DIABETES: Dealing With the Diagnosis
Learn how to cope with this all-too-common disease
Tests After DiagnosisA fourth test, the glycosylated hemoglobin test, is generally used to monitor diabetes after a diagnosis has been made.
Glycosylated hemoglobin testAnother measurement widely used in diabetes management is the glycosylated hemoglobin test. This blood test reflects the average blood sugar level over the preceding two to three months and will help your doctor monitor your efforts to keep your blood sugar as close to normal as possible. Because having food or a drink before the test won't skew the results, a glycosylated hemoglobin test can be performed at any time of day, even after a meal. Hemoglobin is the oxygen-carrying protein in red blood cells. When glucose in the blood attaches to hemoglobin, the bound product is called HbA1c. (It's also known as glycosylated hemoglobin, glycated hemoglobin, or glycohemoglobin.) Healthy, nondiabetic people usually have an HbA1c level of about 5%, meaning that approximately 5% of their hemoglobin molecules have glucose attached to them. If your diabetes has been well controlled during the previous two to three months, the HbA1c level should be close to normal, that is, less than 7%. If your blood sugar has been high, the level will be elevated. Studies have shown that keeping HbA1c levels low reduces the chances of developing complications of diabetes. It is therefore wise to keep HbA1c levels as close to the nondiabetic range as is safely possible. The American Diabetes Association advises people with the disease to strive for an HbA1c level of 7% or less.
Not quite diabetesSome tests can also uncover lesser degrees of abnormal glucose metabolism, which may eventually develop into full-blown diabetes. A fasting plasma glucose reading between 100 mg/dL and 126 mg/dL indicates impaired fasting glucose. If this is the case and an oral glucose tolerance test is performed, a two-hour glucose result between 140 mg/dL and 200 mg/dL is considered impaired glucose tolerance. Both conditions raise your risk for diabetes and cardiovascular disease. To monitor these conditions, it's best to have annual glucose tests.
Decreasing Your Diabetes RisksThere's much you can do to reduce that risk. While it's true that you can't change your genetic makeup, it is possible to significantly change your lifestyle, which works to reduce risk. For example, if you have high triglycerides or high blood pressure, or if you're overweight, eating healthier can help. If you don't get much exercise, taking a walk just three times a week can also reduce your risk. Major diabetes risk factors include:
—Being 45 or older.
—Being African American, American Indian, Asian American, Pacific Islander, or Hispanic American.
—Having a parent or sibling with type 2 diabetes.
—Having a history of gestational diabetes.
—Giving birth to a baby that weighed more than 9 pounds.
—Having high blood pressure (140/90 or higher).
—Having an HDL (good cholesterol) level lower than 35.
—Having high triglycerides (250 or higher).
—Being inactive, or exercising fewer than three times a week.
What Causes Type 2 Diabetes?Predominantly a disease of later life, type 2 diabetes generally develops after age 40. Blood sugar levels usually rise slowly and progressively over the years before they become high enough to be considered in the diabetic range. Two conditions, impaired glucose tolerance and impaired fasting glucose, often precede type 2 diabetes, and for this reason are known collectively as pre-diabetes. In both types of pre-diabetes, blood sugar levels are above normal, but not high enough to be considered clinical diabetes. A conservative estimate is that more than 20 million U.S. adults have pre-diabetes and, therefore, are much more prone to developing type 2 diabetes. Like people with type 2 diabetes, those with pre-diabetes tend to be overweight, have high blood pressure and abnormal lipid levels, and have a higher risk for cardiovascular disease. Type 2 diabetes and its underlying causes, insulin resistance and defective insulin secretion, probably have a genetic basis. But in most cases, environmental factors also play a major role. For example, before the 20th century, diabetes was virtually unknown to Native Americans. But as hunting or farming gave way to a sedentary lifestyle, higher-fat diets, and obesity, diabetes became rampant. People from many other cultures have had similar experiences after adopting "Western" habits. Thus, in people who are genetically susceptible, the influences of older age, increasing obesity, and a sedentary lifestyle all unmask the tendency to develop diabetes. The distribution of body fat also seems to be particularly important. People who tend to store fat in their abdominal area rather than their hips — so-called central obesity — are more likely to become diabetic.
10 Ways to Stay Healthy
Originally published in Diabetic Living magazine, Spring 2007
—Being active and carefully managing your blood glucose lets you lead a long, healthy life. Do your best to:
—Eat regular, well-balanced meals.
—Stay physically active.
—Have routine checkups.
—Make time to do the things you enjoy.
—Talk to your doctor if you're lonely or depressed.
—Take your medications as prescribed.
—Drink plenty of fluids.
—Look after your appearance to feel good about yourself.
—Monitor your blood glucose and evaluate the results
—Get enough sleep. Being active and carefully managing your blood glucose lets you lead a long, healthy life.
From the Harvard Health Publications Special Health Report, Diabetes: A Plan for Living. Copyright 2004 by the President and Fellows of Harvard College. Illustrations by Susan Avishai and Marcia Williams. All rights reserved. Written permission is required to reproduce, in any manner, in whole or in part, the material contained herein. To make a reprint request, contact Harvard Health Publications.