I'm Dr. David Hite, a member of the American Association of Diabetes Educators.
I provide Diabetes Education classes for a large non-profit healthcare organization in Sacramento, California. I know that most of you can't attend my diabetes class in person at the clinic, so I've created an educational DVD and this e-book "Type-2: Straight Talk About Diabetes Self-Care" to help you understand Type-2 Diabetes, and learn how you can Take Control of Your Diabetes or offer needed help to a friend or loved one who may be struggling to avoid the medical complications that often come with this disease. This information is also perfect for those of you who have pre-diabetes and want to reverse those symptoms and avoid progression to diabetes. If you have not already done so, I encourage you to get my complete Diabetes Basics-Take Control DVD presentation and learn even more about your condition. Good health. Live well.

Type-2: Straight Talk About Diabetes Self-Care

Diabetes is a chronic condition. It’s not yet curable. But we do know some secrets to help you stay healthy and avoid diabetic complications. Your doctor is a very important part of staying healthy, so visit and have blood tests 2-3 times each year so you can spot potential problems early and to make sure you're still on track. But also remember what you do for yourself when you leave the doctor is just as important as anything your doctor can do. The secret involves Taking Control of your diabetes by following my 5 M’s of diabetic care. Sounds simple, but you all know that diabetes is a complex and frustrating medical condition. There’s a lot to learn, but the more you know, the easier it will be to stay healthy. I hope this section specifically on the topic of Monitoring will help to answer some of your questions and set you on the road to good health.

MONITORING

If I have so much sugar in my blood why do I feel so tired and hungry all the time?

When you have diabetes, sugars are trapped in the blood in high amounts. Your cells aren't absorbing sugar properly, and that’s why you may feel hungry and lack energy much of the time. Your body cells are crying out for nourishment despite having sugar all around them. It’s easy for a person with diabetes to overeat in response to these “hunger feelings” and gain weight. This weight gain, especially when the weight is held in the belly area, actually predisposes a person to diabetes and makes it harder to control once you have it because it increases insulin resistance. This inability to use insulin properly causes the pancreas to work harder and tire sooner. Lowering insulin resistance is one of the most important keys to successful diabetes management. Click this link to watch your pancreas in action.

Which type is more common?

Type-2 diabetes, sometime called noninsulin-dependent diabetes mellitus (NIDDM) or adult-onset diabetes, is by far the most common type. 285 million people worldwide suffer from type-2 diabetes. India has the greatest number with 50 million. Of the 24 million people in the U.S. with diabetes 23 million have type-2. It usually occurs later in life, typically after the age of 40 (Though due to the dramatic increase in childhood obesity, many younger people are now being diagnosed with type-2 diabetes. Ninety percent of all people with type-2 diabetes have gained significant weight around their mid-section prior to diagnosis). In type-2 diabetes insulin is still being produced by the pancreas, but it’s no longer effective in lowering blood sugars because the cell receptors that open the doors to the inside of the cells seem to be stuck shut. This condition is called insulin resistance.

Trapped sugars in your blood indicate that your body has lost its ability to properly absorb the fuels you eat. The normal amount of sugar found circulating in the blood 12 hours after eating would be 99 or less (measured in milligrams of sugar in each deciliter of blood). A 12-hour fasting blood sugar of 100 to 125 indicates that your body is struggling to control blood sugars and is called “pre-diabetes”. A level of 126 or higher in two separate tests establishes the clinical diagnosis of diabetes.

My doctor says that excess sugars in my blood will eventually damage my body.

Sugar isn’t poison. It’s the main fuel for your body. We all need some sugar in our blood. Sugar is a highly reactive fuel that's supposed to leave your stomach quickly, travel through the blood, and then be absorbed into your hungry cells and burned for energy. The issue for maintaining good health is managing how much sugar is in the blood at any time and for how long. You see sugar is a great energy source, but it’s also corrosive. Trapped sugars in the blood accelerate the corrosive damage to blood vessels and leads to the breakdown of important body tissues and to the diabetic complications that cause failing health.

I like to use rusting to describe what goes on in your blood when sugars are not controlled. Rusting is a slow destructive process that takes time to develop and is easy to overlook. But if allowed to progress unchecked, it can cause the eventual destruction of things like a bike or mower. Knowing this, we protect our possessions by keeping them out of the elements. That way we reduce the risk that rust is going to do any serious damage. In the same way knowing how to use the 5 M's of diabetic care to help self-regulate your blood sugars and keep them in a healthier range, you'll be able to avoid most of the corrosive damage associated with diabetes and lower our risk of complications.

If sugar is so corrosive why don’t all people have damage to their bodies?

They do! We can measure the corrosive damage caused by sugar in everyone, even if they don’t have diabetes, by using a simple blood test called hemoglobin A1c (abbreviated hgbA1c). Hemoglobin is the protein that carries oxygen and makes blood red. (You may be familiar with this test and I hope you’re able to have it done several times each year) Your red blood cells live about 3 months, so it’s a convenient way to measure the amount of damage (glycation) present and determine average blood sugar levels during the 3 months before the test. A person without diabetes will have between 4.5% and 5.5% damage to their red blood cells (hemoglobin) from the corrosive effect of sugar. This normal level of blood sugar causes little damage and is easily repaired in a healthy person. I've worked with uncontrolled diabetic patients with hgbA1c damage as high as 17%. This means that blood sugar has been nearly 500 for the past 3 months.

Remember this test also tells us that the protein structure of your blood vessels themselves is being damaged in the same way, and it’s this high level of blood vessel damage that causes diabetic complications. A healthy hgbA1c for a person with diabetes is somewhere below 7%. That means blood sugars are averaging about 155. This is still in a range that is considered diabetic, but research shows that when corrosive damage is kept low like this, your body can keep up with the repair to your blood and blood vessels and the risk for diabetic complications is significantly lower. So it’s fair to say that it’s uncontrolled diabetes that leads to damage and failed health, because the damage is happening faster than your body can repair it.

The graph below shows how the risk of complications increases as blood sugar rises. Work hard to keep your hemoglobin A1c below 7% and you will most likely avoid severe diabetic complications.