Myth or Truth in Diabetes – Find the Answers!

There is a large amount of confusing information out there when it comes to diabetes care and overall health. Find out the common realities and myths when it concerns you and your diabetes. This may help you prevent future problems.

1. Having “insulin resistance” can raise your risk of developing the metabolic syndrome, pre-diabetes and type 2 diabetes

Answer – Truth

Insulin, which is made by the beta cells in your pancreas, is needed to keep your blood sugars regulated and steady throughout the day and night. “Insulin resistance” is when your cells do not respond well to your insulin and your pancreas pours out more and more trying to adjust your blood sugars. After a while, the pancreas can’t keep up and you either produce less insulin or your body does not use the insulin effectively making your blood sugars rise.

Insulin helps your body push glucose (from carbohydrates) into your cells and muscles to be used for energy or stored for later use in the fat and the liver. With insulin resistance, your cells do not open allowing for the sugar to come in and your blood sugar starts to climb. This is when health problems may begin to occur. There is a higher risk of a stroke, heart attack, diabetes, cancer and Alzheimer’s. Listed below are some consequences of insulin resistance, if not treated.

• Metabolic syndrome. Insulin resistance is the metabolic syndrome. “Metabolic syndrome” includes a measurement of high cholesterol, high blood pressure, high triglycerides, multiple skin tags and an over-sized waist circumference. Metabolic syndrome/insulin resistance elevates the risk for pre-diabetes and type 2 diabetes. Your doctor should be screening these common measurements on a regular basis during your visits.
• Pre-Diabetes. Pre-diabetes is when blood sugars are higher than normal but not quite considered diabetes. Normal fasting blood sugars are measured between 60-99mg/dl. Pre-diabetes fasting blood sugars are measured between 100-125mg/dl. Pre-diabetes should be addressed and treated with lifestyle changes including weight loss 5-7% of your body weight, adopting an exercise plan as well as a healthy eating plan with reduced calories and portions. Besides type 2 diabetes, pre-diabetes is a risk factor for heart disease, eye disease(retinopathy), nerve disease(neuropathy), and kidney disease.
• Type 2 Diabetes. Type 2 diabetes is diagnosed when the fasting blood sugar measures 126mg/dl on 2 separate occasions or when your A1C (3-month blood test) is 6.5%. All the above problems associated with pre-diabetes are more dominant when type 2 diabetes develops.

What are some possible causes of insulin resistance?

• Obesity, especially belly fat
• Sleep apnea
• Family history
• High stress levels
• Polycystic ovarian syndrome, PCOS
• Non-fatty liver disease, NASH
• Use of steroids for other medical conditions
• Lack of exercise
• Eating a highly processed/refined diet

Who is at higher risk for developing insulin resistance?

• Those over age 45
• Family history of metabolic syndrome, pre-diabetes or type 2 diabetes
• African Americans, Hispanics, Asian Americans and Native Americans
• History of gestational diabetes

Insulin resistance generally carries no symptoms early on. Blood glucose monitoring is a way to diagnose the beginnings of insulin resistance. A fasting blood test or a OGTT (oral glucose tolerance test) may show higher than normal numbers. Monitoring lipids and blood pressure can also be important.

The good news is insulin resistance can be reversed with:

• Weight loss
• Stress/anxiety management
• Proper and consistent sleep
• An exercise program as simple as daily walking
• A balanced diet high in non-starchy vegetables with moderate intake of fruit, lean protein, whole grains for fiber, low-fat dairy and calorie-free beverages
• No smoking
• No alcohol or modified intake of alcohol

2. There is no association between Diabetes and Parkinson’s disease

Answer – Myth

Although more in-depth studies are needed, an association between diabetes and Parkinson’s disease has been found. The common factors seen in both diseases are: insulin resistance, systemic inflammation and protein disorders. High sugar can disrupt dopamine levels, as the brain becomes used to higher levels of sugar as seen in diabetes. Parkinson’s disease is a progressive neurological illness associated with disrupted dopamine levels. Both illnesses are considered chronic health problems. Both problems should be treated with a team approach.

According to research documented in Movement Disorders in March 2021, “Type 2 diabetes was associated with a 31% increased risk of Parkinson’s, with faster symptom progression when diabetes was present”. High glucose from diabetes may cause brain inflammation. There is no present research proving that “Diabetes causes Parkinson’s”, but there are many studies suggesting it. Type 2 diabetes affects the blood vessels causing vascular disease. Vascular disease may lead to reduced brain blood flow which could speed up the development of Parkinson’s.

Another theory is “the same processes that cause diabetes also cause the nerve cell degeneration present in Parkinson’s”. Insulin resistance, which was discussed earlier, may be a factor in both diseases. Aging and genetics are also a factor in both diabetes and Parkinson’s.

The takeaway message at this time is to manage blood sugars as best as possible – shooting for an A1C of 6.5% to 7.0% – unless told otherwise by your physician. This can avert risk factors and negative health outcomes possibly leading to Parkinson’s. A big difference is diabetes can be diagnosed by simple blood tests and Parkinson’s does not have a definitive blood test for diagnosis. It is usually diagnosed by a movement disorder neurologist based on symptoms. Certain brain scans may be used as well.

Parkinson’s Disease symptoms include:

• A tremor at rest which usually starts on one side and progresses to both sides beginning in fingers and hands
• Impaired taste and impaired/reduced sense of smell
• Arms do not swing while walking
• Stooped or forward leaning posture
• Handwriting changes and becomes smaller over time
• Slower movement/feet shuffling/feels like feet and legs are difficult to lift
• Severe muscle stiffness
• Poor balance
• Severe sweating
• Increased runny nose
• Urinary incontinence/constipation
• Muscle jerking and excessive movement during sleep

There is no defined reason or current cure for Parkinson’s but there are many treatments available. Medications will be prescribed based on which stage you are in and your present symptoms. Medications can usually manage problems with walking, movement and tremors. Parkinson’s medication tends to work better early on and can diminish working over time. Visiting your neurologist as well as working with a physical therapist and a speech pathologist is beneficial as this disease progresses. As with diabetes, focus on taking your medication properly, eating well, doing exercise and balance movements, using stress management techniques and getting restorative sleep.

3. If you have diabetes in the United States in 2021, your blood sugar and blood pressure control have never been better, due to the latest information, treatments and diabetes medications

Answer – Myth

Diabetes remains one of the most challenging health problems in the 21st century. According to data published in The New England Journal of Medicine, “the percentage of US adults with diabetes meeting both glycemic (blood sugar) and blood pressure control targets declined from 2010-2018. Control had steadily increased from 1999-2010”. As a nation we had been doing much better during previous years but now the trends of diabetes control are getting worse and we must act.

More uncontrolled diabetes and hypertension means more complications to nerves, kidneys, eyes and your heart. More deaths are resulting from diabetes complications, along with grief and heart ache for families and friends and costs for individuals as well as for the entire nation. We need to reeducate and treat people with diabetes for improved blood glucose numbers and overall health. In 2007-2010, glycemic control was achieved in 57% of US adults. Today, this has dropped to about 50%, although we have more medications, treatment plans and information accessible to help treat diabetes. It should be seen as a “wake-up call” to those involved in our health care system. It needs to be seen by the individual patient.

We need to treat diabetes with all our tools at a national level. The numbers for control were defined as, “an A1C less than or equal to 7% (unless otherwise advised by your physician) and a blood pressure of 140/90 mm/hg or less”. Why would/should this happen when we have more access to information, knowledge, different high quality diabetes medications and guidelines available to every physician and health care provider, set by the AACE (American Association of Clinical Endocrinologists)? One of the answers was “there was less use of medication in younger and ethnic groups of people who did not have health insurance and they did not receive adequate medical treatment”.

What can be done to get back on track for diabetes care and control in our nation?

With healthcare much more available and affordable due to the Affordable Care Act enacted in 2010, diabetes treatment goals should become a priority nationwide. Diabetes screening can easily be performed along with proper medical treatment and follow-ups. Treatment needs to include a diabetes team consisting of a primary care physician or internist, endocrinologist, cardiologist, dermatologist, podiatrist and eye doctor. Treatment and management should be individualized for each patient depending on their specific needs.

Management should be proactive, not reactive, while treating aggressively before complications appear. Changes in medical condition should be addressed in a prioritized and timely manner. The goals of diabetes care should include the “prevention of complications and optimal quality of life”. There are more types of insulin, injectables, diabetes pills, continuous glucose monitoring (CGM) devices and insulin pumps. Lifestyle changes are affordable to everyone and should be implemented.

Certified and accredited diabetes educational management programs are covered by insurance and should be utilized by patients. Local YMCA programs use coaches and navigators (instructed in diabetes care) to help patients with diabetes as well. They are excellent at keeping you motivated in your care. Constant follow up is critical. Keeping patients and family members informed helps with continuous progress in their diabetes treatment. Education and reinforcement is constantly needed and changes should be made if symptoms progress. We as a nation have work to do but with everyone on board, including patients, we can take control of diabetes in our country.

4. People with diabetes are more likely to get colds, flu, pneumonia, COVID-19 and other viruses

Answer – Truth

“People with diabetes are 3 times more likely to die from the flu and pneumonia”. Illnesses make your blood sugars soar and that much more difficult to control. When you are sick, your body sends out hormones to fight off the infection and these hormones make it harder for blood sugars to stay in an acceptable range. “Even with well-managed diabetes, your risk of complications gets higher when you have the flu”. High blood sugars also make it easier to develop colds, flu, COVID and pneumonia.

With pneumonia, you may need to take steroid medications for improved breathing and decreased inflammation, which will raise your blood sugars even more. Out of control blood sugars cause dysfunction of your immune system. Flu vaccination has been associated with “reduced hospitalizations among people with diabetes”. Fungal infections, urinary tract infections and skin infections appear more frequently when you have diabetes especially when blood glucose is high.

The best things you can do to prevent viruses during this time are:

• Keep blood sugars as controlled as possible, at all times.
• Get an annual flu shot in late September or early October. They need to be updated each year since the flu virus mutates.
• Get a pneumonia shot. Talk to your health care provider about updating it every 5 years. You will get a stronger variation of the pneumonia vaccine at age 65.
• Do not touch or rub your eyes, nose or mouth which can easily spread germs.
• Wash your hands regularly and frequently with warm water and soap for 20 seconds or longer. Use a hand gel with at least 60% alcohol if regular soap and water are unavailable.
• Avoid crowds and people who are currently sick.
• Wear a face mask, when and if indicated.
• Get plenty of fresh air.
• Stay hydrated. Watch out for dehydration.
• Eat foods high in vitamin C like citrus and red peppers. Discuss taking a zinc supplement, a vitamin B supplement and vitamin D supplement with your physician. Make sure it does not interfere with your prescription medications.
• Take your diabetes medications as directed even when you are sick. You may need to adjust your insulin dosage; discuss with your doctor.
• Establish a sick-day plan and have a sick day box prepared. Include a digital thermometer, OTC-sugar free medications for a fever, congestion or stomach problems, sugar tablets for hypoglycemia, foods such as clear broth, soda crackers, regular Jello as well as extra sugar-free popsicles and sugar-free liquids. “Sick day guidelines need to be initiated when you become ill to prevent further problems”. Check blood sugars more frequently, have a ketone testing kit if blood sugars go above 240mg/dl. Call your doctor if you have consistent blood glucose levels of 200-250 mg/dl or above, ketones in your blood or urine, a fever over 101, are short of breath, have chest pain or cannot keep liquids or solids down. Contact your physician if you are not feeling better in 2-3 days. Recover from your virus or other infection completely before returning to your full, regular activities.

Diabetes can be challenging if you do not know all the facts. There are so many myths that can confuse and frighten you. Learn what is true and what is not. Your diabetes will thank you. You can do this!

Sources:

• https://www.everydayhealth.com/type-2-diabetes/insulin-resistance-causes-symptoms-diagnosis-consequences/
• https://www.everydayhealth.com/type-2-diabetes/type-2-diabetes-linked-to-increased-risk-of-parkinsons-disease/
• https://www.parkinson.org
• https://www.healio.com/news/endocrinology/20210712/fewer-us-adults-with-diabetes-achieving-glycemic-bp-targets-since-2010
• https://www.healthline.com/diabetesmine/news-medicare-expanding-cgm-coverage
• https://www.healthline.com/diabetesmine/what-is-continuous-glucose-monitor-and-choosing-one
• https://www.cdc.gov/flu/highrisk/diabetes.htm
• https://www.apdaparkinson.org/article/link-between-diabetes-and-parkinsons/