood sugars no higher than 180. Hopefully, two hours after the meal they can get down to 140.
A: There are lots of different insulins – rapid-acting insulin begins working about 15 minutes after it’s given and stays in the bloodstream for 2 to 4 hours. Short-acting insulin works within 30 minutes and is effective for 3 to 6 hours. Inhaled insulin is new to the market and works in 15 minutes; then it’s out of your system in two hours. We have intermediate-acting insulin that reaches the bloodstream 2 to 4 hours after taking it and that works for 12 to 18 hours. And then we have long-acting insulins that begin working several hours after injection. They lower blood sugar slowly over time in a very steady fashion. They provide a baseline of insulin that keeps your blood sugar down overnight and in between meals.
A: People tend to say to me that they didn’t realize how bad things were until they got on a diet and exercise program and started taking the medications—they say they didn’t know how bad they were feeling until they started feeling well!