Diabetes is a rapidly growing health problem that significantly affects the lives of millions of Americans. According to a July 2017 report by the Centers for Disease Control and Prevention, 100 million people in the United States have diabetes or pre-diabetes. With almost a third of the nation’s population impacted, it’s important to look at the modes of prevention and treatment.
With November being National Diabetes Awareness Month, endocrinologist Maria Subang at Kaiser Permanente’s Parkside Medical Offices shared pertinent information about types, prevention, symptoms and treatment.
“Type 1 is essentially autoimmune-mediated diabetes mellitus and autoimmune-mediated,” said Subang. “We often see diagnosis in young individuals, which is why it used to be referred to as juvenile diabetes; but I’ve diagnosed individuals as old as 75.” With type 1, because it’s an autoimmune process it destroys the beta cells in the pancreas that produce insulin, so patients have no insulin at all. While genetics play a part, experts do not know the exact cause as to why the body stops producing insulin in type 1 patients.
Type 2 is the more common form of diabetes, which occurs when the body can’t use insulin the right way. “It’s a process of insulin-resistance,” said Subang. “With type 2, especially in this society, a lot of it has to do with diet and lifestyle.” Without insulin, the body’s cells cannot use sugar as energy, and the sugar instead remains in the blood. Keeping blood sugar levels under control is the key when it comes to diabetes.
For type 2 diabetes, though it can be a matter of genetic predisposition, there are many ways to prevent or delay onset. A crucial step is a healthy diet. It is advised to eat less trans fats and hydrogenated oils; packaged and highly processed foods; white breads, sugary cereals and refined pasted; and processed or red meats. Instead it’s a good idea to consume high-fiber, slow release, whole grain, complex carbohydrates; healthy fats from nuts, seeds and avocados; whole vegetables and fruits; and high-quality protein such as organic chicken and turkey, eggs and beans.
Exercise also plays a central role in prevention and treatment. “A goal of 150 minutes per week of exercise — about 30 minutes, five days a week — can definitely help,” said Subang. “With the epidemic of obesity, the weight factor is important; because as a person packs in more weight, they have the higher risk or incidence of insulin resistance.” Regular exercise, including walking, can help control blood sugar, blood pressure, weight and stress, and increase energy levels and mood.
Some common symptoms of type 2 diabetes include fatigue, thirst, frequent urination, blurred vision and hunger. Some long term health risks of uncontrolled blood sugar levels include kidney failure, blindness, frequent infections, heart disease, stroke, neuropathy, foot problems and amputations, and tooth and gum problems. Though it may start slow, the consequences of untreated diabetes can significantly harm one’s quality of life.
“When a patient comes in to visit, I don’t expect magic,” said Subang. “I always ask my patients what they’re willing to do for their diabetes. It has to be a small goal that they know is feasible. If you give large goals it likely won’t work for them.” She explained that it is not enough for a patient to merely see a doctor for 20 or 30 minutes every three months, there must be an effort on their part to address the condition. “It has to be multidisciplinary, successful treatment is 50 percent or less medication — the rest is lifestyle.”
At Kaiser Permanente, diabetes patients work closely with their primary care provider, an endocrinologist, registered nurse (who is also a certified diabetes educator), and even a nutritionist. “This is a big piece,” said Subang. “A lot of patients don’t understand carbs and diet so they work with our nutritionist right here in Southern Colorado.” Consistent engagement with the team of healthcare professionals works very well and encourages patients to take care of themselves.
Subang has been with Kaiser Permanente since 2015. “I really like how a huge goal at Kaiser Permanente is prevention,” said Subang. “I also like their integrated system — with all specialty and primary care under one roof. I think that’s really better for patient care continuity and better healthcare delivery overall.”
Maria Subang, M.D. is currently accepting new patients.
- Maria Subang, MD, is with the state’s largest physician group—the Colorado Permanente Medical Group—which serves the 680,000 members of Kaiser Permanente in Colorado. To learn more about how Kaiser Permanente can help your family thrive, visit kp.org or call 1-888-681-7878.