By Catrina Satterwhite

We’ve heard far too many times how diabetes has affected a family member. I know that I have had it personally affect a few of my own. According to the American Diabetes Association, approximately 2,694,402 people in Texas, or 12.4 % of the adult population have been diagnosed with diabetes. An additional 621,000 in Texas have diabetes but likely don’t know it. There are over 7 million people in Texas, with 34% of the adult population who have pre-diabetes (blood glucose levels higher than normal but not yet high enough to be diagnosed as diabetes). Every year, these numbers steadily increase.

So, how does one end up with diabetes? Of course, we have heard many theories, such as obesity, genetics, sugar addiction, and more. But, we need to go to the source.

I had the pleasure of speaking with Uma Gunasekaran, who is an MD Endocrinologist, and Lead Physician at Parkland Health Outpatient Diabetes Clinic. Dr. Gunasekaran has confirmed that there can be a correlation between obesity and diabetes but not solely obesity.

“There’s a genetic component to it. When you talk to people who have Type 2 diabetes, they will mention family members who have it as well, but there are a lot of environmental factors too, so things that modify your genetic disposition in a way. So, if you have a genetic predisposition and you happen to live in a place where you are interacting with an environment that kind of triggers that genetic predisposition, you can have more of a chance of getting diabetes. There is also lifestyle too so the choices that you make in terms of eating and exercise. Age is not on anyone’s side too, but that whole interaction with all of that,” said Dr. Gunasekaran.

According to Dr. Gunasekaran, studies have shown that some of these environmental factors may include altitude, distances from the equator, pollution, chemicals that we encounter in our daily lives, and plastics that aren’t BPA free which would be considered endocrine disruptors. These disrupters interrupt the processes in our bodies that help us deal with the negative and positive things, so they throw those processes off. Diabetes is one of those diseases where the processes got thrown off and you ended up developing this condition.

She stresses that you can’t blame yourself for developing diabetes because most of the time it’s a genetic disposition.

Just because your friend lost a bunch of weight and no longer has to take medication does not mean that’s going to happen to you because those genetic influences are a lot stronger than your weight.

Dr. Uma Gunasekaran, endocrinologist and lead physician at Parkland Health Outpatient Diabetes Clinic

“You can’t blame yourself for everything, and you can’t fix everything. A lot of times I’ll find people that have had diabetes for a while who may not be at their ideal weight and will go, “You know if I just got all this weight off, my diabetes would go away.” I said that’s the case for many people, but that doesn’t have to be the case for you. Just because your friend lost a bunch of weight and no longer has to take medication does not mean that’s going to happen to you because those genetic influences are a lot stronger than your weight, “she says.

How does obesity coincide with diabetes?

“What we have discovered is that when you have extra weight that your body doesn’t need, it usually comes in the form of fat depositions and what that means is that your body is not able to use the insulin that it produces as well as it normally does. Diabetes is a condition that which your blood sugars get high, and your own body’s pancreas doesn’t make enough insulin. With Type 2 diabetes, that’s not the case, it’s not the fact that the body doesn’t make a lot of insulin, it just doesn’t make enough to overcome these processes that interfere with the efficient use of insulin which is what that fat deposition is doing. It’s interfering. When you normally need a small amount of insulin to cover the carbohydrates you eat, because your body doesn’t use insulin very efficiently because of the fat, you have to make triple, ten times the amount of insulin to cover what we call “insulin resistance” and that’s what’s related to when you have more fat than you actually need, “she said.

But how can one tackle the weight component associated with diabetes?

“Any amount of weight loss or more importantly weight maintenance is critical, so the key here is not to gain anymore. A lot of times people are like “I need to lose weight” and I’m like if you could just not gain any, that’s a success. The first hurdle is to get people to accept the fact that in the past six months, your weight stayed the same, that’s simply amazing because what you told me is that you’ve been gaining weight for the past 10 years, and in the last six months you’ve gained nothing, so be proud of that first accomplishment. The second thing is to try to lose some amount of weight. When it comes to diabetes, the blood sugars actually look a lot better and do a lot better if you exercise, even without losing weight. Even just walking for 10 minutes helps your blood sugar even if you don’t lose an ounce of weight. Don’t look at the scale as a measure of success. Ideally, you would like to lose as much weight as possible to keep yourself in the ideal body weight but that’s often not a realistic expectation for people especially if you have gotten really far from what your ideal body weight should be. I always tell people, look to lose 5% of your weight because it’s not just about your diabetes, it’s about the rest of your body too,” she said.

As far as symptoms of diabetes, Dr. Gunasekaran states that symptoms are very subtle. Some people feel no different than they did 10 years ago and don’t understand how they were diagnosed with diabetes.

For example, you could be tired from a long work week (which doesn’t necessarily stand out as a diabetic problem). Some of these symptoms may include being thirsty all of the time, frequent urination, and fatigue. Weight loss may be a factor in the loss of calories from frequent urination. Pre-diabetes is even harder to detect pre-diagnosis because you may see none of the symptoms mentioned above. It’s best to see a doctor to rule it out.

“They believe that only one-third of patients even know that they have it [pre-diabetes],” she said.

Some of the long-term effects of diabetes include eye disease or blindness, damage to your kidney leading to dialysis, nerve damage or poor feeling that can start at your feet and work its way up your body, and heart disease.

With minorities leading statistics with diabetes, how do we lower these numbers or at least have better maintenance for those with and without diabetes?

“Lifestyle modification. Trying to eat right and keep moving and that’s just a healthy lifestyle that everyone should be looking at not whether you have diabetes or are at risk for diabetes. It’s just a healthier way to live. Once you’ve gotten passed that, there are multiple medications available that you can talk to your provider about, and what the right medication is for you,” said Dr. Gunasekaran.


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