Marina Litvin, MD, is a Washington University endocrinologist at Barnes-Jewish West County Hospital who focuses on treating patients with endocrine disorders including diabetes. She shares what people can do to help prevent or control diabetes.
Type 2 diabetes is a very common disease, characterized by elevated blood sugars, known as hyperglycemia, resistance to insulin, and the body’s inability to secrete a sufficient amount of insulin to overcome the body’s insulin resistance.
According to 2010 estimates from the Centers for Disease Control and Prevention, about 2 million people in the United States are diagnosed with diabetes each year. Almost 26 million people have the disease and about another seven million people are undiagnosed. Diabetes is the leading cause of non-traumatic lower extremity amputations, new blindness and end-stage kidney disease requiring dialysis. Diabetic patients also suffer from higher rates of heart disease and death from heart disease. Diabetic patients experience more hospitalizations with longer hospital stays, and also show higher rates of depression, especially in the elderly.
By controlling hyperglycemia in diabetics, we hope to minimize the potential complications of retinopathy (eye problems); neuropathy (damage to the nerves usually occurring in the legs and feet); kidney disease; and stroke and heart attack, which can all be devastating. There are multiple treatment options, such as lifestyle modification with healthy nutrition, which includes a diet limited in carbohydrates, fat and calories; regular exercise, medications that can be taken orally or by injection, and insulin.
Certain individuals are at higher risk for Type 2 diabetes including patients with elevated blood glucose levels detected on common screening tools, such as impaired fasting glucose (IFG), usually drawn after an overnight fast; impaired glucose tolerance (IGT), an elevated blood glucose measured two hours after consuming a sugary drink; and/or an elevated hemoglobin A1C, a three month average blood sugar extrapolated from the glucose on red blood cells. Other groups at increased risk include those with a family history of diabetes, those who are overweight, those with a sedentary lifestyle, those who have a history of gestational diabetes (diabetes in pregnancy), and certain ethnic groups, including people of Asian, Hispanic, African American and Native American ethnicities.
Lifestyle changes that can also decrease the risk of diabetes include weight loss, adding moderate-intensity exercise based on a physician’s recommendation and smoking cessation. Patients with a prior history of elevated blood sugars, or those with pre-diabetes, should have at least an annual follow-up. Medications may also be effective in decreasing the risk of progression to diabetes in very specific cases.
Patients should work closely with their diabetes physician specialists, educators and dietitians to help manage their disease, and monitor their blood sugars. Recommended frequency of blood sugar checks varies depending on the severity of diabetes. In mild diabetes treated with diet and/or oral medications, a patient may monitor their blood sugar once a day, at different times of the day. Patients treated with intensive insulin therapy and multiple daily injections will check their blood sugars more frequently. In between physician visits, patients should keep an updated blood sugar log to help fine tune their diabetes regimen. Patients should also be monitored regularly for complications of diabetes with regular eye exams, foot exams, blood pressure and cholesterol monitoring and control.
To schedule an appointment with Dr. Litvin at Barnes-Jewish West County Hospital, call 314.542.WEST (9378).