 What is diabetes? Diabetes is a disease that occurs when your blood glucose or blood sugar is too high. There are many types of diabetes, but the two most common are type 1 and type 2 diabetes. Type 1 diabetes is commonly diagnosed in childhood, but does not mean that adults cannot get it. In this disease, your body makes antibodies which destroy your pancreas, rendering you unable to produce any insulin and you require insulin for survival. This by far is the minority of patients. The majority of patients have type 2 diabetes. In this condition, your body is resistant to the effects of insulin. In both conditions, chronic elevations in blood glucose can lead to complications which we call microvascular or macrovascular complications. These include damage of internal organs like your eyes, kidneys and nerves and increase your risk of heart attack and stroke. Therefore it is very important to control blood sugars or glucose in order to prevent these complications. Who should be tested for diabetes? The current recommendations are that anyone aged 45 years or older should be screened for diabetes. If this initial test is normal, you should be retested every three years. Certain people who carry higher risk factors should be tested sooner. Patients who have a family history, if they are overweight or obese, or are members of certain ethnic groups such as African American, Asian American, Native American, Hispanic American or Pacific Islanders need to be screened sooner. How is diabetes diagnosed? Diabetes can be diagnosed by using one of four commonly used tests. Probably most commonly used right now is a hemoglobin A1C. Your doctor may also test a fasting plasma glucose, which is a blood test drawn before eating or a random blood glucose, or he or she may choose to perform an oral glucose tolerance test. What is a hemoglobin A1C test? That's a great question. A hemoglobin A1C test is a test that doctors commonly use to either diagnose diabetes or follow the long term control of diabetes. What it measures is the amount of blood sugar that is bound to your red blood cell or hemoglobin. Every patient, whether they have diabetes or not, has a certain percent of blood sugar attached to their red blood cells. When you have diabetes, the chronic elevation binds to the blood cell at an accelerated rate and thus we are able to follow the long term control or make a diagnosis for diabetes based on this test. What can someone do to manage their diabetes? Again, that's a great question. Unfortunately, there is no cure for diabetes and requires ongoing management. The first and most important thing I like to tell my patients to do is receive appropriate education. Diabetes requires so much self-management, which the day to day patient needs to comply with in order to be successful in. When I mean lifestyle management, what I mean is eating the right things, obtaining regular exercise and maintaining a healthy weight. At times lifestyle management is not sufficient to control diabetes and you'll require medications and therefore you should consult with your doctor at that time. What's the biggest myth about diabetes and food? So I'm frequently asked this question and what I find as someone comes to me and says, I was just diagnosed with diabetes and now I can't eat any sugar or carbohydrates for the rest of my life. And that's simply not true. Patients actually need a little bit of carbohydrate or sugar in their diet every day. It's required to make sure that your body functions properly. What is important is to limit and have a portion control as to how many carbohydrates you eat daily and choosing the appropriate carbohydrates. So getting your carbohydrates or sugar from fruits and vegetables as opposed to processed foods, things like pizzas and white breads. What is the Diabetes Education Center at NYU Winthrop? So the Diabetes Education Center at NYU Winthrop Hospital is a tremendous resource available to our community. It was actually the first diabetes education center opened in New York State and it is run by certified diabetes educators, nutritionists and registered dietitians. At our Diabetes Education Center, you can receive comprehensive diabetes education when you complete the core program. You can receive medical nutritional therapy, meaning instructions on how to read food labels, learning about appropriate dietary selection, meal planning and also you can have very high level training from some of our diabetes nurses on some of the current technology available such as continuous glucose monitors and insulin pumps. What type of doctor should someone see to manage their diabetes? So generally what's recommended is that patients when they're first diagnosed with diabetes should be seen by their primary doctor whether that's an internist or a family medicine doctor and they can start by building your diabetes care team which should consist of a diabetes educator, a nutritionist and certain times when your case is complex or you have type 1 diabetes it will require the care of a specialist and that would be an endocrinologist. What is an insulin pump and how does it work? An insulin pump is a device that's used to administer insulin. It's used in patients who require continuous insulin therapy. The traditional type of pump is one in which there's an insulin reservoir, a pump, tubing and this is attached to the patient right beneath the skin. This insulin pump continually delivers insulin and replaces the need for multiple daily injections. The continuous little basal rate which we call replaces the long-acting insulin patients would normally use and when it's time for meals patients calculate their carbohydrates and enter the amount that they're going to be eating in their pump and it delivers the insulin requirement for their food. The second type of insulin pumps are patch pumps. In a patch pump the insulin is stored in this device and it is applied to the skin and it obviates the need for tubing. The personal diabetes manager communicates via the pump with Bluetooth. All the pumps on the market right now have the same essential features and you should speak to your physician or diabetes educator as to which one is most appropriate for you. What is a continuous glucose monitor? In order to really delve into that question it's important to first understand how we conventionally monitor blood glucose. A glucometer is a device in which patients can monitor their blood sugar at certain points in time during the day. You may be told by your doctor to either check before breakfast, before dinner or two hours after meals and this information can be very useful but it only gives us a point in time of what your blood glucose is. Sometimes this information is not enough and we want real-time ongoing assessment. A continuous glucose monitor is a device in which a patient puts a tiny electrode beneath their skin and this device allows the glucose to be measured every five minutes and report it to a receiver and displays trends of glucose and provides a lot of valuable information to clinicians in regards to your blood glucose basically minute to minute. Is it true that children with diabetes should avoid exercise? It's one of those things that you commonly hear but again is simply just not true. Although there is a risk with children with diabetes when they exercise of developing hypoglycemia or a low blood sugar this does not mean that they should never exercise and it's quite important for them actually to partake in regular physical activity. Throughout the past decades there's been so many advancements in terms of diabetes technology with insulin pumps and continuous glucose monitor. We've really been able to manipulate and adjust the amount of insulin children get when they get it and monitor for hypoglycemia sooner than when the symptoms develop. Does everyone with diabetes need to give themselves injections? I get this question asked of me all the time. For patients with type 1 diabetes the answer is yes. These patients require insulin for survival and they need to administer insulin multiple times throughout the day. For patients with type 2 diabetes the first line of treatment is lifestyle modification followed by pills. Unfortunately some patients do progress and do require the use of insulin to treat type 2 diabetes. How can I prevent diabetes? The most important thing you can do to prevent diabetes is leading a healthy lifestyle. What I mean by this is ensuring that you eat healthy, ensuring that you get plenty of fruits, vegetables, reducing your intake of sweetened beverages and reducing your intake of processed carbohydrates. Ensuring that you obtain enough regular activity, exercising and maintaining a healthy body weight. If you've already been diagnosed with pre-diabetes the NYU Winthrop Diabetes Education Center has a diabetes prevention program which has been demonstrated to reduce your risk of progressing to type 2 diabetes. For more information on NYU Winthrop Hospitals Diabetes Program please call 1-866-WINTHRUP or visit us online at NYUWINTHRUP.org