Ask the Pharmacist

Q) I have just been told I have pre-diabetes. So many people I know have diabetes and do not seem worried. In fact, they continue to live the same lifestyle as before. I don’t know much about diabetes other than it has to do with high blood sugar and that there is medication to control it. What exactly is diabetes and pre-diabetes and should I be concerned?

A) Your health care provider must have done some recent blood work and detected a higher-than-normal amount of sugar in your blood but not high enough to be considered type 2 diabetes … at least not yet. This is termed pre-diabetes. Most people with pre-diabetes do not have any unusual signs or symptoms and is usually detected by a health care practitioner through routine blood work. Some people may show a darkening of their skin on their armpits, groin and neck.

Most pre-diabetics do eventually acquire type 2 diabetes but it doesn’t have to end this way. You can make changes to your lifestyle to bring your blood sugar down to a normal level and thwart off the progression to diabetes. Though pre-diabetes isn’t as concerning as having diabetes, the slightly elevated blood sugar in your body might already be initiating the long-term damage diabetes causes, especially to your heart, blood vessels and kidneys.

Let’s first discuss what diabetes is and the various types. To help understand diabetes a little better, it may help to have a little knowledge on both insulin and glucose. Glucose is a sugar that is a source of energy for our cells that are integral to our muscles and tissues and it is also a vital source of energy for our brain. Our body gets glucose from two sources – from the food we eat and our liver. The liver comes into play when our body senses that our blood sugar is low and converts its stored glycogen to glucose for the body to utilize.

The more common source, however, is through our food. This dietary source of sugar is absorbed into our bloodstream and then enters the cells where it is needed as a form of energy. This is where insulin comes into play. Insulin is a hormone that is formed in our pancreas. When our blood sugar rises, as it naturally does after eating a meal, the pancreas secretes insulin. Insulin’s sole job is to allow the sugar to enter the cells thereby decreasing the sugar in the blood. Once the blood sugar lowers to a normal value, the pancreas stops the secretion of insulin. This system works well for most of us but diabetes causes either the body to not produce enough insulin or does not allow the body to properly utilize the insulin. Either way, the end result is a higher-than-normal blood sugar.

There are three main types of diabetes.

Type 1: This is an autoimmune disorder where the body is attacking its pancreas and not allowing it to function. Without a properly functioning pancreas, the body isn’t able to produce and secrete insulin to manage the blood sugar resulting in high sugar levels. This type is also termed insulin-dependent. About 10% of people with diabetes are type 1 and is most often acquired in childhood or adolescence. The only treatment for type 1 diabetes is to administer insulin to manage the body’s blood sugar.

Type 2: In this scenario, people either cannot utilize the insulin their body is producing or they are not able to produce enough insulin. About 90% of people with diabetes have type 2 diabetes is most often diagnosed in adulthood although it is becoming increasingly more common in childhood. Contrary to type 1 diabetes, type 2 can sometimes be managed with lifestyle choices that incorporate healthy eating habits and regular exercise. When this doesn’t appear to be sufficient to control the blood sugars, medications and/or insulin treatment may be required.

Gestational diabetes: This occurs when you are diagnosed with diabetes for the first time while pregnant. Having a high blood sugar can affect your pregnancy as well as the health of your baby. It may be managed by incorporating a healthy diet, exercising and if needed, medications. More often than not, after the pregnancy is over, the blood sugar returns to normal. However, having gestational diabetes does increase your risk of acquiring type 2 diabetes at a later date so it is important to keep a close eye on your blood sugar and continue to embrace the healthy lifestyle choices.

The signs of symptoms to be on the lookout for of diabetes are:

· Increased thirst
· Frequent urination
· Fatigue
· Increased hunger
· Numbness in hands/feet
· Blurry vision
· Frequent infections
· Sores that heal very slowly
· Unintended weight loss

There are certain risk factors that are associated with your chance of getting diabetes and some are specific to the type of diabetes.

Type 1
· Family history
· Environmental
· Geographical
· Presence of diabetes immune system cells

Type 2
· Family history
· Had gestational diabetes
· Given birth to baby weighing over 4kg (9lbs)
· Certain race or ethnicity
– African American, Hispanic, American Indian, Asian American
· 45 years or older
· Overweight/obese
· Inactivity (physically active less than 3 times weekly)
· Non-alcoholic fatty liver disease

Gestational diabetes
· Gestational diabetes during a previous pregnancy
· Given birth to baby weighing over 4kg (9lbs)
· 25 years or older
· Family history
· Overweight/obese
· Certain race or ethnicity
· Have polycystic ovarian syndrome (PCOS)

Pre-diabetes
· Family history
· 45 years or older
· Overweight/obese
· Inactivity (physically active less than 3 times weekly)
· Had gestational diabetes
· Given birth to baby weighing over 4kg (9lbs)
· Certain race or ethnicity

The most important step you can make for yourself right now is to ensure your blood sugar is well within the normal range. Having a higher-than-normal blood sugar affects so many parts of your body and can lead to long-term complications that cannot be reversed. These complications develop gradually and, as mentioned previously, can begin during the pre-diabetes stage when you are not yet aware of an above normal blood sugar. Many of us are not as concerned as we ought to be about these long-term consequences of diabetes. We have become so accustomed to our current lifestyle and are unwilling to go through the major changes that are suggested to help bring down our blood sugar. Why would you when there are medications that will do the job for you?

Next week, we will discuss in detail the complications that people with diabetes face, the other health related issues that they should concern themselves with and steps that need to be done to help prevent them.  In the meantime, if you have any questions or health concerns, ask your pharmacist.