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There's No Sugarcoating the Problems of Type 2 Diabetes

High blood sugar can have serious health consequences. But it's one health condition you have the power to prevent or possibly reverse.


We've long been warned of the dangers of too much sugar. The United States Department of Agriculture dietary guidelines have recommended limiting sugar since 1979 — well before the plate, pyramid or even the food wheel made an appearance.

We're not as aware of the dangers of high blood sugar, a problem that one-third of the American adult population has, most without any knowledge of their condition. But much like the sugar in your diet, the level of sugar in your blood is completely under your control.

High blood sugar means you’re at risk for diabetes – or you already have it.

Diabetes is a commonly known condition, of which type 2 diabetes is the most common. Because of the increased levels of sugar in your blood, your cells stop responding normally to insulin. The sugar stays in the blood instead of reaching your cells and converting into energy.

“As you get older, you are more at risk for diabetes,” said Dr. Samuel Gastineau, Family Medicine provider at The Iowa Clinic. “According to the CDC, 45% of people above age 65 have prediabetes, and 29% above age 65 have diabetes.”

Commonly, one thinks of type 1 diabetes as needing insulin and type 2 diabetes as using medications to control your blood sugars without insulin. However, as time goes on, those with type 2 diabetes can become dependent on daily insulin, along with the pokes and testing that comes with insulin use. With type 2 diabetes, the pancreas produces more and more insulin, trying to keep up with demands from elevated blood sugar, which leads to the pancreas becoming damaged over time.

According to the 2020 National Diabetes Report by the CDC, an estimated 88 million adults aged 18 years or older had prediabetes in 2018. Prediabetes usually shows no symptoms, hiding the serious condition from a third of Iowans. You usually don't know you have prediabetes until it progresses, and you notice the signs of type 2 diabetes:

  • You pee a lot, especially at night.
  • You're always hungry, thirsty, and tired.
  • You can lose weight without even trying.
  • You're prone to infections.
  • Sores and bruises don't heal as quickly as they used to.
  • Your skin is dry.
  • Your vision is a little blurry.
  • Your hands and feet are numb and tingly.
  • You experience erectile dysfunction.

These symptoms develop slowly, sometimes over years. So, your high blood sugar can wreak havoc on your body without you realizing, quietly doubling your risk of heart disease and stroke. It can also put you in danger of nerve, eye or kidney damage, serious infections that require amputation, hearing impairment and Alzheimer's disease.

Eating too much sugar is not the cause of high blood sugar.

It sounds simple. A diet high in sugar leads to blood high in glucose. There is a connection, but the causes of type 2 diabetes are more complex.

Eating a lot of sugar is a sign of a poor diet. And poor nutrition can make you overweight or obese. The additional pounds and continued sugar consumption make it more difficult for your body to regulate your blood sugar and leads to insulin resistance. As a result, your pancreas produces insulin, but the muscle, liver and fat cells can no longer absorb it and convert it to energy properly.

In addition to weight and insulin resistance, you have a higher risk of type 2 diabetes if:

  • You're over 45.
  • You already have high blood sugar at prediabetes levels.
  • Your mom, dad, brother, or sister has type 2 diabetes.
  • You live a sedentary lifestyle, exercising less than three times a week.
  • You had gestational diabetes during pregnancy, or your mother had it when you were born.
  • One of your children weighed more than nine pounds at birth.
  • You're African American, Hispanic, Native American, or Alaska Native.

Your age, genetics and heritage are out of your control. But things you can control, like your eating and exercise habits, are proven to prevent type 2 diabetes.

Both prevention and treatment of type 2 diabetes are in your hands.

So you check a few boxes on the list of risk factors. That doesn't mean you're destined to get type 2 diabetes. It's a highly preventable disease. Even if you're already prediabetic, you can reverse that and return your blood sugar to normal levels.

“This damage occurs over many years and is why we focus on encouraging patients to make lifestyle changes to their diet and activity level,” said Dr. Gastineau. “Only about 24% of those with diabetes are meeting their goal of 150 minutes of physical activity a week – this is something we aim to improve.”

In fact, exercising can have some of the best effects in maintaining blood sugar. Exercise increases the amount of blood sugar that your muscles uptake, independent of insulin, which helps control your blood sugar levels despite insulin resistance.

You don't have to take extreme measures to do so. Losing five to seven percent of your body fat can make a big difference. You can shed that excess fat with relatively simple changes to your lifestyle:

  • Eat a balanced diet. Follow the USDA guidelines and eat a diet high in fruits, vegetables, protein and whole grains, and low in sugar and fat. Limiting sugary snacks and processed carbs, and increasing healthier, time intensive foods last longer and is more easily stored.
  • Reduce portion sizes. Eat smaller portions of healthy foods to stay at or below the daily recommended amount of calories. Check the USDA calorie needs for your age, sex and physical activity level.
  • Get out and move. A sedentary lifestyle is a big factor in obesity and type 2 diabetes. Aim for at least 30 minutes of physical activity five days a week. To lose weight and keep it off, up to 60 minutes a day is recommended.
  • Take your time. Quick diets and intense fitness programs can help you shed pounds. But you risk injury or gaining back weight after the program's end. For sustained success, make gradual changes to your diet and slowly build up your activity and intensity.

“Individuals with prediabetes are likely to progress to diabetes unless lifestyle changes occur,” Dr. Gastineau said. “This is why there is a focus on finding those with prediabetes and encouraging and helping them change their diet and exercise levels so we can prevent progression to diabetes.”

Over 11 percent of adults in Iowa have diabetes, a number that trends with the national average. An even greater number — 35.4 percent — have prediabetes, meaning their blood sugar levels are higher than normal but not high enough to be diagnosed as diabetes.

If you do get a diagnosis of type 2 diabetes, the same techniques can help you lose weight and reduce blood glucose levels. Your primary care provider can help you develop a plan to manage your weight and condition. It's possible to manage type 2 diabetes with lifestyle changes alone. Your provider may also recommend additional treatments:

  • Blood glucose monitoring – Keeping a watchful eye on your blood sugar is the only way to make sure it is within the target range.
  • Insulin therapy – When type 2 diabetes affects your body's production of insulin, you have to ease the pressure on the pancreas by regularly injecting yourself with insulin and regulate your blood sugar.
  • Medication – Many medications help manage your disease and symptoms. Depending on your condition and other health issues, you may get medicine that lowers glucose production, increase insulin secretion or reduce blood sugar levels.

Test your blood sugar to see if you have diabetes or prediabetes.

Everyone's risk factors are different. But if you live in Iowa, statistics show you have a 1 in 3 chance of having high blood sugar. If you think you're at risk or you've noticed symptoms of type 2 diabetes, talk to your doctor about testing.

The A1C test is used to diagnose type 2 diabetes. It measures how much sugar is covering the hemoglobin in your blood and indicates your average blood sugar level over the last few months.

  • Normal: Less than 5.7%
  • Prediabetes: Between 5.7% and 6.4%
  • Type 2 diabetes: 6.5% or higher

With the results of an A1C test and the recognition of symptoms or confirmation by additional testing, your provider can make a diagnosis and develop a treatment plan that helps you normalize your blood sugar.

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