Diabetes

Diabetes is a chronic health condition that affects the way your body uses glucose (blood sugar). Glucose is your brain’s main source of energy. It also fuels other important body functions like muscle movement.

The best diabetes care focuses on the most current research and treatments. The team of skilled healthcare professionals from the Cray Diabetes Self-Management Center at The University of Kansas Health System works to help you enjoy a full life that’s not limited by your diabetes symptoms.

Diabetes causes blood sugar levels to rise above normal levels. After you eat a meal, it’s normal for blood sugar levels to increase. The pancreas releases insulin to help make sure that this glucose gets to the cells that need energy the most. In people with diabetes, however, blood sugar is not lowered as effectively. This can happen for a few different reasons:

• The pancreas doesn't produce enough insulin
• The insulin that is produced doesn't work well enough
• The receiving cells don't respond properly to insulin

Some people are born with diabetes, and other people develop diabetes over time. More than 1.5 million Americans are diagnosed with diabetes every year.

Some people may be diagnosed with prediabetes, a condition where blood sugar levels are higher than normal but not high enough to be diagnosed as type 2 diabetes. Prediabetes indicates a higher risk of developing diabetes. It means insulin resistance is going up, but your body can almost keep up or can keep up most of the time. However, if left untreated, prediabetes can become type 2 diabetes.

Not everyone experiences symptoms with diabetes. Symptoms can vary from person to person and can also vary depending on your blood sugar levels.

Some symptoms common to diabetes include:

• Excessive hunger
• Extreme fatigue or weakness
• Feeling unusually irritable
• Increased thirst
• Increased urination, including bedwetting in children
• Nausea or vomiting
• Rapid weight loss with no clear cause
• Recurrent infections, such as gum infections, skin infections or vaginal infections
• Wounds or sores that take a long time to heal

The risks for developing diabetes differ by type. Because type 1 diabetes is a genetic condition, having a close relative with type 1 diabetes is the primary risk factor. While type 1 diabetes is often diagnosed in childhood, it can also develop at an older age. Triggers for type 1 diabetes are unclear. In addition to genetics, environmental factors, like viruses, may play a role. Doctors aren’t sure how to prevent type 1 diabetes.

Type 2 diabetes has multiple risk factors:

• Being over the age of 45
• Being overweight
• Having a close family member with type 2 diabetes
• Having prediabetes
• Having previously had gestational diabetes
• Living a sedentary lifestyle

Additionally, environmental factors may make someone more at risk for developing type 2 diabetes. Those who have lower socioeconomic status and live in neighborhoods that are exposed to environmental factors are at higher risk of developing type 2 diabetes. Ultimately, insulin resistance is the key that triggers type 2 diabetes.

Type 1 diabetes is seen more often in Caucasians, and type 2 diabetes is seen more often in African-Americans, Latino-Americans and Native Americans.

To diagnose diabetes, your doctor may use one or several tests to measure your blood sugar levels:

• A1C (glycated hemoglobin) test: Measures your average blood sugar levels over the previous few months
• Fasting blood sugar test: Tests your blood sugar levels following an overnight fast
• Glucose tolerance test: This test begins with an overnight fast followed by a blood sugar test, then drinking an oral sugar solution, then measuring blood sugar again over the following 2 hours
• Random blood sugar test: Checks your blood sugar at a random time for levels over 200 milligrams per deciliter (mg/dL)

When the body can’t properly regulate blood sugar levels, a combination of diabetes treatments can help control the symptoms of diabetes. Making diabetic-friendly dietary and lifestyle changes is an essential part of living with diabetes:

• Eat a sensible low-sugar diet that centers around whole foods and lean protein
• Exercise regularly – exercise helps lower blood sugar levels and reduces insulin resistance in the short term
• Maintain a normal, healthy weight

You should always check with your doctor before beginning any exercise routine or making any dietary changes. Your doctor may recommend that you work with a registered dietitian to help you create a customized meal plan. If blood sugar levels remain high despite these changes, your doctor may suggest diabetes medication as well.

Blood sugar levels can be checked by doing a finger-stick glucose test multiple times a day. A newer alternative to finger-sticks is a continuous glucose monitor (CGM). CGMs read blood sugar levels continuously and send the reading to an insulin pump at frequent intervals. The pump then changes the amount of insulin it will deliver based on your blood sugar levels. The CGM connects to a smartphone app that will alert you to low or high blood sugar levels. A CGM can also generate reports that may be used by your care team to adjust insulin dosing.

In addition to tracking blood sugar, type 1 diabetics will also need medication to control their insulin levels:

• An insulin pump, which can be programmed to deliver a consistent level of insulin
• Manual insulin injections, either by syringe or using an insulin pen
• Oral medication – although insulin cannot be taken orally, other medications can help aid insulin and glucose functions in different ways to control diabetes symptoms

Other possible treatments for diabetes include an artificial pancreas system or a pancreas transplant.

Treating diabetes with GLP-1 agonists

One class of medications that is used to treat type 2 diabetes is glucagon-like peptide 1 agonists (GLP-1). These medications include:

• Dulaglutide (Trulicity)
• Exenatide (Byetta)
• Exenatide (Bydureon)
• Liraglutide (Victoza)
• Lixisenatide (Adlyxin)
• Semaglutide (Ozempic and Rybelsus)

In addition to treating diabetes, these medications are also particularly good for the heart. While lowering blood sugar always has positive outcomes for cardiovascular function, research has shown that GLP-1 agonists have additional effects that are protective of the heart and lower the risk of heart attack and stroke.

However, these medications are not enough on their own, and accessing GLP-1s can be difficult due to shortages or cost. Incorporating lifestyle changes related to diet and exercise is essential.

The Cray Diabetes Self-Management Center at The University of Kansas Health System is recognized by the American Diabetes Association as meeting national standards for diabetes education and support. We provide ongoing, personalized education and support to help you build the knowledge and skills you need to manage your diabetes.

Additionally, the Cray Diabetes Self-Management Center stands as the clinical arm of the KU Diabetes Institute, where translational research, innovative educational technology and practices are implemented.

As a patient, you may be eligible to participate in clinical research. You'll have the opportunity to receive the most advanced therapies or procedures that are only available when you participate in a clinical trial. Our endocrinologist will discuss your eligibility for clinical trials.

We believe in a collaborative approach to treatment. In addition, we feel the relationship between you and your healthcare provider is important, so you will see the same doctor and/or educator as long as you continue your treatment with us. We also work closely with your primary care physician to achieve the best outcome. Your team will include:

• A certified diabetes educator
• A registered dietitian nutritionist
• An endocrinologist
• Mid-level diabetes specialist (either a physician assistant or nurse practitioner)
• Other resources, as needed

It's not always easy to maintain the diet, exercise and other lifestyle changes necessary to reduce your risk of complications. During your periodic visits, we'll provide you with the latest information about maintaining your health. At the health system, we are dedicated to providing the care, education and emotional support needed throughout your life. We offer accredited group and one-on-one classes led by a certified diabetes educator and/or licensed dietitian. Topics include:

• Carbohydrate counting and meal planning
• Comprehensive education for patients newly diagnosed with diabetes
• Latest diabetes technology available
• Monitoring blood glucose and pattern management

Your primary care physician must refer you to a group or one-on-one class. Although one-on-one sessions are covered by Medicaid, group classes are not. Contact your insurance provider for more information.