Ask the Doctor – Deciphering Diabetes, Changes in Diet Can Help Prevent This Common Disease

Q. I received a phone call from my primary-care physician, who sent me for some routine blood tests after my physical. She told me I had prediabetes because my A1c level came back at 6.1{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5}. What is an A1c test, and how bad is that number?

A. Hemoglobin A1c is an important blood test that provides information about your average blood sugar over the last three months. Higher hemoglobin A1c indicates poor diabetes control. The usual range of hemoglobin A1c is between 4{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} and 5.6{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5}. Hemoglobin A1c between 5.7-6.4 {06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} indicates an increased risk of diabetes, and hemoglobin A1c greater than 6.5{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} indicates diabetes. Your hemoglobin A1c of 6.1{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} indicates that you are at increased risk of developing diabetes in the future.

Q. Why does someone get diabetes or become prediabetic?

A. Diabetes is a metabolic disorder involving the way our body handles energy. Our body breaks down carbohydrates found in food into glucose. With the help of insulin, cells throughout the body absorb glucose and use it for energy. Prediabetes or diabetes develops when the pancreas does not make sufficient insulin or is unable to use insulin effectively, or a combination of both.

Q. I was told that I am on my way to developing type 2 diabetes. How does that differ from other types? Is it worse? Better?

A. There are two types of diabetes. Type 2 develops when the body is unable to use insulin effectively, which we refer to as insulin resistance. Type 2 diabetes usually develops during adulthood, although there has been a rise in children being diagnosed with type 2 as a result of their eating habits today. It can be prevented or delayed with lifestyle modifications such as eating healthy and exercising more. Treatment for most people involves oral medications. Type 1 diabetes usually begins in childhood or young adulthood. It cannot be prevented and is treated with injectable insulin only. Both are concerning to one’s health because each can lead to serious complications if not well-controlled in a timely fashion.

Q. My doctor wants me to make an appointment with a diabetes counselor in her office to talk about making lifestyle changes, but can that really ward off diabetes? I know that sugar isn’t good for those with diabetes, and the possibility of giving up my dark chocolate candy bars and daily Dr. Peppers is daunting.

A. Making changes in your diet can dramatically lower the chances of your prediabetes developing into diabetes. A diabetes educator will work with you to formulate a plan to make healthy eating choices and to become more active, as well as provide you with the tools to better manage your prediabetes.

Q. My mother told me that my grandmother had diabetes. Is it hereditary? And because she had it, is it more likely that I will develop it? Also, does that mean I would be more likely not to respond to lifestyle changes?

A. Genes play a very important role in the development of diabetes, but its development is also dependent on both environmental and behavioral factors, such as lifestyle habits and weight. Since your grandmother had diabetes, you have a higher risk of developing it, too. However, this fact should not prevent you from adopting lifestyle modifications that could make a difference for you.

Q. I don’t like surprises and can’t get in to see the diabetes counselor for a month. What is she likely to tell me?

A. Your diabetes educator will work with you to develop a healthy eating plan, including a diet that is low in carbohydrates, but rich in proteins and vegetables. She will talk to you about the importance of eating small, multiple meals a day, and will also help you in formulating an exercise regimen.

Q. I’m 54 and just had my first grandchild. I want to be around to see him grow up. I’ve heard of people going on dialysis or having a toe cut off because of their diabetes, and am afraid something like that might happen to me. Is it likely?

A. If your blood glucose remains elevated for long duration, it can eventually damage your tissues, including eyes, kidneys, and other organs. However, if you keep your blood sugar on target, it will help prevent the development of these serious complications caused by diabetes.

Q. What will the course of action likely be if lifestyle changes are not effective?

A. If lifestyle changes do not yield adequate improvement, then drug therapy is the next step. There are many oral and injectable medications that can be used to manage your diabetes. However, healthy eating, along with exercise and maintaining your weight, are the backbone of diabetes management, even when drugs are used.

Q. Is there anything else I didn’t ask that would be important to know?

A. It is very important to maintain your blood pressure and cholesterol when you have diabetes. Smoking should absolutely be avoided. These factors, along with having diabetes, increase your chances of developing life-threatening complications such as a heart attack or stroke. v

Dr. Neha Malhotra is an endocrinologist at Baystate Medical Center, where she sees patients in the Baystate Endocrinology and Diabetes Practice at 3300 Main St. in Springfield; (413) 794-7031.