November is National Diabetes Month, a time when communities across the country join forces to raise awareness about type 1 and type 2 diabetes. According to the Centers for Disease Control (CDC), more than 100 million U.S. adults are living with diabetes or prediabetes.

For every two people with diagnosed diabetes, there is one person who has diabetes and does not know it. Of greater concern, the prevalence of diabetes is increasing at an alarming rate, causing many health experts to label it as an epidemic. Type 1 and type 2 diabetes are different disorders although both affect blood sugar control. Type 1 diabetes involves the ability of the pancreas to secrete insulin. It often has a genetic cause and is not generally related to lifestyle.

Type 2 diabetes represents a gradual process when the body's ability to manage carbohydrates, especially glucose, becomes gradually less effective over many years. This is called insulin resistance and is often related to being overweight or being under fit. Prediabetes is the time when insulin resistance goes up and before the blood sugars are high enough to be diagnosed as diabetes.

Closer to home, the Alaska Department of Health and Social Services recently reported that diabetes is among Alaska’s leading causes of death. Its prevalence has risen from 3.8% in 2000 to 9.9% in 2018. More than 100,000 Alaskan adults have been diagnosed with diabetes or prediabetes, with more likely at risk but not yet diagnosed.  

Dr. Steiner is a family physician at  Tanana Valley Clinic and has been helping patients with diabetes for over 20 years. Below he addresses some of the most commonly asked questions about diabetes.

What is diabetes?    

Diabetes is a chronic health condition associated with abnormally high levels of sugar (glucose) in the blood. Insulin is the hormone primarily controlling blood glucose levels. An inability of the body to properly use insulin or the absence or insufficient production of insulin causes diabetes.

What is the difference between type 1 and type 2 diabetes?

Type 1 diabetes, or insulin-dependent, diabetes occurs when the pancreas produces too little or no insulin. Although type 1 diabetes usually appears during childhood or adolescence, it can also develop in adults.

Type 2 diabetes occurs when cells resist the effects of insulin – also called insulin resistance. To compensate, the body increases the secretion of insulin. At some point it can no longer keep up and then secretion drops off to the point where it may no longer be produced. You can think of it as your pancreas working as hard as it can, but eventually it gets tired and is not able to produce the insulin it needs to anymore.

About 90% have type 2 diabetes and 8% of people have type 1. Gestational diabetes, (where blood sugar increases during pregnancy), accounts for the remainder.

How do you test for diabetes? 

One common test for diabetes is called a glycated hemoglobin (A1C) blood test which measures average blood sugar for the past three months. The test does not require fasting. An A1C level of 6.5 percent or higher indicates that you have diabetes. An A1C between 5.7 and 6.4 percent indicates prediabetes. Below 5.7 percent is considered normal.

Physicians recommend getting a baseline A1C test at age 45, or sooner if you are overweight, or have one or more risk factors for prediabetes or type 2 diabetes. Risk factors include: family history of diabetes, high blood pressure, polycystic ovary syndrome, are inactive, have a history of gestational diabetes or of having heavy babies (greater than 9 pound birthweight) or are a member of certain ethnic groups (Black, Hispanic, American Indian or Asian American).

What can I do to prevent diabetes?  

Type 1 diabetes is an autoimmune disorder, and can be managed but not prevented. You can manage the disease by eating healthy, exercising and working with your doctor to identify treatment options. Insulin is the only currently available treatment of type 1 diabetes. Researchers are working to fully understand what triggers the autoimmune disease and hope to learn more about ways to prevent, treat and cure the disease.

Individuals with type 2 diabetes have options to manage or prevent their disease. Prior to developing type 2 diabetes, most people have prediabetes – their blood sugar is higher than normal but not high enough yet for a diabetes diagnosis. More than 88 million U.S. adults have prediabetes, though over 80% of them don’t know it. Lifestyle changes such as losing weight, eating a healthy well-balanced diet which is low in processed and sweetened foods, and engaging in regular, moderate physical activity may reduce the progression of type 2 diabetes by up to 70%.

What are the early signs of diabetes?

Common signs of type 1 and type 2 diabetes may include:   

• Increased thirst
• Frequent urination
• Extreme hunger
• Dry mouth
• Itchy skin
• Fatigue
• Blurred vision
• Unexplained rapid weight loss

I’ve been diagnosed with prediabetes, what does that mean?

Prediabetes is a serious health condition where blood sugar levels are higher than normal, but not high enough yet to be diagnosed as type 2 diabetes. The good news is that if you have prediabetes, lifestyle changes can help prevent or delay type 2 diabetes and other serious health problems. Since prediabetes has no clear symptoms, it’s important to talk to your health care team about getting checked if you are over the age of 45, overweight, are physically active less than 3 times a week, or have a close relative with type 2 diabetes.

If I’m diagnosed with diabetes, how will it impact my life?  

Most people with diabetes live full lives. But, diabetes is a demanding disease and can impact your life in many ways. It is important to be active in your own diabetes care and self-management. In addition to working with your medical provider, is important to involve Diabetes Educators and Dieticians.  Diabetes is an emotionally stressful disorder, and mental and emotional counseling is often very helpful.

Here are four tips for staying healthy and living well with diabetes.

	Get active. Exercise is good for your heart. It lowers your blood pressure and helps your body’s muscles use insulin more effectively. If you keep fit, you might need less medicine to control your blood sugar.
	Eat well. Eating well is another key to managing diabetes. That means eating a wide variety of foods – protein, dairy, grains, and fruits and vegetables – every day. It also means watching your portion sizes, getting enough fiber, and avoiding an overload of fat, salt, alcohol, and sugar.
	Stay vigilant. It’s important to take your medications for diabetes and any other health problems even when you feel good. You may be asked to keep track of your blood sugar. Check your feet every day for cuts, blisters, red spots, and swelling. Call your health care team right away about any sores that do not go away.
	Work with your health care team. If you have questions about diabetes or experience any of the symptoms outlined above, please contact me or your primary care provider for more information.

Dr. Charles Steiner is a board-certified physician in the Internal Medicine Department at Tanana Valley Clinic. Dr. Steiner is one of the longest serving physicians at TVC, specializes in family medicine and provides comprehensive type 1 and type 2 diabetes care and management.

EDIT 02/08/2022 - Dr. Charlie Steiner retired from Tanana Valley Clinic on 12/31/2021.