Uncontrolled Diabetes: Recognizing the Signs and Taking Action

Diabetes is a chronic condition that affects how the body regulates blood sugar levels. Typically, the body uses insulin, a hormone produced by the pancreas, to convert food into energy. In people with diabetes, either the body doesn't produce enough insulin, or the cells don't respond effectively to it, leading to high blood sugar levels.

An estimated 34.2 million Americans, or 10.5% of the population, battle diabetes, according to the Centers for Disease Control and Prevention (CDC). This staggering number highlights the widespread impact of the disease in the nation.

Diabetes is a global issue. 

• Canada: The situation in Canada is equally concerning, with 11.3 million Canadians, representing 29.3% of the population aged 12 and over, diagnosed with either diabetes or prediabetes, according to the Canadian Diabetes Association.
• United Kingdom:  As reported by Diabetes U.K., over 5.3 million individuals, or 9.3% of the population, in the United Kingdom have diabetes. This data underscores the significant health care burden the disease poses in the U.K.
• Australia: According to the Australian Institute of Health and Welfare, 3.4 million people, or 12.5% of the population aged 16 and over, are currently grappling with diabetes in Australia. This emphasizes the need for comprehensive prevention and management strategies in the country.
• New Zealand: While the population size is smaller, New Zealand also faces a significant challenge. An estimated 460,000 New Zealanders, representing 11.1% of the population aged 15 and over, are battling diabetes or prediabetes, according to the New Zealand Ministry of Health.

These figures paint a worrying picture of the growing diabetes epidemic, urging individuals to prioritize preventative measures, early detection, and effective management strategies to combat this widespread health concern that makes other health issues harder to deal with. 

Complications of diabetes add to long-term care risk when you get older.

How is Diabetes Diagnosed? 

Doctors diagnose diabetes through blood tests, such as the A1C test, which measures average blood sugar levels over the past 2-3 months. Other tests may be used depending on individual circumstances.

The A1C test is also known as hemoglobin A1c or HbA1c. Hemoglobin is a protein in your red blood cells that carries oxygen throughout your body. When sugar is present in your bloodstream, it attaches to hemoglobin.

Here's a breakdown of what the A1C test tells you:

• High A1C: Indicates poorly controlled blood sugar and an increased risk of developing diabetes complications.
• Low A1C: Indicates well-controlled blood sugar in individuals with diabetes or those at risk.
• Normal A1C: Indicates normal blood sugar levels for individuals without diabetes.

Why is A1C important?

• It provides a longer-term picture of blood sugar control compared to finger pricks, which measure blood sugar at a single point in time.
• It is used to diagnose prediabetes and type 2 diabetes.
• It helps monitor how well your diabetes treatment plan is working and adjust it if needed.

A1C ranges:

• Normal: Below 5.7%
• Prediabetes: 5.7% to 6.4%
• Diabetes: 6.5% or higher

It is important to note that A1C is just one piece of the puzzle. Your doctor will consider your individual circumstances and may use other tests along with A1C to make informed decisions about your health.

Reasons for High A1C

Several factors can contribute to a high A1C, including:

• Unhealthy diet: Lack of physical activity, sugary drinks, and excessive carbohydrates can raise blood sugar levels.
• Not taking medication as prescribed: Skipping or forgetting medication doses can lead to uncontrolled diabetes.
• Stress: Chronic stress can elevate blood sugar levels.
• Certain medical conditions: Illnesses or infections can temporarily raise blood sugar.

High Blood Glucose

A high blood glucose reading on your diabetes glucose meter can be one of the most apparent signs of uncontrolled diabetes. While the occasional high or low reading doesn't always indicate a more severe problem, consistently high readings might.

A blood glucose reading also called a blood sugar reading, measures the amount of glucose (sugar) present in your bloodstream at a specific point in time. This test is typically done by pricking your fingertip with a small lancet and using a blood glucose meter to analyze the blood sample.

The reading is displayed in milligrams per deciliter (mg/dL). Generally:

• Normal blood sugar level before eating (fasting): Less than 100 mg/dL
• Normal blood sugar level 1-2 hours after eating: Less than 140 mg/dL

If your blood sugars remain high, speaking to your doctor about treatment plan adjustments or lifestyle changes can be crucial.

Managing and Controlling Diabetes

Individuals who effectively manage their diabetes typically experience a good quality of life with a reduced risk of disability and premature death. They often respond positively to dietary and exercise adjustments, though many require medications to regulate blood glucose levels and prevent complications.

John Buse, MD, PhD, the Verne S. Caviness Distinguished Professor of Medicine in the Division of Endocrinology and Metabolism in the UNC Department of Medicine, says that medication, diet, and exercise are the usual effective treatments. 

There is general agreement among doctors that Metformin, the most common first-line medication for treating type 2 diabetes, combined with diet and exercise is the best early approach in diabetes care. However, most people with diabetes will require more than one medicine to control their condition over time.

Metformin is considered the first-line therapy for most people with type 2 diabetes. It helps the body use insulin more effectively and reduces glucose production in the liver. Other medications may be deployed: 

• Sulfonylureas: These medications stimulate the pancreas to release more insulin. Examples include glimepiride (Amaryl), glipizide (Glucotrol), and glyburide (DiaBeta, Glynase).
• DPP-4 inhibitors (gliptins): These medications increase the body's incretin levels, stimulating insulin release and decreasing glucagon secretion (a hormone that raises blood sugar). Examples include sitagliptin (Januvia), linagliptin (Jentadueto), and alogliptin (Kazano).
• GLP-1 receptor agonists: These medications mimic the effects of glucagon-like peptide-1 (GLP-1), a natural hormone that promotes insulin release, suppresses glucagon secretion, and slows down stomach emptying. Examples include liraglutide (Victoza), dulaglutide (Trulicity), and semaglutide (Ozempic).
• SGLT2 inhibitors: These medications work by blocking the reabsorption of glucose by the kidneys, allowing excess sugar to be excreted in the urine. Examples include dapagliflozin (Farxiga), empagliflozin (Synjardy), and canagliflozin (Invokamet).

Doctors employ various strategies to keep diabetes under control, including:

• Lifestyle modifications: Eating a balanced diet, regular exercise, and maintaining a healthy weight are crucial.
• Medications: Different medications, like insulin or oral medications, may be prescribed to regulate blood sugar levels.
• Blood sugar monitoring: Regularly checking blood sugar levels at home allows for diet, exercise, or medication adjustments.

Complications of Uncontrolled Diabetes

Uncontrolled diabetes can lead to serious health problems, including:

• Heart disease and stroke: High blood sugar damages blood vessels, increasing the risk of these conditions.
• Nerve damage: This can lead to pain, numbness, tingling, difficulty walking, and diabetic neuropathy.
• Kidney disease: Uncontrolled diabetes can damage the kidneys, potentially leading to kidney failure.
• Eye problems: Diabetes can increase the risk of glaucoma, cataracts, and even blindness.
• Skin and foot problems: Uncontrolled diabetes can lead to slow-healing wounds and infections.

Increased Risk of Long-Term Care

Uncontrolled diabetes can significantly increase the risk and need for long-term care due to complications like blindness, amputations, and severe nerve damage that can limit mobility and daily activities.

• What Is Long-Term Care?

Awareness

While type 2 diabetes (the most common form of diabetes) can develop at any age, it most commonly occurs in adults over 45 years old. However, the risk of developing the condition increases significantly as you age, with the highest prevalence reported in the 65 and above age group. 

It is crucial to be aware of the signs of uncontrolled diabetes and take proactive steps to manage the condition. Early detection, consistent monitoring, and adherence to treatment plans are essential to prevent complications and improve overall health and well-being. If you have concerns about your diabetes management, consult your doctor to discuss personalized strategies and ensure optimal control.

Genetics and Diabetes 

Taking action when you are younger to avoid or delay diabetes is key to overall good health. Studies have shown that genetics play a significant role in type 2 diabetes, with an estimated heritability of 40-50%. This means that if a close family member, like a parent or sibling, has type 2 diabetes, your risk of developing it increases.

• Multiple genes: Unlike some diseases caused by a single gene mutation, type 2 diabetes involves a complex interplay of multiple genes. Researchers have identified numerous genetic variations (polymorphisms) associated with an increased risk, but none guarantee the development of the disease.
• Gene-environment interaction: While genetics play a role, environmental factors like diet, physical activity, and weight also significantly influence the development of type 2 diabetes. Even individuals with a genetic predisposition can reduce their risk by maintaining a healthy lifestyle.

Therefore, having a family history of type 2 diabetes increases your susceptibility, but it's not a guaranteed outcome. Adopting healthy habits and regular checkups with your doctor remains crucial for managing your risk and overall well-being. 

Planning for Aging and Health Complications

Chronic health issues, like diabetes, can complicate aging and the future need for long-term care. Healthy people have a high risk of needing long-term care because of longevity, but chronic health issues can mean additional care services or the need for care at younger ages. 

Your retirement plan should include Long-Term Care Insurance. While you can obtain an LTC policy if your diabetes is well controlled, other health issues, including your weight, could make it much more difficult.

• What Is Long-Term Care Insurance? What Does It Cover?

Insurance companies use different medical underwriting methods. Still, it is best to obtain coverage when you are younger and healthier. 

Diabetes is not something to ignore. Being proactive with your health and planning will improve your quality of life in the decades ahead.