Sinai Health Magazine

Fall 2019 | The Changing Face of Diabetes

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Dina Reiss

Diabetes 101

Dr. Dina Reiss is an endocrinologist at Sinai Health’s Bridgepoint Active Healthcare. She completed her residency training in internal medicine at Massachusetts General Hospital/Harvard Medical School, and a fellowship in endocrinology and metabolism at the University of Toronto.

Q: What is diabetes, and what causes it?

DR: There are two different types of diabetes, with type 2 diabetes making up about 90 per cent of cases. Type 2 diabetes is a disease of insulin resistance. Your body is still producing insulin, but you’re not producing enough for your body’s needs. This can cause high blood sugar levels in the body, which leads to further complications.

Type 1 diabetes is less common. This is a disease in which your body is not producing any insulin at all. It’s usually an autoimmune disease that develops when your body destroys the beta cells of the pancreas that produce insulin. Less frequently, it can also occur after a patient has had their pancreas surgically removed (for example, for the treatment of cancer). Patients often get it when they’re younger, but latent autoimmune diabetes in adults can occur as well.

Q: What is pre-diabetes?

DR: Pre-diabetes is a pre-diagnosis of diabetes. It means that your blood sugar levels are a bit above normal but they are not high enough to be considered type 2 diabetes. A pre-diabetes diagnosis is a good opportunity for intervention, especially in younger patients. It’s a chance to say, “Hey, if I don’t do something about this now, I’ll have full-blown diabetes.”

For example, you might want to start thinking about lifestyle changes, such as changing your diet or increasing your physical activity. Occasionally, this condition is treated with medication such as metformin, which reduces insulin resistance, to help prevent getting diabetes in the future.

Q: What are the risk factors for diabetes?

DR: For type 2 diabetes, the risk factors include obesity; metabolic syndrome (which is a constellation of traits such as abdominal obesity, high cholesterol and high blood pressure); certain medications such as steroids; physical inactivity; older age; and having a strong family history of the disease. The older you are, the more likely you are to get it. Your ethnic background is also a factor: being of African, Arab, East Asian, Hispanic, Indigenous or South Asian descent can increase your risk of developing type 2 diabetes. A sedentary lifestyle and unhealthy eating habits are also risk factors.

For type 1 diabetes, meanwhile, the biggest risk factor is genetics. Having a first-degree relative such as a sibling or parent with it can increase your risk. Type 1 can also occur in patients who’ve had pancreatic surgery or other injuries to the pancreas.

Q: How do I know if I have diabetes? What symptoms should I watch for?

Some of the symptoms include sweet-smelling urine alongside increased urination and thirst; weakness; blurry vision; numbness; tingling or pain in the lower extremities; rapid, unexplained weight loss for example, several pounds over a few weeks.

Q: How do I know if I have diabetes? What symptoms should I watch for?

DR: Some of the symptoms include sweet-smelling urine alongside increased urination and thirst; weakness; blurry vision; numbness; tingling or pain in the lower extremities; and rapid, unexplained weight loss — for example, several pounds over a few weeks.

Q; How is diabetes diagnosed?

DR: Diabetes can be diagnosed through a simple blood test at most doctors’ offices. There’s also an oral glucose tolerance test where a patient has to drink a sugary liquid and their blood glucose level is measured a few hours later.

Q: What kind of treatment options do I have?

DR: Treatment really depends on the individual. Patients who have type 1 diabetes absolutely have to be on insulin. Some patients who have type 2 do not require insulin at all; it can often be well-managed by diet alone or medications, like metformin, that help to lower blood glucose levels. I have had many type 2 patients make positive lifestyle choices that helped them lose weight and reduce or even eliminate the need for pills or insulin therapy.

For type 2 diabetes patients who do need insulin, there are different types of insulin regimens available, ranging from a once-daily basal insulin regimen to multiple daily injections. Type 1 diabetes patients tend to require multiple daily injections or an insulin pump.

Q: How would I take insulin? Is there a pill?

DR: Unfortunately, there is no insulin pill at this time. Insulin is only available through injection or via an insulin pump.

Patients with type 1 diabetes have a choice of using a pump or injecting insulin directly. The pump is a small computerized device, worn outside the body, that delivers small doses of short-acting insulin continuously. Patients need to know how to manage the pump and give themselves a bolus infusion (an additional dose of rapid- acting insulin) when they’re having a meal or snack. The pump is not a perfect pancreas, of course, but it eliminates the need for patients to inject themselves three or four times a day.

Some patients don’t like the idea of wearing a pump. They’d rather have the freedom of living without it, even if that means injecting insulin themselves. It’s a very personal choice.

Q: If I manage my disease carefully, am I still at risk of complications??

DR: If you manage your diabetes well, you are much less likely to be affected by the associated complications, such as heart disease, stroke, kidney disease and diabetic eye disease. Some patients are able to control their diabetes so well, their sugars are nearly or actually normal, and their risk factors are equal to someone without diabetes. However, it’s important to note that even mild elevations in blood sugar can increase your risk of microvascular complications, including nerve, eye and kidney problems.

Q: How can I change my diet to manage my diabetes?

DR: To manage diabetes, I tend to refer my patients to a registered dietitian with the direction to try and eat foods with lower-glycemic loads or a lower-glycemic index. You want to stay away from high-glycemic-index foods such as white bread, chips, junk food, soda and fast foods. Sodium content is also important. I tend to recommend less than two grams of sodium a day, especially for patients with hypertension.

Instead, you want to eat complex carbs, organic proteins like chicken and fish and foods high in omega-3s, such as salmon. Try to increase the fruits and vegetables in your diet. A good rule of thumb is that your dinner plate should be half vegetables or salad, a quarter carbohydrates, like rice or potatoes, and a quarter (preferably lean) protein.

If you’re trying to lose weight to better manage your diabetes, the easiest way to do that is by cutting calories, and paying attention to the overall caloric content of the food you eat. To lose weight most patients should consider eating between 1,500 and 1,800 calories a day, under the guidance of a registered dietitian or physician.

Often patients struggle to adhere to a new diet for the long term. Make sure you work with your dietitian or doctor to choose a dietary pattern that aligns with your values and treatment goals, so you can stick with it in the future.

Illustration by: Amy Wetton