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ABCs of cardiovascular disease prevention: 'D' is for diabetes

Diabetes is a condition characterized by blood sugar that is too high. After we eat a meal, insulin is released from our pancreas to try to bring blood sugar down.

DENVER — As we continue to countdown to the 9Health Fair at the end of the month, which is only about four weeks away, we come back to our ABCs of Cardiovascular Disease Prevention.  

Last week, we talked about C for Cholesterol and today 9Health Expert Dr. Payal Kohli explains the “D”.

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What does the “D” stand for?

Kohli: “D” stands for two things – first is diet and second is diabetes.  We will talk about diet another day because there is a lot to talk about there but today we will focus on diabetes.  

Diabetes is a condition characterized by blood sugar that is too high.  After we eat a meal, insulin is released from our pancreas to try to bring our blood sugar down. When we have Type I diabetes, the pancreas is making too little to no insulin at all so you have to take insulin injections to replace the function of the pancreas.  With Type II diabetes, your level or function of insulin is not adequate to bring down your blood sugar enough.  So, over time, the pancreas makes more and more insulin (“works overtime”) to try to keep the blood sugar normal and eventually the pancreas can “burn out” and insulin production can drop, like in Type I Diabetes.  If this happens, then Type II diabetics may have to take insulin in addition to oral diabetes medications.

What are the risks of having diabetes?

Kohli: Because diabetes causes an increase in blood sugar, this excess sugar in the bloodstream can damage the walls of the arteries, which can cause cholesterol to stick.  Diabetes is said to cause “accelerated vascular aging” or increase the rate at which our blood vessels age because of the toxic effects of the excess sugar.  Diabetes can also affect other organs, causing complications such as nephropathy (kidney dysfunction), neuropathy (nerve dysfunction), retinopathy (changes in the retina) and increased risk of infections. So, keeping our blood sugar close to the “normal” range, using oral medications and/or insulin, is important to prevent these complications of diabetes.

What are the risk factors for diabetes?

Kohli: Many of the risk factors for diabetes are similar to the other risk factors for cardiovascular disease.  Older age, physical inactivity, family history of diabetes, certain races and obesity are all risk factors for developing diabetes.

How do we know if we have diabetes?

Kohli: With Type I diabetes, symptoms can develop quickly, over a few weeks and are symptoms of increased blood sugar, such as increased thirst, increased urination, blurry vision and weight loss.  With Type II diabetes, symptom onset is much slower and can take several years to occur and likely will not even be noticeable.  So, doing screening bloodwork and checking for diabetes is one of the best ways to know your risk. 

A fasting blood sugar of >126 mg/dl is considered abnormal.  However, a single sugar is just a snapshot in time.  A blood test called Hemoglobin A1c (HbA1c) tells us what our average sugar has been for the past ~3 months.  If your HbA1c is <5.7%, it is considered “normal”.  If your HbA1c is 5.7-6.4%, you are called “pre-diabetic” which means that your average blood sugar is starting to creep up but has not yet crossed the threshold for being diabetic. When your HbA1c is 6.5% or greater, you are said to be a diabetic and your doctor will likely recommend an oral medication called metformin.  But, remember that this is a spectrum of risk.  So, there is nothing magical about the threshold of 6.5%.  Your risk for the disease increases even if you are pre-diabetic so it is important to modify your risk factors and change your lifestyle habits so you can reverse your pre-diabetes and prevent it from progressing to diabetes.

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