Managing Type 2 Diabetes

Do you know that approximately, 537 million people have diabetes worldwide? In Trinidad and Tobago, 14.8% of adults have diabetes. That’s almost 150 000 persons! There are different types of diabetes, however, Type 2 Diabetes is by far the most common, affecting both men and women. In this article we will discuss Type 2 Diabetes and its management. Let’s dive in!

What is Type 2 Diabetes?

Diabetes also known as Diabetes Mellitus is a chronic (lifelong) condition in which our bodies are unable to properly use the glucose (sugar) we get from food. When we eat, an organ in our bodies known as the pancreas produces insulin. Insulin is important for helping glucose in the blood to enter cells and be used for energy. In Type 2 diabetes, the pancreas either does not produce enough insulin or our bodies do not respond well to the insulin. This results in very high glucose levels in the blood which is dangerous to the body and can have long term effects.

What increases your risk of developing Type 2 Diabetes?

A Risk factor is something that increases your chance of developing a condition. Some risk factors for Type 2 Diabetes cannot be changed. These include:

Age: Being 40 years or older
Ethnicity:Being of East Indian and African descent increases your chance of developing diabetes at a younger age.
Family history:Having a parent, sister, or brother with diabetes increases your risk.
Medical History of :
- High blood pressure
- High triglycerides (high fats in the blood)
- Continuously high blood glucose readings
- Low HDL Cholesterol (this is a good type cholesterol which helps get rid of bad fats)
- Heart disease
- Stroke
- Diabetes in pregnancy known as Gestational Diabetes
- Polycystic Ovarian Syndrome (PCOS)
- Depression

Fortunately, some risk factors can be changed. These include our lifestyle choices such as :

Having a poor diet – Eating foods that are greasy and high in sugar and fat
Being overweight or obese which greatly increases your risk of Type 2 Diabetes, even in children.
Lack of physical activity
Smoking
Drinking Alcohol
Poor sleep habits – sleeping too much or too little can also increase your risk

What are some signs and symptoms of Type 2 Diabetes?

If you experience any of the following symptoms, you should reach out to your doctor.

Polyuria – urinating (peeing) more often especially at night.
- When blood sugar levels are high, your body tries to get rid of the extra sugar through urine. A lot of water is lost from the body as you go to the bathroom more often.
Polydipsia – feeling very thirsty
- Because you lose more water than usual you feel very thirsty and have the urge to drink lots of water.
Polyphagia – feeling very hungry despite eating
- Your body is unable to use the glucose as it normally would to give you energy so you feel hungry even after eating.
Feeling more tired than usual
Losing weight without changing your diet or exercise
Tingling or numbness of hands or feet
Cuts that heal slowly
Getting infections more often
Blurred vision
Dry itchy skin
Sometimes you may also notice dark, thick, velvety skin under the arms, behind the neck and in the groin area. This may be a sign of insulin resistance.

Some persons may have Type 2 Diabetes for many years without knowing, as they do not experience any symptoms. During this time, high blood glucose levels can still cause damage to the body.

Follow up Tests

If you or your loved one has been diagnosed with Type 2 Diabetes, your doctor may perform blood tests to determine how well your diabetes is being controlled. A few are discussed below:

A fasting plasma glucose test: This requires you to fast for at least 8 hours before your blood test. It takes place in the morning and measures blood sugar levels before you have eaten.
Hemoglobin A1c (HbA1c) level– This tells us how well your blood sugar was controlled over the past 3 months. This test can be done at any time of the day and does not require fasting.
Random blood glucose test: A small sample of blood is taken and blood sugar measured. This test can be done at time of the day and does not require you to fast.

How can you manage your Type 2 Diabetes?

There are several ways you can work with your doctor to effectively manage Type 2 diabetes. Adopting healthy lifestyle choices is one of the most important ways you can help control your blood sugar levels.

Some of these include:

Healthy Diet
Food is something that should be enjoyed, we just have to make the right choices!
- For example: You should have 3 balanced meals and 2 healthy snacks per day. Balanced meals should include a staple like rice or whole grain bread, lean proteins such as fish or chicken, legumes like peas or beans, and plenty of vegetables.
- Drink lots of water and eat your fruits in moderation.
- Avoid sugary foods, foods cooked with oil and butter (fried foods, pastry, roti etc), avoid soft drinks or any sweetened drinks and using too much salt.
- Avoid skipping meals: Remember to eat on time, for example 3-4 hours apart, consuming small portions at a time, helps control our blood sugar levels.
Increased Physical Activity
- Start to slowly and gradually increase your physical activity. Aim for 30 minutes of moderate-intensity aerobic activities per day such as brisk walking, jogging, dancing, cycling, or swimming.
Maintain a healthy weight
- Maintaining a healthy weight helps improve blood sugar control and lowers levels of fat in the blood decreasing your risk of heart disease.
Monitoring your blood sugar levels – Regularly monitoring your blood sugar levels at home helps determine if lifestyle changes and medications are effective or if changes are needed
Setting achievable goals
- Together with your doctor you can make goals that work for you. Example: I will go walking 4 times per week.

It is also important to know that if these lifestyle changes alone are not helping to control your blood sugar levels, your doctor may recommend medication to lower your blood sugar. These may be in the form of tablets or injections that assist your body to process sugar more effectively. A combination of medications may be used depending on how well your diabetes is controlled. It is important to take your medication exactly as your doctor told you to.

What happens when Type 2 Diabetes is Poorly Controlled?

Managing Type 2 Diabetes is not just about controlling your blood sugar levels; but also working to prevent negative long term effects.

Diabetes is one of the top three leading causes of death and disability in Trinidad and Tobago. In 2019 approximately 1400 persons died due to poorly controlled diabetes. Leaving your diabetes untreated can damage many organs and decrease the number of years of life. Some organs affected include :

Feet- Diabetes is one of the main causes of foot amputations in Trinidad and Tobago, leading to over 500 foot amputations each year. Over time high blood sugar levels can damage nerves and blood supply to feet. When nerves are damaged, you may not notice cuts/wounds on your feet. These cuts take longer to heal and your chances of getting infections are very high. Sometimes infections are difficult to control and you may need surgery to remove your foot in order to save your life. Caring for your feet and controlling your sugar levels are very important .
Heart –Poorly controlled diabetes increases your chances of getting a heart attack.
Brain – Increased risk of stroke: Having a stroke can decrease your ability to walk, talk and perform daily activities.
Eye Disease- According to the Ministry of Health, Diabetes is the main cause of adult blindness in our country. Losing your sight which can greatly impact your life at home and work.
Kidney – High sugar levels damage kidneys, over time they do not work well and toxins build up in your body.
Nerves – Nerve damage can lead to pain and tingling in hands and feet. Sometimes you may not feel anything at all.
A topic not often talked about is that Diabetes can also take a toll on your mental health. It is quite common to feel depressed, overwhelmed or anxious about managing your condition, especially when it may become a financial burden.

However, it is important to remember that you are not alone on this journey! We are here to always guide and provide the necessary support to help you successfully manage your Diabetes and effectively prevent potential complications. Therefore, it starts with you. You can do it!

What is the life expectancy of persons living with Type 2 Diabetes?

Now, you should have a better understanding of how Diabetes can negatively impact your life. Studies have shown that on average, by age 50, people with Type 2 Diabetes tend to live about 6 years less than those without the condition.

However, it has also shown that by properly managing your diabetes, you can change this! If you are overweight or obese losing and maintaining a healthy weight can add almost 3 years to your lifespan. Controlling your blood pressure, cholesterol (fat) levels and HbA1C values can also improve health and increase years of life in persons living with Type 2 Diabetes.

This means that by regularly attending check-ups, staying active and becoming informed can make a positive difference on your health in the long-term.

How do you prepare for your appointment?

Preparing for your doctor’s appointment is the first and best step in successfully understanding and managing your Diabetes. In doing so, there are important things that you should do before and during your appointment.

Before your appointment:

Keep a login a book of your blood sugar levels, medications and any symptoms or concerns you may have experienced.
Set a reminderof upcoming blood tests as well as the date of your doctor’s appointment.
Sometimes your doctor may ask you to fast from eating and drinkinganything approximately 8 hours before your blood test. This can help us to best monitor your blood sugar levels.
Write down any questionsor topics that you want to discuss with your doctor during the appointment.

During your appointment:

Inform your doctor of any persons in your family that have a history of diabetes, or any related conditions.
Bring all your medicationsthat you are currently taking, to your appointment. This can help your doctor make any necessary adjustments.
Bring the log of your blood sugar levelswhich can help your doctor understand how well your diabetes is being managed at home.
Be prepared to discuss your diet, exercise routine and other lifestyle factors that can impact the management of your diabetes.
Ensure that you understandthe next steps in your treatment plan and ask any questions on topics that you need to clarify.
Ask about follow-up appointmentsand what you should focus on until your next visit.

Conclusion

As we come to the end of our discussion, it is important to remember that while Type 2 Diabetes may not be curable, it is certainly manageable. I want you to imagine what a successful journey can look like. Picture enjoying meals with your family without constantly worrying about your blood sugar levels. Imagine waking up feeling energized and ready to engage in activities that bring you joy. Each small step i.e. a balanced diet, regular exercise and consistent check-ups, will make a positive difference to help you regain control over your health.

Many patients have expressed the delight of transforming their lives from one of feeling imprisoned by their Diabetes to fully thriving in an unbelievable way. So, as we embark on this journey together, keep in mind that managing your Type 2 Diabetes is about creating a vibrant, fulfilling life and not one where your diagnosis is all encompassing. You can absolutely achieve that level of normalcy and our job is to guide and support you along the way.

References:

Managing Type 2 Diabetes

Is Your Diabetes Control on Track?

High adherence to best practices:

Moderate adherence:

Low adherence or signs of complications: