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As the United States surpasses 250,000 deaths from Covid-19, it’s worth noting that people with diabetes account for roughly 40% of that morbidity, according to the Centers for Disease Control and Prevention.

The news is not all bad. By eating right and keeping your body active, diabetes often can be avoided and even sent into remission, says Dr. John Smith, lead medical director at Blue Cross and Blue Shield of North Carolina.

In recognition of National Diabetes Month, Dr. Smith agreed to discuss some of the factors associated with diabetes — a chronic disease that disproportionately affects Black and Latino residents.

What is Diabetes?

Dr. Smith: Diabetes is a condition where your blood sugar levels are high. There are two types of diabetes: Type 1 is when your body does not make insulin; Type 2, also called adult-onset diabetes, is when the insulin in your body does not perform the task that it should, which is to lower the blood sugar level. This is the most common type of diabetes.

Fact: 34.2 million U.S. adults have diabetes; about 7.3 million are undiagnosed. An estimated 88 million adults have pre-diabetes.  In total about, 122 million Americans live with diabetes or prediabetes (37% of the U.S. population), according to the American Diabetes Association and the Center for Disease Control. In North Carolina, about 1 million people (12.% of adults) have diabetes. Approximately, 50,000 adults are newly diagnosed with diabetes each year.

What is a normal level of blood sugar?

Smith: Normally, your blood sugar is somewhere between 80 and 140 mg/dL, but it can vary based on your health conditions. It also can vary based on what you’ve eaten or when you last ate. If your doctor has asked you to “fast” before your diabetes test — which means you won’t eat anything for at least eight hours before the test — then your blood sugar levels should be less than 100.

What are the common symptoms for diabetes?

Smith: Symptoms of diabetes may include blurred vision, weight loss, increased thirst and increased hunger. These are not specific for diabetes, but if you have any of those symptoms with a blood sugar level over 200, that’s indicative of diabetes.

Why is diabetes so harmful?

Smith: Over time, if you have elevated blood sugars, it can damage your organs. It can cause heart disease, increase your risk for strokes, high blood pressure, blindness, kidney failure, and damage to the nerves (neuropathy). It also can cause gastroparesis, a condition in which your stomach does not move food to the intestines in a normal fashion. In men, it can cause erectile dysfunction. It can also increase your risk of lower limb amputations and death.

The CDC reports that 40% of the people who have died from Covid-19 also had diabetes. What accounts for that high percentage?

Smith: At this point, there’s not enough evidence to say that people with diabetes are more likely to get Covid-19. But if you do have diabetes and you also get Covid-19, then it’s typically more severe and you are more likely to have complications. Severe complications are more likely if your blood sugar isn’t controlled or if you have multiple underlying conditions, such as diabetes, heart disease or high blood pressure.

If you fall into the category of being an essential worker and you have diabetes, it’s important that you make good lifestyle choices and exercise. It’s also important that you follow CDC guidance in terms of wearing a face mask, practice social distancing, and wash your hands frequently. It’s also important to remember that now as Covid-19 will be occurring during flu season, that some of the same preventive measures used for Covid-19 (such as hand washing and distancing) also will help to reduce your risk of getting the flu.

How is diabetes treated?

Smith: The foundation treatment for diabetes is healthy eating and exercising. Eating healthy means eating more fruits, vegetables, lean proteins, whole grains — foods that have high nutritional value and fiber but are low in fat and calories. Typically, you want to limit saturated fats or refined carbohydrates — starchy foods such as mashed potatoes and macaroni and cheese. You also want to limit sweets.

Exercise is also important due to it moving the sugar out of the bloodstream into the cells, where it can be used as energy. Even moderate exercise can reduce your risk for complications from diabetes. You need to choose an exercise you enjoy, like walking, swimming or biking, because you will be more likely to stick with it. You should talk with your health care provider before you begin an exercise program to ensure that your heart and body are healthy enough to exercise.

If diet and exercise do not adequately control blood sugars, medications (pills or injections) may be used.  Some people may benefit from bariatric surgery. Just because you are on medications or have bariatric surgery, they are not a substitute for a healthy diet or exercise. Diet and exercise would still be the cornerstone of treatment.

Why are African Americans disproportionately impacted by diabetes?

Smith: There are several factors:

 Diet. People of color often have what’s called a Southern diet — lots of fried foods, desserts and other foods that don’t necessarily have the best nutritional value.

 Obesity. In North Carolina, the obesity rate is about 38.1%, but for Black people, it’s about 41.3%.

Family history is another risk factor; we think there probably is some genetic component.

Access to health care. When you look at patients who don’t go to the doctor, lack of insurance is sometimes the barrier. Black people are about one-half times more likely to not have insurance compared to White people.

Food deserts. Black people are more likely to live in what we call “food deserts,” which are communities where it’s hard to get fresh fruit, vegetables or other helpful whole foods.

Fact: Compared to non-Hispanic Whites, Blacks and Latinos are 50% more likely to be diagnosed with diabetes.

Who should be screened for diabetes?

Smith: The American Diabetes Association has established several guidelines for screening: Anyone with a body-mass index (BMI) of 25 or higher should be tested. Additional risk factors for which you should be screened include being over the age of 45, high blood pressure, heart disease or high cholesterol levels, physical inactivity, first-degree relatives (parent, brother, or sister) who have been diagnosed with diabetes

So, it sounds like diabetes can be avoided.

Smith: For the most part, it can be avoided. About 70% of the risk factors for diabetes are due to lifestyle choices. If you can make healthy lifestyle choices (follow a good diet and exercise), diabetes can be avoided in most cases. And if not prevented, it can be controlled.

Any final thoughts or advice?

Smith: It’s much better to prevent diabetes than to treat it. It’s not easy to lose weight, and maintaining a healthy weight, even with regular exercise, is hard; but it certainly is worth it because we all want to be healthy and enjoy life.

If you have diabetes, you do not have to try to control it all my yourself. There are many resources available to you, whether it’s from your health care provider or the American Diabetes Association.

Fact: About 53,000 NC residents are diagnosed with diabetes each year.

Dr. John Smith is a NC Physician and Lead Medical Director at Blue Cross and Blue Shield of North Carolina (Blue Cross NC). He has over 17 years of clinical practice experience as a family practitioner working in a variety of care settings, including a hospital and a community health center, and a group model HMO model. He also has 14 years of experience in utilization management, appeals and provider network quality at Blue Cross NC. He led the provider (physician and facility) tiering program for quality, cost, and efficiency from 2015-2020.Dr. Smith serves as a co-chair for the National Quality Forum (NQF) Neurology Workgroup and was a member of the NC Institute of Medicine (NCIOM) Serious Illness Workgroup in 2019. He is now a member of the NC Serious Illness (NCSI) Coalition.

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