Chapter 1

What It Means to Flourish with Diabetes

IN THIS CHAPTER

Getting a grip on diabetes

Understanding diabetes basics

Considering the principles of a good diet for diabetes

Working exercise into your schedule

Keeping your blood pressure down

Making lifestyle changes that count

Diabetes is one of the most common long-term medical conditions of today's generation, with rates rising dramatically across the globe year on year. Diabetes occurs when problems arise with how blood glucose is regulated; so there's no getting away from the fact that what you eat, combined with modern medicinal therapy is fundamental to its prevention, reversal, avoidance of complications, and optimum long-term management. Of course, that's good news because a greater understanding of how to improve your lifestyle can empower you to take control and help you to live your best life. The even better news is that this journey can be enjoyable, fun, sociable, inspiring, and tasty.

This chapter serves as your entry world into what you need to know about diabetes. Here we discuss the basics about the different types of diabetes and the complications that can arise if blood glucose control is poor. You discover the types of lifestyle changes you can make to make a tangible and measurable difference.

Recognizing Diabetes

With so much diabetes around these days, you may think that recognizing it should be easy. The truth is that it's not easy, because diabetes is defined by blood tests. You can't just look at someone and know the level of glucose - blood sugar - in their blood.

Blood glucose rises and falls depending on what a person is doing - varying with eating, fasting, or exercising. If control of blood glucose levels is compromised and levels rise beyond certain thresholds with risks of complications, then diabetes is diagnosed.

Here we examine what diabetes is, classify the different types of diabetes, discuss the consequences of diabetes, and mention how you can manage it.

Defining diabetes

In 2023 the U.S. Centers for Disease Control and Prevention reported that about 38 million people in the United States have established diabetes and one in five of them don't know they have it.

The level of glucose that means you have diabetes is as follows:

• A casual blood glucose of 200 milligrams per deciliter (mg/dl) or more at any time of day or night, along with symptoms such as fatigue, frequent urination and thirst, slow healing of skin, urinary infections, and vaginal itching in women. A normal casual blood glucose should be between 70 and 139 mg/dl.
• A fasting blood glucose of 126 mg/dl or more after no food for at least eight hours. A normal fasting blood glucose should be less than 100 mg/dl.
• A blood glucose of 200 mg/dl or greater two hours after consuming 75 grams of glucose.

A diagnosis of diabetes requires at least two abnormal levels on two different occasions. Don't accept a lifelong diagnosis of diabetes on the basis of a single test.

A fasting blood glucose between 100 and 125 mg/dl or casual blood glucose between 140 and 199 mg/dl is prediabetes. Most people with prediabetes will develop diabetes within ten years unless they make significant lifestyle changes. Although people with prediabetes don't usually develop small blood vessel complications of diabetes like blindness, kidney failure, and nerve damage, they're more prone to large vessel disease like heart attacks and strokes, so you want to get that level of glucose down. In 2019 an estimated 98 million people - that's more than one in three people - in the United States have prediabetes.

The American Diabetes Association has added a new criteria for the definition of diabetes, based around a person's A1C number. A1C is a measure of the average blood glucose for the last 60 to 90 days. If the A1C is equal to or greater than 6.5 percent, the person is considered to have diabetes.

Many countries use different measurements for blood glucose - millimole per liter (mmol/l). The equivalent cut off values for a diagnosis of diabetes are 7.0 mmol/l for a fasting glucose and 11.1 mmol/l for a casual measurement (sometimes called a random blood glucose). The equivalent in mmol/mol for an A1C of 6.5 percent is 48.

Categorizing diabetes

The following list describes the three main types of diabetes:

• Type 1 diabetes: This used to be called juvenile diabetes or insulin-dependent diabetes. It mostly begins in childhood and results from the body's self-destruction of its own pancreas. The pancreas is an organ of the body that sits behind the stomach and makes insulin, the chemical or hormone that gets glucose into cells where it can be used. You can't live without insulin, so people with type 1 diabetes must take insulin shots. Type 1 diabetes represents about 10 percent of total diabetes numbers.
• Type 2 diabetes: Once called adult-onset diabetes, type 2 used to begin around the age of 40, but it's occurring more often in children, many of whom are getting heavier and heavier and exercising less and less. The problem in type 2 diabetes isn't a total lack of insulin, as occurs in type 1, but a resistance to the insulin, so that the glucose still doesn't get into cells but remains in the blood. It's often associated with being overweight and having a family history of diabetes.

• Gestational diabetes: This type of diabetes is like type 2 diabetes but occurs in women during pregnancy, when a lot of chemicals in the mother's blood oppose the action of insulin. About 4 percent of all pregnancies are complicated by gestational diabetes. If the mother isn't treated to lower the blood glucose, the glucose gets into the baby's bloodstream. The baby produces plenty of insulin and begins to store the excess glucose as fat in all the wrong places. If this happens, the baby may be larger than usual and therefore may be hard to deliver.

  When the baby is born, they're cut off from the large sugar supply but are still making lots of insulin, so their blood glucose can drop severely after birth. The mother is at risk of gestational diabetes in later pregnancies and of type 2 diabetes as she gets older. About 50 percent of women with gestational diabetes develop diabetes at some stage, so regular testing and adopting a healthy lifestyle are both really important after a diagnosis of gestational diabetes. Women should be screened for gestational diabetes at 24 to 28 weeks of the pregnancy.

• Other types: A small group of people with diabetes suffer from one of these much less common varieties of diabetes:
  • Latent autoimmune diabetes in adults (LADA), which has characteristics of both type 1 and type 2 diabetes
  • Genetic defects of the beta cell, which makes insulin
  • Medications that affect insulin action like cortisol or prednisone
  • Diseases or conditions that damage the pancreas like pancreatitis or cystic fibrosis
  • Genetic defects in insulin action

Knowing the consequences of diabetes

If your blood glucose isn't controlled - that is, kept between 70 and 139 mg/dl after eating or under 100 mg/dl fasting - damage can occur to your body. The damage can be divided into three categories: irritations, short-term complications, and long-term complications.

Irritations

Irritations are mild and reversible but still unpleasant results of high blood glucose levels. The levels aren't so high that the person is in immediate life-threatening danger. The most important of these irritations are the following:

• Blurred vision
• Fatigue
• Frequent urination and thirst
• Genital itching, especially in females
• Gum and urinary tract infections
• Obesity
• Slow healing of the skin

Short-term complications

These complications can be very serious and lead to death if not treated. They're associated with very high levels of blood glucose - in the 400s and above. The three main short-term complications are the following:

• Ketoacidosis: This complication is found mostly in type 1 diabetes. Ketoacidosis is a severe acid condition of the blood that results from lack of insulin. The patient becomes very sick and will die if not treated with large volumes of fluids and large amounts of insulin. After the situation is reversed, however, the patient is fine.
• Hyperosmolar syndrome: This condition is often seen in neglected older people. Their blood glucose rises due to severe dehydration and the fact that the kidneys of the older population can't get rid of glucose the way younger kidneys can. The blood becomes like thick syrup. The person can die if large amounts of fluids aren't restored. They don't need that much insulin to recover. After the condition is reversed, these people can return to a normal state.
• Hypoglycemia or low blood glucose: This complication happens when the patient is on a drug like insulin or a pill that drives the glucose down but isn't getting enough food or is getting too much exercise. After it falls below 70 mg/dl, the patient begins to feel bad. Typical symptoms...