By Ghada Elshimy, MD, as told to Alyson Powell Key
We consider type 2 diabetes part of the metabolic syndrome. It starts as prediabetes, and then if you don't follow a healthy lifestyle -- don’t exercise enough or control your diet -- you can get type 2 diabetes. So, the most important thing is to stop it at an earlier phase. If you have high blood pressure, eat a lot of fat, and have an inactive lifestyle, you need to change all of this from the beginning to stop type 2 diabetes from happening.
Once you have diabetes, it can affect your entire life. And the longer you have it, the more problems you're likely to have. That’s why, with type 2 diabetes, we look for other conditions. This includes checking your kidneys, tesing your feet for feeling, and doing an eye exam, because it’s likely that damage has already happened. Our main goal is to control further damage: The earlier you implement a better lifestyle, the better quality of life you have.
Medication and Lifestyle
Type 2 diabetes has a couple of available treatments -- oral pills and injectables, which you take once daily or once weekly. If diabetes is uncontrolled and hemoglobin A1c is more than 9%, you’ll definitely need insulin. The benefit of taking oral medication like an SGLT2 inhibitor or GLP-1 receptor agonist is these medications can cause moderate weight loss. They may also help protect other organs that are affected by diabetes. There are a lot of medications on the market. Some don't affect your weight, some can cause weight gain, and others can lead to weight loss. We always try to prescribe diabetes medications that make you lose weight to stop diabetes from getting worse.
Even if I give you a medication that can help you lose weight, if you continue eating unhealthy food, not exercising, and having an inactive life, your diabetes won't be well controlled. Losing weight -- 5% to 7% of your starting weight -- has a meaningful impact on your blood sugar and overall quality of life. Sometimes we can take you off medication once you lose weight.
We always suggest 115 minutes of moderate-intensity exercise per week. This means activities like jogging or biking, not just walking. Exercise builds more muscle, which can use more glucose, lower your insulin requirement, and lower sugar.
There are also multiple online apps you can use to help track what you eat. Keeping a food diary is very helpful, because you have to know what you’re eating to stop unhealthy habits. We also encourage you to stick to a diet, whether it’s fasting off and on, the Mediterranean diet, or ketogenic diet. The most important thing to see long-term effects is to set small goals and don’t give up.
Other Diabetes-Related Problems
We divide diabetes complications into two parts: macrovascular, which affects the big vessels in your body, and microvascular, which affect the small vessels. Macrovascular complications include heart attack and stroke. Controlling diabetes and taking cholesterol-lowering medication can prevent heart attack and stroke.
Microvascular complications happen when there’s too much glucose in your kidney and eye vessels and around the nerves and nerve endings. That’s how you get neuropathy or numbness in your hands and feet. You can also get retinopathy or nephropathy, which are diabetic changes to your eyes and kidneys. You can also have other problems, like autonomic dysfunction. This causes dizziness and fainting episodes. Or you might get gastroparesis, which can cause bloating and eating problems.
If the disease is just starting, then we start treatment right away to stop it from advancing. If we find one microvascular complication and don’t correct your sugar quickly, you're liable to have others. That’s why we encourage people to check their feet every day to make sure there’s no infection. If you lose the feeling in your feet, you’re not going to feel an infection or foot problem. We’ll refer you to a foot doctor (podiatrist) to check your feet. We also suggest that you get an annual eye exam. If your kidney function starts to get worse, you’ll need to see a kidney doctor (nephrologist) to check the amount of protein in your urine every year.