Learn how to successfully manage diabetes and you can live a normal life
By Laurie Davies

Everything changes when your doctor says, “You have diabetes.” As he talks, your mind conjures up images of a bleak future: daily injections, no more chocolate, drastic lifestyle changes.

Relax. A diabetes diagnosis doesn’t mean you have to inject insulin daily or be banished to a life without sweets. In fact, through sound nutrition, regular exercise and, if needed, oral medication, you may even be able to turn back the clock on this disease.

Diabetes Demographics
An estimated 18.2 million Americans live with diabetes, a chronic condition in which glucose backs up in the bloodstream because of the body’s inability to use or store it.
With type 1 diabetes, a person completely stops producing insulin, a hormone that enables the body to use glucose. It usually afflicts juveniles. With the more prevalent type 2 diabetes, the body either doesn’t produce enough insulin or is unable to use it properly. Type 2 diabetes is more likely to run in families, usually affects adults and occurs with greater frequency among minority populations—African-American, Hispanic, Asian-American, Pacific Islander and Native American. The reasons for this are not entirely understood.

“Genetics and a tendency toward obesity in these populations seem to be at work,” says Kwame Osei, MD, director of the Division of Endocrinology, Diabetes and Metabolism at The Ohio State University Medical Center. “We know—although we don’t know exactly why—that minority populations have a tendency to have insulin resistance [a silent condition in which your muscle, fat and liver cells don’t use insulin properly] very, very early. This runs in families, and then you have a vicious cycle.”

Managing Diabetes
While type 1 diabetes is not reversible by conventional therapies and is controlled through insulin injections, a person with type 2 diabetes can make lifestyle changes to get glucose levels back to normal. In fact, unlike some other diseases, type 2 diabetes can be very tightly managed by you—the patient.

“If you are overweight and go on a good diet and exercise program, you may actually reverse the process,” says Osei, adding that 90 percent of diabetes patients are obese.
So, where do you start? First of all, says Fred Miser, MD, a family physician at The Ohio State University Thomas E. Rardin Family Practice Center, forget the idea that you have to go on a restrictive “diabetes diet.”

“What I try to emphasize is not ‘diet’ but basic nutrition aspects—eating colorful vegetables and fruits and eating the right amounts of food,” he says. Decreasing calories and adding fiber can also help control blood sugar. “People think, ‘I can’t eat my birthday cake. I can’t eat ice cream.’ Well, you can’t eat a gallon of ice cream, but there’s no reason why you can’t have some.”

Of course, the other part of weight loss is exercise. Again, don’t assume you have to train for a marathon. “Most of my diabetic patients have never exercised in their lives,” Osei says. “So I encourage them to walk in the evenings. Walk the two flights of stairs to their office instead of taking the elevator. Start small.”

Not only can exercise help in weight loss, but it also changes some of the “signals” in muscles that absorb glucose, making them work more efficiently. “For this to happen, you don’t have to lose 100 pounds. The magic number seems to be about 10 to 20 percent of body weight,” Osei says.

What If Losing Weight Fails to Help?
First of all, weight loss can never “fail.” Even if your blood glucose level doesn’t return to normal, weight loss takes a huge burden off your heart and other organs.
Sometimes, however, medication is needed to help control type 2 diabetes. A wide variety of oral prescription drugs now allows doctors to target the pancreas, which produces insulin; the liver, which produces glucose; and even specific enzymes.

For example, a category of drugs called biguanides decreases the amount of glucose produced by the liver and aids in glucose absorption. When they’re combined with sulfonylureas, which stimulate the pancreas to release more insulin, they may work together to lower blood sugar, Osei says. If needed, insulin therapy is also available. “We are able now with medicines to pinpoint ways to manage glucose—almost everyone can get it under control,” Miser says.

Taking Charge
Since the manager-on-duty for diabetes is you, you’ll want to chart your progress. Blood glucose meters and the regular logging of results can help you and your healthcare provider identify times of day or certain days when you need to adjust your management strategy.
In fact, regular healthcare appointments can help identify other complications. After several initial visits, Miser recommends seeing your family physician, internist or endocrinologist every three to six months—more often if you also have hypertension or heart disease. Upon diagnosis, Miser also advises appointments with a nutritionist, a diabetes educator, a podiatrist and an optometrist or ophthalmologist.

Finally, if you want to add one more surefire way to help keep complications from diabetes at bay, quit smoking. “Diabetes hardens the small blood vessels to the outer extremities,” says Richard Schlanger, MD, PhD, FACS, director of the OSU Wound Healing Center at University Hospital East. “If you smoke, you’re killing off the large blood vessels, too.”
The resulting poor circulation can prevent even the smallest wound from healing. “Smoking with chronic wounds is like pouring gasoline on a fire,” Schlanger says. “It’s toxic.”

A Hopeful Condition
In the end, diabetes patients should guard against thinking they just have “a little extra sugar.” Complications from diabetes can be severe—including heart disease, blindness, amputation and kidney failure. Still, a diabetes diagnosis doesn’t mean your life is over. A combination of lifestyle changes, glucose monitoring, prescription medication and regular medical examinations can help you live a normal life.

“Today, people don’t have to suffer from the complications of diabetes,” Miser says. “Now, more than ever before, diabetes is a very hopeful condition. We understand it well, and we understand how to manage it well.”

Happy Feet
As hard as it may be to believe, a person with diabetes could step on a tack and not even know it. This is because diabetes—especially if left unchecked—can destroy nerve endings in the extremities.

“People with diabetes should inspect their feet daily to make sure there are no cracks, calluses or ulcerations,” says Richard Schlanger, MD, PhD, FACS, director of the OSU Wound Healing Center at The Ohio State University Hospital East. He also recommends stroking the foot to check for sensation.

If a wound becomes evident, seek medical help promptly. “Continuing to walk on a wound can cause it to develop into an ulcer,” Schlanger says. “If it doesn’t heal early, it will go on to infection, and in extreme cases, may even require amputation.”

And, he cautions, no two wounds are alike. “If you’ve had success healing one wound, it doesn’t mean you will with the next. The old expression applies: ‘Don’t try this at home.’”
Lynn Lambert, director of the OSU Wound Healing Center, says wound care can include trimming calluses, assessing patients for special shoes and even using hyperbaric medicine, which uses pressurized oxygen to improve healing.

“At the center, we test glucose, protein and oxygen levels—everything we can—to find the underlying cause for the wound,” Lambert says. “We try to get down to the ‘why’ so the patient can heal.”

Protect your feet. To schedule an appointment at the OSU Wound Healing Center, call OSU Medical Center at (800) 293-5123.

Kids and Diabetes
Type 2 diabetes used to go by a different name—adult-onset diabetes.
“We changed from ‘adult-onset’ because children are getting it,” says Kwame Osei, MD, director of the Division of Endocrinology, Diabetes and Metabolism at The Ohio State University Medical Center.

Since this is a relatively new phenomenon, accurate statistics have yet to be compiled. However, reports indicate that up to 45 percent of children with newly diagnosed diabetes have type 2, according to the American Diabetes Association (ADA).

Osei says these kids are almost always obese. Mirroring the adult trend, kids of African-American, Hispanic and Native American descent are at greater risk. And while it usually doesn’t strike until puberty, type 2 diabetes has been documented in children as young as 4, according to the ADA.

Triumph Over Diabetes
Don’t let diabetes get the best of you. Call (800) 293-5123 today to schedule an appointment with an OSU Medical Center physician.