Yes, Type 2 diabetes can be difficult to cope with.
But Dr. Cathy Rolih, clinical physician executive for the Novant Health Diabetes Center of Excellence, has some good news on that front: So much of it is within your control. In this interview, she shares her insight into treating and managing diabetes, and offers hope for those who’ve gotten the diagnosis.
More than 34 million Americans have Type 2 diabetes, about 1 in 10. Certain minority groups, including Black Americans and Latinos, are also at greater risk than white Americans because of genetics and other factors. Risk also increases with age. One-quarter of people over 65 have diabetes.
Another 88 million – that’s 1 in 3 Americans – are prediabetic, meaning their blood sugar levels put them at risk for diabetes.
What do newly diagnosed patients say when they learn they have diabetes?
I’ve had patients break down in tears in my office when I tell them they have diabetes. It’s an incredibly prevalent problem. And we've heard about all the negative outcomes that can happen related to Type 2 diabetes. So, many people come to the discussion with a high degree of fear.
The first thing to do is take a deep breath. The second is to learn as much as you can from reliable sources. Don't go to “Dr. Google” and search diabetes. I refer my patients to the American Diabetes Association for both Type 1 and Type 2 diabetes and to the JDRF for Type 1 (or “juvenile”) diabetes.
But, we all Google everything. What's wrong with Googling Type 2 diabetes?
It's the same problem as Googling anything. You don't know what kind of information you're going to get. Just because it's on the internet doesn't mean it's true.
And people looking for information in a heightened state of concern may not be able to filter and critically evaluate the information they're reading. Anytime you have a new health diagnosis, you should go to the most authoritative source. Your health care provider can direct you to good ones.
Another place to find good information is a diabetes education program. People with Type 2 diabetes, in particular, should get a referral to a certified diabetes educator.
We know the best thing to do post-diagnosis. What's the worst thing you can do?
The worst thing to do is panic and take on a fatalistic attitude. I have had patients who’ve had family members with diabetes who had bad health outcomes, and who felt, when they got their diagnosis, that it doesn’t matter what they do – that this was inevitable. They just kind of threw in the towel from the beginning.
For starters, work on increasing your physical activity. Even if you're not a “jock,” any kind of physical activity can help. Just baby steps. Nothing is too small. If you’re completely sedentary, walking to the end of the block and back once a day is more than a good start.
Patients with Type 2 diabetes should find a way to lose weight. I tell that to all my patients. And I add: That's an easy thing to say and a difficult thing to do. But weight-management really is critical for controlling diabetes, and the better you control your diabetes from the beginning, the better your long-term outcome.
Finally, not everybody needs to be on medication from the beginning, but some people do. And sometimes that includes insulin. Oftentimes, for people with very high blood sugar elevation, insulin is the only choice to manage their blood sugar. And with time, changes in lifestyle and gradual weight loss, many patients can cut back or even eliminate their insulin therapy – even if they're on it immediately after diagnosis.
Can you reverse Type 2 diabetes? Or at least substantially improve your condition?
I’ve seen quite a number of patients make very significant lifestyle changes and reverse their diabetes. Two things are key: Weight reduction – not necessarily a lot, 15 or 20 pounds, depending on where the patient is in the course of their disease – and significantly decreasing carbohydrate intake.
People on very high-carb diets who drink lots of sugar-sweetened beverages and eat a lot of starchy food can have significant improvement in their diabetes control by making small changes.
What are some risk factors for Type 2 diabetes?
The first is a body mass index, or BMI, over 30. BMI is the calculated number that correlates your weight with your height. The higher the BMI, the greater the risk. People should know what their BMI is. The Centers for Disease Control and Prevention website has a BMI calculator. Find your BMI, number one.
No. 2: Know your family history. People with a first-degree relative – a parent or sibling – with Type 2 diabetes – have an increased risk of Type 2 diabetes themselves. So, they should be screened.
And three: Age is a factor. The American Diabetes Association recommends screening people after age 45. The risk of Type 2 diabetes increases with age.
Is there a specific test for Type 2 diabetes?
The most accessible and easiest test is the hemoglobin A1C test. It tells you whether you have no blood sugar elevation or if you’re in the in-between zone, which is called pre-diabetes. It doesn’t have to be done fasting; you can do it any time of day. And it tells you what your average blood sugar has been for the last three months. Ask your healthcare provider to draw hemoglobin A1C level if you are in a high-risk group.
The prevalence of diabetes is higher among African Americans and people of Hispanic background. So, if you have a high BMI and you're African American, Native American or Hispanic, you're also in a higher risk category and should be screened.
What are the dangers of not taking this seriously?
While you can ignore diabetes in the short run, you can't ignore it in the long run. Diabetes that goes unaddressed will result in complications.
You may not feel bad when your blood sugar is only a little or even moderately elevated. But elevated blood sugar that goes on for years has negative effects on the body – potential damage to the eyes, which may result in blindness. Add damage to the nerves, particularly in the legs, which can result in loss of sensation. That, in turn, results in not being able to tell if you have an injury or an infection, and that can result in the need for lower extremity amputation.
Diabetes has a negative effect on the kidneys. And decline of kidney function, over time, can result in kidney failure. And then people end up on dialysis. People who have diabetes also have an increased risk of heart attack and stroke.
Can you think of a patient you thought wasn't going to be able to make the turnaround and then surprised you?
Boy, I have loads of them. Many times, patients who make really big turnarounds have a life event that wakes them up. Sometimes it's a health scare with a family member or friend. Other patients may have children they want to see graduate from college or get married.
The people who’ve made big changes are the ones who've been willing to start small. It's difficult in any habit to go from zero to 60 in the space of a couple of days or weeks. Don't be discouraged.
Any thoughts for people who know somebody with Type 2 diabetes who are not making changes?
I think you can say: I'm concerned about you. I see you're struggling. I'm here to support you.
Patients have told me they’ve been criticized by health care providers, by friends and family, and they feel defeated. Let your friends and family know you're there for them, that you’ll help them work on small things so that they'll have big things happen in the future.
Finally, what's the biggest misconception about Type 2 diabetes?
That the cause is eating too many sweets. It's a genetically determined disease. Type 2 diabetes comes from your genetic predisposition, your weight, your physical activity level and your diet. So just cutting back on sweets won't necessarily eliminate diabetes, although it’s an important part of managing it.
