How Managing Diabetes Can be Made Simpler

Can Diabetes be Simple?

You may have read an article by Adam Brown of diatribe.org on 42 Factors That Affect Diabetes. We all know that insulin-requiring diabetes is complicated – but 42 items!

If you have friends or family with diabetes, you have probably discussed your own experiences with all the moving parts that you have to take into consideration every day, at every meal, before and after you exercise or drive, and sometimes it seems like every hour.

Can you make diabetes management simpler?

That is not a simple question. 

It somewhat depends on each person’s own situation:

• How long you have had diabetes?
• What is your basic approach to your life challenges or your personality?
• Perfectionist?
• Or easygoing and easily adapt to changes?
• Teenager?
• Feel invincible – nothing will affect me?
• Toddler?
• Totally dependent on the entire family unit?
• Senior citizen living alone or with extended family?
• In denial – what diabetes?
• Feel fatalistic – things will happen as they are meant to no matter what I do?
• Motivated by success?
• Motivated by fear of complications?
• Motivated to resume a normal life despite diabetes?
• Lifelong learner – well-controlled diabetes doesn’t cause any problems?

Most of us may have some or all of these traits. If diabetes was the same for everyone, that would certainly help to simplify it.  But one of the main advances in diabetes treatment in recent years has been the realization that diabetes management has to be individualized. No two people react the same.  That being said, there are some general principles that are the same.

Nutrition and exercise are the cornerstones of diabetes treatments no matter what type of diabetes you have and what type of diabetes medication(s) you use.

Some people cannot or do not exercise so that may take away one treatment option.

Exercise doesn’t actually make insulin-requiring diabetes any easier.  It adds in another variable but it also provides many benefits like increasing insulin sensitivity and decreasing the need for meal insulin.  But it is a trial-and-error process to safely include exercise and make insulin adjustments for different types and intensities of activities.

Exercise (and all physical activity – house cleaning, laundry, yard work, etc.) helps to keep our muscles moving.  Aerobic exercise works the biggest muscle in our body (which is not your butt) but is your heart. Heart health is also one of the most important factors to consider when making our food choices.

Nutrition is the other cornerstone of diabetes management and since we get about half of our glucose from our food and the other half from our liver, our food is the part we have control over.

Matching insulin to food intake is a skill that must be fine-tuned with practice and knowledge about how the main groups of foods affect your own glucose. 

Carbohydrates, protein and fat all affect the blood glucose so learning how each group affects you is important.  At some point in your diabetes pathway, you have to put some effort into this.  You can make it a priority for a few months of intense record keeping and working with a “diabetes coach” or you can spend 20-30 years “sort of figuring it out”.

• Some people count their carbohydrates and use a carb-to-insulin ratio.
• Some people are very sensitive to fat and need to take insulin for meals with >20-25grams of fat.
• Some people eat very low carb and so have to count a portion of their protein as carbohydrate to avoid highs.

Meeting with a Certified Diabetes Care and Education Specialist (CDCES) for help in understanding how each group of foods affects you is invaluable.  Carb, protein and fat all have important jobs in your body so having small to medium amounts of each type of food 3 times per day is the best way to make sure your body has the fuel and nutrition it needs for you to perform well at whatever you want to do in your life.

Your own food and nutrition are a very personal matter but it is helpful to look at it with someone who can observe it neutrally as “data” as opposed to feeling like someone is looking at your intake like the “food police”.

Some people may simplify the way they take their insulin by looking at their plate and choosing to take insulin based upon whether they are eating a small, or medium (their usual sized meal), or a large/restaurant meal.  They get close enough and can achieve the glucose control they desire using this method. One simple concept that we want to try to mimic is the way the body gives insulin in someone who does not have diabetes.

What this means is that we need a certain amount to cover the liver’s output of glucose.  A little drip that is given in between meals and during the night.

In theory, this is about 50% of a person’s total daily dose as background insulin.  This is true in someone who doesn’t have diabetes.  In someone who does, our liver does not get the signal to shut off when we eat.  Glucose is supposed to come from the food OR the liver.  But with diabetes, that signal is missing.  In addition, when we go to sleep, our liver should drip glucose like a leaking little faucet drip.  Unfortunately, with diabetes, it is as if someone has left our faucet running full blast.  We now know that there are gut (Type 2) and pancreatic (Type 1) hormones that help control the liver’s overproduction of glucose.

We also know that insulin is a hormone that always works to lower glucose.  But we have to give it to people in the right way and in the right amount.  It is the most natural treatment for diabetes. 

It is also a growth hormone so although it controls glucose, it allows the body to store whatever it does not burn up for energy.

So many people feel that insulin helps us to gain weight.  It may not be insulin that makes us gain weight but the food we eat that makes us gain weight.  There is some evidence that even lean people who take insulin will gain weight over time. 

We do know that when glucose is high, we urinate out our food and when we give insulin to improve the glucose, we can either store the food or burn the food. Storing the extra food we don’t burn can lead to weight gain.

There are other hormones that were mentioned earlier that have been the biggest revolution in diabetes treatments in the last 20 years.

You may or may not have heard of incretin therapies.  In Type 1 diabetes, the incretin hormone amylin, is co-located and co-secreted with insulin.  In Type 2 diabetes, GLP1 and more recently GLP1/GIP are incretin gut hormones that are secreted when someone eats and their glucose goes up. 

Both of these Type 1 and Type 2 hormones are deficient in diabetes.

We have now figured out how to make copies of these hormones and replace them with injections.  The special actions of these hormones often allow people to decrease their glucose, their insulin, and their weight. If you want to learn more about these novel treatments that are considered Standards of Care by the American Diabetes Association, please contact your Certified Diabetes Care and Education Specialist, primary care provider, or endocrinologist for a 1:1 discussion of what might be the best treatment for you.

No matter what stage of your diabetes you are at, one way to simplify it is to “make friends with it”.  Many times, once you wrap your head around the idea that it isn’t your fault that you have diabetes, but now that you do, it is 100% your responsibility.  Often, once you decide to be friends with it (like the inconvenience of flossing or brushing your teeth), it can then go into the background of your life and you can achieve whatever your heart desires.

References:

Conway B, Miller RG, Costacou T, Fried L, Kelsey S, Evans RW, Orchard TJ. Temporal patterns in overweight and obesity in Type 1 diabetes. Diabet Med. 2010 Apr;27(4):398-404. doi: 10.1111/j.1464-5491.2010.02956.x. PMID: 20536510; PMCID: PMC3129711.

Brown, Adam, 42 Factors That Affect Blood Glucose?! A Surprising Update