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November is National Diabetes Month, so it’s a good time to remind us all of the “other epidemic” of our age: Diabetes and prediabetes.

More than 34 million Americans have diabetes, and 88 million more are sliding that direction with prediabetes. The bad news is that these people are at rising risk of hardening of the arteries, heart attacks, stroke, kidney disease and failure, progressive retina (vision) damage, painful nerve deterioration, increased susceptibility to many infections including COVID, and shortened life expectancy. It can become a complicated, expensive, exhausting condition.

The good news is that it can be radically controlled, even reversed and sometimes normalized with good attention to self-care such as dietary change and exercise.

What is diabetes? It is all about the glucose sugar in our blood.

We need stable levels of glucose in our bloodstream because glucose nourishes nerve cells and blood cells and gives quick energy to working muscle cells. Our liver and pancreas work together, sensing the glucose level in our bloodstream and working to keep it steadily calibrated as we eat, exercise, fast, and sleep.

When we eat, the sugars and starches rapidly enter our bloodstream as glucose. In response, the pancreas releases insulin that causes the liver to store the sugar and causes cells all over the body to absorb it for energy usage. When we stop eating and blood sugar levels drop, insulin levels also drop, and then the liver starts releasing stored sugar to keep the flow of energy coming.

In type 1 diabetes, the pancreas abruptly loses the ability to manufacture insulin. Without insulin, blood sugars rise to extremely high, dangerous levels, and it is a medical crisis that demands injections of insulin to bring blood sugar under control and manage it long-term. Fortunately, this kind of diabetes is relatively rare and strikes because of a specific, immune dysfunction. Long-term management requires careful balancing of food intake, energy needs, insulin doses and careful monitoring of blood sugar levels, so individuals can live long, healthy lives.

The more common type 2 diabetes comes on gradually, usually associated with weight gain, overeating, excess sugar and carbohydrates in the diet, and not enough exercise. As the body is repeatedly swamped with too much dietary sugar and starch without enough fasting time and exercise in between to burn it off, blood sugars remain elevated and the body must crank out ever higher amounts of insulin to try to control it. Cells become “insulin resistant” however, ignoring the signal to absorb all the sugar. The liver and pancreas go out of calibration, no longer recognizing normal blood sugar level. Gradually, we slide along a prediabetes continuum of worsening blood sugar control often accompanied by rising blood pressure, and rising fats and cholesterol in the bloodstream. The liver often turns so much glucose into fat that it becomes bloated with “fatty liver” and inflamed. Feelings of low energy and lethargy are common.

Remember, though, that your body wants to be healthy! It wants to recalibrate, normalize the blood sugar, clean out the liver, and tune up all the cells that are being damaged by too much glucose and insulin circulating.

You can help make this happen with some lifestyle changes: by spacing out meals, skipping snacks, eating smaller portions, and sensibly reducing sugar and starch intake. Daily modest exercise burns up some of the extra sugar and re-sensitizes our billions of muscle cells to the insulin. Meals that have balanced, moderate portions of protein, fat and starch are gradually digested so the pancreas is not swamped with a sudden surge of sugar. Not eating for six hours between meals or going 12 hours overnight without snacking gives the liver and pancreas time to correct the blood sugar down to normal. With each daily cycle of sensible eating and exercise, the body heals itself. The sense of energy, wellbeing, alertness, and physical capability return.

The role of a diabetes educator is to help you achieve this. Whether you are at risk of getting diabetes because of family history, or you have the early stages of prediabetes or diabetes, a diabetes educator can help you make the choices that can lead you to a healthier, cleaner diet, comfortable exercise, and habits you can live with.

My services as the Grace Cottage Family Health diabetes educator are offered to you free of charge. You do not need insurance to benefit from this resource. You can come for support and education as often and for as long as you want.

It really works! Studies show that prediabetes and diabetes can be prevented in individuals at risk and dramatically reversed or controlled by sticking with healthy habits.

To show you that this is true, I would like to share a couple of local success stories.

One gentleman in his 70s came to me over the course of a couple of years. For a while, his weight see-sawed, but he kept coming in, and he kept trying, and slowly he made progress. Over time, he added a moderate amount of physical activity, slowly reduced his intake of unhealthy carbs, worked on portion control, and lost about 13 pounds. As a result, he was able to completely reverse his pre-diabetes.

Another client came in frustrated about her inability to maintain weight loss. This woman had tried various diets with some initial success, but the weight always came back. I talked to her about food choices and showed her a picture of a healthy dinner plate, and in response, she exclaimed, “I can eat all of that?!” She was learning that by eating healthy amounts of real food, she could feel full instead of deprived.

In order to achieve lasting success with reversing prediabetes and reversing or managing diabetes, you have to make healthy choices not just once, but consistently over time.

No, change is not easy, but I’m here to help. Over time, it does get easier as you develop new and healthier habits.

My services are offered free of charge. To make an appointment, call me at 802-365-3640.

Deborah Brown earned her LPN degree at the Thompson School of Nursing and her RN degree at Vermont Technical College. She has worked as a nurse at Grace Cottage and at Brattleboro Memorial Hospital. She joined the Grace Cottage Community Health Team in 2016.


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