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Diagnosed with diabetes

Fifty-six year old Jim Dieter was diagnosed with diabetes after a blood glucose test revealed his blood sugar levels were dangerously high. To help manage his illness, Dieter has started to eat healthy, manage his portion sizes and regularly test his blood sugar levels. According to the American Diabetes Association, nearly 26 million children and adults in the United States have diabetes. Another 79 million Americans have prediabetes and are at risk for developing type 2 diabetes.

MORRIS – Last February, Jim Dieter started to lose weight. It was just a pound or two a week, and since his family was eating better anyway he figured it was normal.

Five months later, Dieter, age 56, had lost 40 pounds without really trying. He also felt thirsty all the time, and was making frequent trips to the bathroom, changes he couldn’t really explain.

About that time, Dieter saw an advertisement for Men’s Health Night, a community health event at Stevens Community Medical Center, in the newspaper. Since he didn’t have horseshoes that particular Tuesday evening, he decided to go – he hadn’t been to the doctor for awhile and he was starting to get concerned.

“I’d done enough research online to know that there were a couple of things that could be wrong with me – one of them was diabetes,” said Dieter. “I figured this would be a very inexpensive, easy way to find out if I had any of the other symptoms.”

After a standard blood glucose test revealed that Dieter’s blood sugar level was dangerously high, Dr. Greg Abler, a physician participating in the event, checked him into the emergency room.

“They said I should be unconscious on the floor,” Dieter said.

With a diagnosis of type 2 diabetes, Dieter joined the approximately 25.8 million Americans who have diabetes.

Age, genes and weight

There are two types of diabetes. Type 1 diabetes usually appears in juveniles or young adults, and occurs when the pancreas no longer makes insulin.

Type 2 diabetes, on the other hand, is more common in adults and older adults.

According to the American Diabetes Foundation, about 18.8 million American have been diagnosed with diabetes, while another 7 million remain undiagnosed for the disease.

“This is a little bit of an overstatement, but probably everybody who walks the earth has a propensity to develop type 2 diabetes,” said Abler.

An individual’s likelihood of developing type 2 diabetes is affected primarily by age, genes and weight. Older adults and those with a family history of the illness have a higher chance of developing diabetes. And overweight adults, no matter how young, are at risk for developing type 2 diabetes too.

“The only thing you can really do to help prevent it is try and keep your weight down, but even with that said, there’s a lot of people that are quite thin that get type 2 diabetes, so it’s not a guarantee,” said Abler.

One common misconception is that type 2 diabetes is caused by eating a lot of sugar or junk food. The problem isn’t necessarily the type of food, but that people eat too many calories and gain weight, said Abler.

“If you take somebody and you had them lose weight but just eat like 1,000 calories of Snickers bars a day, you’re probably not going to get diabetes because you’re losing weight,” said Abler. “Whatever you do, if you lose weight with diet, less calories, then you’re less likely to develop type 2 diabetes – that’s even eating a strict carbohydrate diet.”

Making a diagnosis

Type 2 diabetes can appear in two different ways. In some cases, like Dieter’s, symptoms come on quickly, over the course of just a few months. In those situations, patients will usually experience weight loss, increased urination, blurred vision, and increased hunger and thirst, Abler said.

“It’s an easier case to diagnose because it’s not a subtlety,” said Abler.

When Dieter was finally diagnosed, his blood glucose level had reached nearly 700, a condition known as diabetic hyperosmolar syndrome. A normal blood glucose level ranges from between 70 and 180, depending on how recently the individual has eaten.

According to the Mayo Clinic, when blood sugar levels top 600, a patient’s blood becomes “thick and syrupy.” Filtering the sugar out draws fluid from the body, which can eventually lead to life-threatening dehydration or a coma.

But in most cases, diabetes appears more slowly and patients may not experience any alarming symptoms, said Abler.

“There are a lot of people out in the public that don’t know they have diabetes,” said Abler.

Abler said it’s important for older patients or individuals with a strong family history of type 2 diabetes, the threshold for going to a doctor for a glucose test should be lower.

There are three thresholds to test for diabetes in a clinic: two fasting blood sugar tests of 126 or higher, one random blood sugar test of 200 more with symptoms, or a glucose tolerance test.

“It’s not expensive to make the diagnosis,” said Abler.

Managing diabetes

Since he was diagnosed, Dieter has used a combination of medication and healthy eating to bring his blood sugar down and manage his illness.

Initially, Abler prescribed insulin injections to help bring his blood sugar levels back into a normal range. However, insulin injections aren’t often a good long-term solution for type 2 diabetics because patients don’t like to give themselves injections and insulin can sometimes cause patients to gain weight – one of the risk factors for diabetes in the first place.

Instead, there are several different types of drugs that are commonly used to treat type 2 diabetes. These drugs can lower blood glucose levels by helping the body produce more insulin, decreasing the amount of glucose produced by the liver, blocking the breakdown of starches, or helping insulin be used more efficiently. There are some risk to medications, including hypoglycemia (low blood sugar) or interactions with other drugs.

Dieter, however, said he wanted to try and manage his diabetes naturally before relying on drugs. Although type 2 diabetes is not caused by eating junk food, healthful eating and exercise can help keep blood glucose levels in a healthy range after a diabetes diagnosis.

“From the very beginning, my thought was let's control the diabetes and then we’ll figure out the rest of it later,” said Dieter. “I didn’t like the concept of taking massive quantities of drugs to cure everything that ails me when the diabetes is the center of everything.”

Dieter met with Susie Eklund, his “diabetes guru,” and nutritionist Donna Anderson at SCMC to come up with a plan to manage his blood sugar.

“They really got me on the right track,” said Dieter. 

Today, Dieter has started to eat healthier, in smaller quantities, and with the aid of computer software, tracks everything he eats each day.   The program tells him the nutrition content of what he’s eating to help him make healthy decisions. This includes reading labels to know what the serving size is for each food.  He checks his blood sugar regularly and logs that information too. Since he brought his blood glucose below 180, he said it has never spiked again.

After a type 2 diabetes diagnosis, it’s important to keep both blood pressure and cholesterol under control, Abler said. Diabetics are at higher risk for kidney disease, heart disease, strokes and problems with their eyes and feet.

“A lot of type 2 diabetics can have a fairly healthy, normal, long life,” said Abler. “It is a little bit labor intensive – it’s not easy. It does require a little bit more work. You have to be a little bit compulsive.”