Living Well with Diabetes

Diabetes, a disease marked by high levels of sugar in the blood, is more common than ever before. In the United States, the prevalence of diabetes has more than quadrupled in the past two decades. Not only are more people being diagnosed with diabetes, they’re also developing the disease at younger ages.

That’s worrisome because the risks of complications from this common disease — which include heart attack, stroke, blindness, kidney failure, and amputation — become greater the longer you have diabetes. But you can delay or even prevent the development of debilitating long-term complications. It starts with getting your blood sugar goals. And thanks to innovations such as high-tech monitoring devices, improved medications, and nearly painless insulin injectors it's easier than ever to be successful.

This special health report will help you better understand and manage your diabetes. It includes detailed, updated information about medications and alternative treatments for diabetes, and a special section on weight-loss strategies. By reading this report, you’ll also learn the basics of how your body metabolizes sugar, how and when to monitor your blood sugar, and how to cope with both short- and long-term complications of the disease. Perhaps most importantly, you’ll see that it’s not just possible to live with diabetes; it’s possible to live well.

Prepared by the editors of Harvard Health Publishing in collaboration with David M. Nathan, Professor of Medicine, Harvard Medical School, and Director, Diabetes Center and Clinical Research Center, Massachusetts General Hospital. 53 pages. (2021)

Diagnosing diabetes
In making a diagnosis, your doctor will take into account any symptoms, your family history, and the results of your blood tests. To summarize, any of the following results signifies diabetes:

• fasting plasma glucose: 126 mg/dL or above
• oral glucose tolerance two hours after the sugar drink: 200 mg/dL or above
• HbA1c: 6.5% or above.

But what type of diabetes do you have? In the past, it was usually very easy to judge by the person’s age whether he or she had type 1 or type 2 diabetes. Those who developed it as children or adolescents had type 1. Those who developed it much older had type 2. Similarly, people who were overweight or obese were likely to have type 2 diabetes, and thin people were more likely to have type 1.

Now, however, the lines have been blurred. As a result of the obesity epidemic, younger and younger people are developing type 2 diabetes—and we now know that one in five people with type 1 develops it as an adult. That makes it harder to use age and obesity as a guide.

Identifying people with prediabetes
As noted, several of the blood tests for diabetes can also uncover prediabetes—a condition marked by lesser degrees of abnormal glucose metabolism. Having prediabetes is not a guarantee that you will develop full-blown diabetes, but it does put you at higher than-average risk, since the likelihood of developing diabetes increases along with blood glucose and HbA1c levels. If your results fall into the intermediate ranges listed below, you are at high risk for developing diabetes and should have screening tests every year:

• fasting plasma glucose: 100 mg/dL to 125 mg/dL (called impaired fasting glucose)
• oral glucose tolerance: 140 mg/dL to 199 mg/dL (called impaired glucose tolerance)
• HbA1c: 5.7% to 6.4%.

In addition to putting you at risk for full-blown diabetes, higher levels of blood glucose or HbA1c—even in these prediabetic ranges—increase your risk for cardiovascular disease.

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