For 32 years as a driver for Metro Mobility, Felton Williams provided transportation for Twin Cities residents with disabilities and health conditions.
He met many people with type 2 diabetes and complications from the disease—including kidney failure—on his trips. Dialysis clinics were a common stop.
“I used to pick people up and talk to them about it,” Felton says while sitting in a meeting room at a DaVita Kidney Care center in St. Louis Park, just before his own regularly scheduled dialysis treatment. “I never thought I would be the one needing the treatment. But sometimes you don’t know what might happen to your health.”
Williams, a 69-year-old Blue Cross member from St. Louis Park, retired from driving last August when he learned that his own kidneys had failed, aided by type 2 diabetes and high blood pressure. Despite his setbacks, he knows it could be much worse without careful management of his conditions. His diabetes diagnosis 10 years ago led to lifestyle changes that have allowed him to travel the world with his wife, spend time with his seven grandchildren, and enjoy life.
“I just want to live my life the best I can now while I still can,” Williams says. “Just because I have diabetes or I’m on dialysis doesn’t mean I can’t do that.”
More than 30 million Americans—over 9 percent of the population—are living with diabetes, according to the American Diabetes Association (ADA). About 25 percent of Americans 65 and older have the condition, and type 2 is the most prevalent. But as the disease has grown more common, education, management strategies and treatment options have advanced significantly, improving the outlook for affected patients.
TYPE 2 DIABETES BASICS
Whereas type 1 diabetes is an autoimmune disease usually diagnosed in children and young adults, type 2 develops later in life.
People with type 1 diabetes do not produce insulin, a hormone the body needs to absorb glucose—broken down sugars from carbohydrates—into the bloodstream to produce energy. In type 2 diabetes, the body resists insulin, initially prompting the pancreas to make more, but ultimately allowing glucose to build and sapping cells of energy.
Left untreated, type 2 diabetes can lead to kidney damage, nerve damage— especially in the hands and feet—heart and blood vessel disease, skin and mouth conditions and other complications. As with many chronic conditions, early detection is important, but common symptoms—excessive thirst, frequent urination, fatigue, weight loss and blurry vision—are often not obvious right away.
“We strongly recommend that people who have a family history of diabetes, women who had gestational diabetes, and people who are overweight, need to be screened for diabetes,” says Elizabeth Seaquist, director of the Division of Diabetes and Endocrinology in the Department of Medicine at the University of Minnesota. “They can’t wait to feel sick. They need to be screened to determine if their blood sugars are normal.”
What is high blood sugar? According to the ADA, 5.6 percent or lower is normal for someone without diabetes. Between 5.7 and 6.4 percent indicates prediabetes, at which stage an individual is at higher risk of developing diabetes, which is diagnosed at 6.5 percent or higher on two separate occasions.
The ADA recommends a diabetes screening every three years for Medicare-age adults, though some doctors recommend more frequent testing, especially for individuals with the risk factors Seaquist mentioned. She and Dr. Anders Carlson, medical director of Park Nicollet’s International Diabetes Center in St. Louis Park, emphasize awareness of those risks:
Family history is critically important. If you had a parent with type 2 diabetes, you have a 30 percent chance of getting type 2 diabetes yourself.
Age itself is a big factor. To have normal blood sugars in your body, you have to be able to make enough insulin and use it e ffectively. Part of the aging process is a reduction in our ability to make insulin.
Lifestyle and diet are paramount. Unhealthy eating and a lack of exercise can reduce the body’s ability to make and e ffectively use insulin. Smoking has also been shown to increase the likelihood of developing diabetes and related complications. For help quitting, check out the Blue Cross support program at bit.ly/bcquitsmoking.
There is risk associated with race. Certain populations including African Americans, Hispanics, American Indians, and some Pacific Islanders and Asian Americans are more predisposed to developing diabetes.
KEYS TO MANAGEMENT
When Williams was diagnosed with diabetes, he worked with his doctor to make some big changes to his life.
He started walking twice a day for 20 minutes at a time, stopped drinking pop and cut back on other sweets, started paying close attention to the ingredients in what he ate, and he reduced his portions. He also takes a daily pioglitazone pill, which decreases glucose production and increases insulin sensitivity. His wife and family help keep him on track, but he says holding himself accountable is most important.
“You have to do it yourself,” Williams says. “The doctor and the dietitian, they can tell you what to do, but it all depends on you and what you do.”
Lifestyle changes, medication and insulin are the core treatments for type 2 diabetes. For those with the disease, or caregivers looking after a loved one with the disease, there are a few key management strategies to adhere to:
Follow doctor recommendations. Though the general advice for beating diabetes is universal, each patient is unique and should refer to their doctor’s plan for care, Seaquist says. Patients might be referred to a dietitian, diabetes educator, or other resources to help in their journey. The advice from that professional support network needs to be taken seriously and followed. And don’t be afraid to ask questions!
Eat a well-balanced diet. This is probably the most common advice for people with diabetes, because it is so important, Seaquist says. People with diabetes need to get a sense for how everything they put in their body a ffects blood sugar, she says. Mealtimes should be regular and include fruit, vegetables, whole grains and other nutrient-rich foods, in moderate portions. Foods that are high in fat and calories should be limited—but they don’t need to be cut out completely. “People don’t need to avoid eating everything they like,” Seaquist says. “They need to avoid eating big portions of everything they like.” Individuals should also work with their health care providers to develop a diet that will help them maintain a healthy weight or lose weight, depending on their needs.
Exercise regularly. Getting a workout doesn’t have to be challenging. There are a wide range of physical activities that can help people with type 2 diabetes manage their weight. Most important is just staying active every day, Seaquist says. Small steps like walking to the mailbox or around the block can help get someone on a path to greater wellness. Many programs are available to help Medicare-age adults stay in shape, such as Blue Cross’s Silver&Fit program (silverandfit.com).
Know your numbers. Your doctor will help you set target blood sugar numbers and guide you on how frequently to check. Minimal monitoring might involve an A1C blood test a few times a year. Others might need to use at-home monitors to check blood sugar multiple times a day. This is especially important for people taking medications that they might need to adjust on a daily basis, Seaquist says. “It can be really reinforcing, even in people who aren’t taking medicines, to see it,” Seaquist says. Blood pressure and cholesterol should also be monitored, per doctor recommendations. The ADA recommends blood pressure under 140/90 for adults with diabetes. Cholesterol goals should be discussed with your doctor.
Screen for complications. Individuals living with diabetes need to be extra vigilant about the complications the disease can create, namely cardiovascular problems, kidney disease, eye diseases (retinopathy), and skin and foot problems. Your primary doctor should be able to check for most of those conditions through physical, urine and blood tests annually or more frequently if recommended, Seaquist says. It is important to have a separate annual dilated eye exam, and Carlson says an annual dental exam is also recommended.
Williams receives dialysis treatment—the filtering of blood to make up for the loss of kidney function—three times a week, for four hours at a time. He’s on a waiting list for a new kidney, but he hasn’t let his condition slow him down.
Though he didn’t have any known parent history of diabetes, he now has a brother with the disease. The two exchange information and support. Williams also works to pass along healthy habits to his two sons—neither diagnosed with diabetes—and his grandchildren. This year he’s planning to take a trip with his wife to Hawaii, where the couple was married 18 years ago. All in all, Williams considers his life to be normal, and he’s planning to enjoy retirement.
“I know diabetes is hard for people,” he says. “But you have to do what you have to do to keep your life intact and keep going.”