A native of Houston, Dr. Ann Smith Barnes is an assistant professor of medicine at Baylor College of Medicine, the medical director of the Adult Weight Management Clininc at Ben Taub General Hospital and the medical director of Weight Management Services and Disease Prevention for Harris Health.
Spotlight: How do you get diabetes?
Dr. Ann Smith Barnes: My patients will say, “oh you know diabetes runs in my family,” and feel there is no way to escape it because it must be genetic. In fact, there are some genetic factors, but there are some unhealthy lifestyle choices impacting weight, putting them at greater risk of developing diabetes.
When we increase our weight we often increase fat in our bodies, which affects the way it responds to insulin. Excess fat makes our bodies less able to use insulin to control the sugar levels in our body, and that’s called insulin resistance. Your pancreas which makes insulin, begins to work harder to make more insulin, but your body doesn’t respond. Eventually your pancreas gets really worn out and isn’t able to keep up. Your sugar levels rise while your insulin production stays flat. Those elevated sugars are diabetes.
Spotlight: Are there warning signs you may be at risk for diabetes?
Dr. Smith Barnes: The American Diabetes Association has determined that the hemoglobin A1C, which is an average measure of your blood sugar over a three month period, is a reasonable tool to use to screen for diabetes or pre-diabetes. Normal sugar levels, using the hemoglobin A1C is less than 5.7. Frank diabetes is a hemoglobin A1C level of 6.5 or higher. Pre-diabetes is 5.7 – 6.4. This means over three years’ time, you are at very high risk of becoming diabetic, but you have time to make life changes to prevent it or push it off into the future so it does less damage to your body.
The Diabetes Prevention Study from the early 2000’s revealed the most effective way to reduce the risk of diabetes is exercise. It showed people could reduce their risk by 60% with 150 hours of exercise a week. In Houston, many YMCAs across the city, are doing the Diabetes Prevention Program. You get intensive coaching on how to use the equipment and which classes you should to take. There’s a lot of good counseling on weight loss and physical activity. There is a fee, so it can be challenging for some folks. If they are Harris Health patients they may qualify for grants. Your employer’s health insurance provider may cover the fee as well.
Spotlight: Is it possible to be cured of diabetes through proper diet and exercise?
Dr. Smith Barnes: Once you have diabetes you could never really say you are cured of it. You can say it is under amazing dietary control. Your risk, though, is still extremely high to be diabetic again because your pancreas has worked overtime making insulin, so there’s an increased risk it will begin to fail in the future.
Spotlight: Once you get diabetes how can you control or manage it?
Dr. Smith Barnes: There are some standard things you should be very attentive to. In most patients your blood sugar levels should be less than 126. One thing you can do is really look and keep track of your sugars. So you can adjust what you eat, adjust your physical activity, or your doctor can adjust medications to make sure your sugar levels are well controlled. If you’re elderly, 70-80 years old, the number might not need to be that low because you worry about it getting too low. For most people you want to try to get it as close to normal as possible. When you wake up in the morning your blood sugar should be less than 126 and as close to 100 as possible.
The other ways you can begin to control your sugars is adjusting what you eat. You’ll often hear diabetics shouldn’t eat as many carbohydrates as others because carbohydrates—starches, pasta, bread, rice, white sugar—turn into sugar, and that’s exactly what you don’t need.
Physical activity burns sugar which is helpful in bringing sugar levels down. It’s recommended the average person should get 150 minutes of exercise a week.
Spotlight: Besides sugar levels, what else should you monitor?
Dr. Smith Barnes: You need to get regular eye exams, once a year, to make sure you don’t have damage to your eyes and your vision. Some of those changes happen before you realize it.
You also need to get your feet checked. You can do it partly yourself but you also need a clinical person to do it regularly. Make sure you don’t have any ulcers or spots that look like an infection. Because your nerves are damaged, you may not realize when you get an infection which, if left untreated, may lead to an amputation. So make sure you protect your feet with good footwear, not walking around barefoot, and check your feet daily for new cuts or dings.
It’s so critically important to prevent the onset of diabetes because more and more research shows that once you have it, it’s hard to overcome its cardiovascular effects. Your blood vessels get clogged; you’re at a greater risk for heart attack, stroke, and eye and kidney damage. It’s possible with appropriate physician monitoring to control your diabetes and live a long, productive, and happy life.