Louis B. Malinow, MD is an MDVIP-affiliated physician that's been practicing in Baltimore for more than 20 years. He's board certified in Internal Medicine, a certified Hypertension Specialist and a Diplomate of the American Board of Clinical Lipidology. Dr. Malinow graduated from the University of Maryland School of Medicine and completed his residency at Stanford University Hospital in Stanford, CA. Dr. Malinow is one of the only physicians in Maryland that specializes in both high blood pressure and high cholesterol management. He is also a member of the prestigious Alpha Omega Alpha medical honor society and is recognized by Best Doctors and Top Doctor by U.S. News & World Report and Baltimore Magazine. Dr. Malinow has appeared on numerous news programs advocating for preventive care and wellness.
Low blood sugar (hypoglycemia), is common in people with type 1 and type 2 DM. Most cases are mild and are not considered medical emergencies. Effects can range from feelings of unease, sweating, trembling, and increased appetite in mild cases to more serious effects such as confusion, changes in behavior such as aggressiveness, seizures, unconsciousness, and (rarely) permanent brain damage or death in severe cases. Moderately low blood sugar may easily be mistaken for drunkenness; rapid breathing and sweating, cold, pale skin are characteristic of low blood sugar but not definitive. Mild to moderate cases are self-treated by eating or drinking something high in sugar. Severe cases can lead to unconsciousness and must be treated with intravenous glucose or injections with glucagon.
DM is a strong independent predictor of short- and long-term recurrent ischemic events, including mortality, in acute coronary syndrome (ACS),6,7 including unstable angina and non-ST-elevation MI (NSTEMI),8 ST-elevation MI (STEMI) treated medically,9 and ACS undergoing percutaneous coronary intervention (PCI).10,11 Furthermore, the concomitant presence of cardiovascular risk factors and comorbidities that negatively affect the outcomes of ACS is higher in DM patients.12
Commonly, diabetic patients’ random blood glucose measurement will be greater than 200 mg/dL. Additionally, diabetic patients’ urinalysis will be positive for greater than 30 mg/g of microalbumin on at least two of three consecutive sampling dates. Type 2 diabetics who have had diabetes mellitus for more than 2 years will usually have a fasting C-peptide level greater than 1.0 ng/dL. Patients with type 1 diabetes will have islet cell and anti-insulin autoantibodies present in their blood within 6 months of diagnosis. These antibodies, though, usually fade after 6 months.
Many older people have difficulty following a healthy, balanced diet that can control blood glucose levels and weight. Changing long-held food preferences and dietary habits may be hard. Some older people have other disorders that can be affected by diet and may not understand how to integrate the dietary recommendations for their various disorders.
Other studies have focused, not on sugar overall but specifically on sodas and other sugar-sweetened beverages. Many have found no significant relationship, apart from sugar’s extra calories that lead to weight gain. For example, the Women’s Health Study,8 the Atherosclerosis Risk in Communities Study,9 the Black Women’s Health Study,10 and the Multi-Ethnic Study of Atherosclerosis found no significant associations between sugar consumption and diabetes risk after adjustment for measures of body weight. Some studies have had mixed results, exonerating sucrose, but indicting glucose and fructose.12,13 And some studies have shown associations between sugar-sweetened beverages and diabetes that persist after adjustment for body weight.14,15
A proper diet and exercise are the foundations of diabetic care, with a greater amount of exercise yielding better results. Exercise improves blood sugar control, decreases body fat content and decreases blood lipid levels, and these effects are evident even without weight loss. Aerobic exercise leads to a decrease in HbA1c and improved insulin sensitivity. Resistance training is also useful and the combination of both types of exercise may be most effective.
Type 1 diabetes mellitus is characterized by loss of the insulin-producing beta cells of the pancreatic islets, leading to insulin deficiency. This type can be further classified as immune-mediated or idiopathic. The majority of type 1 diabetes is of the immune-mediated nature, in which a T cell-mediated autoimmune attack leads to the loss of beta cells and thus insulin. It causes approximately 10% of diabetes mellitus cases in North America and Europe. Most affected people are otherwise healthy and of a healthy weight when onset occurs. Sensitivity and responsiveness to insulin are usually normal, especially in the early stages. Type 1 diabetes can affect children or adults, but was traditionally termed "juvenile diabetes" because a majority of these diabetes cases were found in children.
Home blood glucose monitoring kits are available so patients with diabetes can monitor their own levels. A small needle or lancet is used to prick the finger and a drop of blood is collected and analyzed by a monitoring device. Some patients may test their blood glucose levels several times during a day and use this information to adjust their doses of insulin.
A1C: Your A1C, also called glycated hemoglobin, reflects your average blood glucose levels for the past 2 to 3 months. If your A1C is 6.5% or greater, your doctor may diagnose diabetes. If your A1C is between 6.0% and 6.4%, your doctor may diagnose prediabetes. Of note, A1C cannot be used to diagnose type 1 diabetes, diabetes in children, adolescents, or pregnant women.
Complications of diabetes are responsible for considerable morbidity and mortality. The acute complications of diabetes are hypo- and hyperglycemic coma and infections. The chronic complications include microvascular complications such as retinopathy and nephropathy, and the macrovascular complications of heart disease and stroke. Diabetes mellitus is the commonest cause of blindness and renal failure in the UK and the USA. Other common complications include autonomic and peripheral neuropathy. A combination of vascular and neuropathic disturbances results in a high prevalence of impotence in men with diabetes. Peripheral neuropathy causes lack of sensation in the feet which can cause minor injuries to go unnoticed, become infected and, with circulatory problems obstructing healing, ulceration and gangrene are serious risks and amputation is not uncommon. Evidence from meta-analysis of studies of the relationship between glycemic control and microvascular complications (Wang, Lau, & Chalmers, 1993), and from the longitudinal multicenter Diabetes Control and Complications Trial (DCCT) in the USA (DCCT Research Group, 1993), have established a clear relationship between improved blood glucose control and reduction of risk of retinopathy and other microvascular complications in insulin-dependent diabetes mellitus (IDDM). It is likely that there would be similar findings for noninsulin-dependent diabetes mellitus (NIDDM) though the studies did not include NIDDM patients. However, the DCCT included highly selected, well-motivated, well-educated and well-supported patients, cared for by well-staffed diabetes care teams involving educators and psychologists as well as diabetologists and diabetes specialist nurses.
The genes identified so far in people with type 2 include many that affect the insulin-producing beta cells of the pancreas, says Craig Hanis, PhD, a professor at the Human Genetics Center at the University of Texas Health Science Center in Houston. And yet he emphasizes that why people get type 2 isn't at all clear yet: "What it tells us is that diabetes is a complicated disease."
But the 2015-2020 Dietary Guidelines recommend keeping added sugar below 10 percent of your overall daily caloric intake. And the American Heart Association suggests consuming no more than 9 teaspoons (tsp) — equal to 36 grams (g) or 150 calories — of added sugar if you're a man, and 6 tsp — equal to 25 g or 100 calories — if you're a woman. "Naturally occurring sugars don't count in these recommendations," notes Grieger, which means you should worry less about those sugars in fruits and veggies, for instance, than you should about those in processed fare.
Type 2 diabetes is different. A person with type 2 diabetes still produces insulin but the body doesn't respond to it normally. Glucose is less able to enter the cells and do its job of supplying energy (a problem called insulin resistance). This raises the blood sugar level, so the pancreas works hard to make even more insulin. Eventually, this strain can make the pancreas unable to produce enough insulin to keep blood sugar levels normal.
Type 1 DM is caused by autoimmune destruction of the insulin-secreting beta cells of the pancreas. The loss of these cells results in nearly complete insulin deficiency; without exogenous insulin, type 1 DM is rapidly fatal. Type 2 DM results partly from a decreased sensitivity of muscle cells to insulin-mediated glucose uptake and partly from a relative decrease in pancreatic insulin secretion.
Fatigue and muscle weakness occur because the glucose needed for energy simply is not metabolized properly. Weight loss in type 1 diabetes patients occurs partly because of the loss of body fluid and partly because in the absence of sufficient insulin the body begins to metabolize its own proteins and stored fat. The oxidation of fats is incomplete, however, and the fatty acids are converted into ketone bodies. When the kidney is no longer able to handle the excess ketones the patient develops ketosis. The overwhelming presence of the strong organic acids in the blood lowers the pH and leads to severe and potentially fatal ketoacidosis.
Because both yeast and bacteria multiply more quickly when blood sugar levels are elevated, women with diabetes are overall at a higher risk of feminine health issues, such as bacterial infections, yeast infections, and vaginal thrush, especially when blood sugar isn't well controlled. And a lack of awareness about having prediabetes or diabetes can make managing blood sugar impossible.