Not Your Grandpa's Diabetes

Many people greet a Type 2 diabetes diagnosis with more than the usual dismay because they have already watched a beloved relative diagnosed with diabetes go through the horrors of amputation, blindness or kidney failure.

As an example of what I mean, a delightful lady who posts online under the nickname "Ozgirl" once explained that when she was a child she thought all people lost their legs as they got older because all her older relatives had diabetes and all had no legs.

If you have that kind of family history, and these kinds of memories are haunting you, you may well flee into denial and ignore your blood sugar completely until you, too, suffer these same terrible complications. Many people do.

But this is an avoidable tragedy. With the tools we have available today, no one, no matter what their blood sugar history might be, has to develop these terrible diabetic complications.

Here is a list of the changes that have taken place in the last decades that explain why you don't have to go through the horror that diabetes was for an earlier generation:

1. Much Earlier Diagnosis. If your relatives was diagnosed with diabetes in the 1970s or 80s, they probably had been living with dangerously high blood sugars for many years before anyone noticed.

There were no commonly agreed upon cutoffs for diagnosing diabetes until 1978. Then the ADA devised diagnostic cutoffs that were intentionally set very high--just before people began to go blind--because as they explained in print, there was no effective treatment for any but the most severe forms of diabetes, and having a diagnosis in their medical records might keep people from getting insurance coverage.

So by the time grandpa got diagnosed, he had significant complications--retinopathy, nerve damage, protein in the urine and advanced heart disease. (You can read the history of how diabetes diagnosis has changed HERE.)

Doctors who keep up with diabetes treatment diagnose people much earlier now. If you have a good doctor he will diagnose you in the very early stages of "prediabetes." If you catch diabetes earlier, it is possible to normalize blood sugars and completely avoid complications, no matter what your genetic heritage.

2. Much Better Blood Sugar Tracking Technology. It has only been within the last 8 years that most people diagnosed with Type 2 diabetes have been given blood sugar meters and taught to track their blood sugars with them.

Before that, most doctors only checked a patient's blood sugar with urine dips done once every couple months. In most people, the urine dip test is only able to detect blood sugars that have been over 180 mg/dl (10 mmol/L) for several hours before the test. Even if your blood sugar tested out well above 180 mg/dl on the urine dip, most doctors in the old days would tell you you were fine, though that level is high enough to produce significant complications. Doctors only worried about extremely high blood sugars then--those over 350 mg/dl. But we now know that prolonged exposure to blood sugars over 140 mg/dl causes complications.

I went through an entire diabetic pregnancy in 1985 without ever seeing a blood sugar meter until I was in the delivery suite. So you can be sure that if Grandpa was diagnosed between 1950 and 1995 he may never have seen one either. If he has an old doctor now, he may still not have one, or if he was given one, he may not have been taught how to use it properly.

The blood sugar meter is the single most powerful tool we have to help us regain blood sugar control. If you follow the advice given here (or here if you are in a part of the world that uses mmol/L measurements) you will have the information you need to lower your A1c to a level that prevents most diabetic complications.

3. Much Better Medications. The only drugs available for people with Type 2 diabetes until the mid 1990s were the sulfonylurea drugs and insulin injections. These drugs cause hypos and since they were being given to people who were not using blood sugar meters, the only way they could be prescribed safely was by giving doses low enough that the patient's blood sugar would stay in what the doctors thought was the "safe" range--200-300 mg/dl. That level, we now know, is high enough to cause significant complications. In addition, earlier versions of these sulfonylurea drugs turned out to promote heart attacks and caused hunger that led to weight gain.

Doctors now should be prescribing metformin to newly diagnosed patients with Type 2. Metformin does not cause hypos and it is protective against heart disease. Patients who are given insulin are also given blood sugar meters, and, if their doctors are up-to-date, modern insulin regimens which lower blood sugar to safe, near-normal levels.

4. Doctors Only Learned How Important Lowering Blood Sugars Was in the early 1990s. Until the DCCT study was published in 1993 doctors did not know that lowering blood sugar could prevent complications for people with Type 1 diabetes. Until 1998 they had no evidence that lowering blood sugar would prevent complications in people with Type 2 diabetes. Many doctors believed that complications grew out of some other underlying cause, not blood sugars, and hence they worried more about avoiding low blood sugar than avoiding high blood sugars. Grandpa's A1c was very likely way over 10% in the range that we now know guarantees complications.

Sadly, the average A1c in the U.S. is STILL around 10% which is high enough to cause complications, but as thousands of people with diabetes who are active online have learned, it is possible to lower A1c and avoid complications. We do it, and so can you!

5. There Were No or Few Effective Medications for High Blood Pressure Until the 1990s. High blood pressure is a major contributor to complications, especially kidney disease and blindness. Until the 1960s there were no drugs at all that could lower blood pressure. The early diuretic drugs helped, but they caused side effects that made many people stop taking them.

But today's ACE inhibitor drugs have been shown to be very helpful to people with diabetes. They are cheap and effective and will go a long way to prevent the kidney failure that carried off so many people with diabetes in the past.

6. The Diet They Gave Grandpa Made His Blood Sugar Worse. The low fat diet that was prescribed to people with diabetes from the end of World War II to only a few years ago in the mistaken belief that it could prevent heart disease, encouraged people with diabetes to eat the foods most likely to raise their blood sugar and worsen their diabetes.

Fortunately, scientific research has made it crystal clear that low fat diets do not improve health and that lowering your carbohydrate intake by cutting way back on starches and sugars not only improves blood sugar but also lowers your risk of heart disease.

You don't have to suffer the way your elders did. It will take some effort on your part, but you can do it. The keys to getting the best treatment possible are:

1. Educate yourself about diabetes.

2. Make sure your doctor's training in diabetes treatment is up-to-date and that he or she shares your commitment to achieving the normal blood sugars that prevent complications.

3. Use your blood sugar meter to help you understand what foods you can eat.

4. Select your medications with care and only use those that safely lower your blood sugar and promote your health.

5. Keep an eye on your blood pressure and keep it normal.

6. Interact with others in the online diabetes community who have been successful in controlling their own diabetes and preventing complications.