More Specialized Diabetes Diagnoses Require More Specialized Care

Posted: November 04, 2019
Categories: Healthy Living
hero woman with doctor

Most people have heard of diabetes, but when you hear this word as a diagnosis, your attention to detail surrounding this disease may change.

What is diabetes? How will it affect my health? My life?

The truth is that more than 30 million people in the United States have diabetes, and one in four are undiagnosed. In addition, more than 84 million U.S. adults have prediabetes, and 90% don’t know they have it.

With such staggering numbers, we’re here to guide you through learning about the different types of diabetes (the diabetes spectrum), how each affects the body and how specialized medical providers can help you manage your condition.

Linda Cohen, ARNP, AdventHealth Medical Group nurse practitioner who is board certified in advanced diabetes management, a certified insulin pump trainer and specialist in continuous glucose monitoring devices, shares her insights into how to feel empowered and thrive with a diabetes diagnosis.

 

Types of Diabetes

“Our knowledge about diabetes has grown, which has led to a broader diabetes spectrum and more specialized treatments,” says Cohen.

Let’s take a closer look at the types of diabetes that make up the spectrum.

 

Type 1 Diabetes

If you have type 1 diabetes, your pancreas doesn’t produce the insulin your body needs to get glucose (sugar) from your bloodstream into your body’s cells. The treatment requires insulin therapy and close monitoring of your diet and glucose levels.

Slow-acting insulin (basal) may be prescribed to help regulate your glucose levels between meals and fast-acting insulin (bolus) to regulate your glucose levels after meals. 

Type 1 diabetes can affect children and adults. You may be at an increased risk for type 1 diabetes if you have a family history of the disease.

Symptoms can be severe and life threatening, and may include: 

  • Bed-wetting in children who’ve never wet the bed before
  • Blurred vision
  • Excessive thirst
  • Extreme hunger
  • Frequent urination
  • Mood changes and irritability
  • Unintended weight loss
  • Weakness and fatigue

Cohen advises, “It’s very important to talk to your primary care provider if you or your child have any of these symptoms because type 1 diabetes can come on suddenly and be severe if not treated promptly and properly.”

 

Type 2 Diabetes

Type 2 diabetes accounts for the majority of people on the diabetes spectrum and means your body is insulin resistant or your pancreas is not making enough insulin to control your blood sugars.

With insulin resistance your pancreas might make insulin, but your cells don’t respond properly. One of the signs of insulin resistance is acanthosis nigricans where pigmentation of your skin is brown or darkened over the back of your neck, elbows or knuckles.

In type 2 diabetes, your pancreas increases insulin production trying to force your cells to work, but ultimately, blood sugar levels remain high. Over time, this can lead to very serious complications.

Your diabetes care team will work closely with you to help you best manage your condition. This can include:

  • Prescription medications (including slow- and fast-acting insulin)
  • A glucose monitor and test strips
  • A plan to achieve and maintain a healthy weight
  • Education on a healthy diabetes meal plan
  • Routine check-ups and lab tests

You may be at risk for type 2 diabetes if you: 

  • Are African American, Hispanic /Latino American, American Indian, Alaska Native
  • Are over age 45
  • Are overweight
  • Don’t get enough physical activity
  • Have a parent, sister or brother with diabetes type 2
  • Have been diagnosed as having pre-diabetes
  • Have had gestational diabetes

Common symptoms include blurry vision, dry mouth, extreme thirst and hunger, fatigue, frequent urination, headaches and unexplained weight loss.

 

Gestational Diabetes 

Pregnancy may cause you to become insulin resistant, resulting in high sugar levels. Approximately 2 to 10% of pregnancies in the United States are affected by gestational diabetes, but since gestational diabetes doesn’t commonly have any symptoms, testing for it is a routine part of your prenatal care.

It usually happens during weeks 24 to 28 of pregnancy, but your obstetrician may test you sooner if they think you’re at increased risk. 

You may be at risk for gestational diabetes if you: 

  • Are African American, Hispanic /Latino American, American Indian, Alaska Native, Native Hawaiian or Pacific Islander
  • Are older than 25
  • Are overweight
  • Gave birth to a baby weighing over 9 pounds
  • Had gestational diabetes with a previous pregnancy
  • Have polycystic ovary syndrome

Management of gestational diabetes involves following your treatment plan and any diet modifications prescribed by your obstetrician. This may include checking your blood sugar, eating healthy meals created by your obstetrician or dietitian, staying active within your doctor’s guidelines, and having your baby’s growth and development checked at prenatal examinations.

Luckily for most women, the risk of having diabetes right after childbirth is low, however, 50% of women with gestational diabetes go on to develop type 2 diabetes later on in life. It is recommended that those women have lifelong screening every three years.

 

MODY (Maturity-Onset Diabetes of the Young)

This is frequently characterized by onset of hyperglycemia (high blood sugar) at an early age, usually before age 25 years, although diagnosis may occur at older ages. MODY is characterized by impaired insulin secretion with minimal or no defects in insulin action. The three most common forms of MODY that have been identified are (MODY 1) HNF4A-MODY, (MODY 2) GCK-MODY, (MODY 3) HNF1A-MODY.

Those with GCK-MODY experience mild, stable, fasting hyperglycemia and do not require diabetes medications except during pregnancy. Those with HNF1A or HNF4A usually respond well to low doses of sulfonylureas.

 

LADA (Latent Autoimmune Diabetes in Adults)

LADA is also known as type 1.5, non-insulin requiring autoimmune diabetes, slowly progressing type 1 diabetes, later onset with positive antibodies. Those with LADA may have been diagnosed initially as type 2 diabetes but progress faster to insulin dependence. 

Type 1/LADA are usually younger than 50 years of age, may be leaner and have a personal and/or family history of autoimmune disorders. They are generally unresponsive to noninsulin therapy and present with a rapid progression to requiring insulin therapy.

 

Prediabetes

Prediabetes is defined as individuals whose glucose levels do not meet the criteria for diabetes but are too high to be considered normal. Fasting blood glucose is between 100 and 125 and A1c levels are 5.7 to 6.4%.

Prediabetes is associated with obesity, dyslipidemia with high triglycerides and hypertension (high blood pressure). Treatment options involve life-style modifications, such as meal planning, exercise and weight loss.

Ultimately, controlling prediabetes can prevent or delay the progression to type 2 diabetes.

 

Diagnosing and Monitoring Diabetes

While there may be more specific tests to determine the type of diabetes diagnosis, there are three very common tests that are often a part of initial diabetes testing.

  • Oral Glucose Tolerance Tests (OGTT)

This test compares your blood sugar before and two hours after you drink a sugary solution. A result of 140 or above suggests you have pre-diabetes and a result over 200 indicates that you have diabetes.

  • A1C

A1C measures your average blood sugar over the past two to three months. Pre-diabetes is indicated if your result is equal to or greater than 5.7, and a result equal to or greater 6.5 indicates diabetes.

  • Fasting Plasma Glucose (FPG)

FPG measures your blood sugar after you’ve fasted for at least eight hours. A result equal to or greater than 100 indicates pre-diabetes and a result equal to or greater than 126 indicates diabetes.

Two abnormal tests, same sample or subsequent sample, are required to make the diagnosis unless showing symptoms of hyperglycemia.

 

Treatments for Diabetes

“Due to the complexity of the diabetes spectrum and how each type affects people differently, it’s important to trust a diabetes specialist in your routine diabetes monitoring, management and care,” explains Cohen

With us, diabetes care involves an entire team, with access to endocrinologists, diabetes educators, insulin pump specialists, registered dietitians or nutritionists and more. Care should also include a plan for the prevention of complications such as blindness, stroke, heart disease, nerve damage, amputations of limbs and kidney failure. 

“It’s important for people with diabetes to understand that it’s possible to successfully manage their disease with the help from experts who can guide them to the support, education and care they need at any point along their journey,” Cohen concludes.

 

Feel Empowered to Manage Your Diabetes Linda Cohen APRN

A diabetes journey is as unique as each individual, so trust a care team that puts you first. Take the next step in your diabetes care by scheduling an appointment with Linda Cohen, ARNP,who can provide you with a personalized plan that fosters your whole health.