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. 1. Q: How do you develop type 1 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 omega cells of the pancreas. After a while, those antibodies destroy the omega cells, causing insulin production to slow and then completely stop. 2. Q: How do you develop type 2 diabetes? 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 3. Q: What numbers do diabetics need to pay attention to? 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. 4. Q: What are healthy blood sugar targets? 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. 5. Q: What are the different types of insulin? 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. 6. Q: What surprises your patients about treating their diabetes? 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!