People with diabetes are unable to control the level of sugar in their blood, usually due to a breakdown in how their bodies use the hormone insulin. It’s not completely clear how obesity can contribute to diabetes, but it is known that excess weight is associated with chronic inflammation and a dysfunctional metabolism. And these factors in turn make it easier for someone to stop responding to the presence of insulin as easily as they once did. So by using surgery to help very obese people with diabetes lose weight, the logic goes, you can indirectly treat or prevent the condition. But doctors such as David Cummings, a senior investigator at the University of Washington’s Diabetes & Obesity Center of Excellence, are pushing back against this way of thinking.
The Diabetes Control and Complications Trial (DCCT) was a clinical study conducted by the United States National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) that was published in the New England Journal of Medicine in 1993. Test subjects all had diabetes mellitus type 1 and were randomized to a tight glycemic arm and a control arm with the standard of care at the time; people were followed for an average of seven years, and people in the treatment had dramatically lower rates of diabetic complications. It was as a landmark study at the time, and significantly changed the management of all forms of diabetes.
Apart from these medications, treating diabetes effectively means taking a well-rounded approach: You’ll need to eat well, exercise, and manage stress, because all these factors can affect your blood sugar levels. Staying healthy with diabetes also requires caring for yourself — like protecting your feet, practicing oral hygiene, and tending to your mental health.
Rarely, people with diabetes erupt in blisters. Diabetic blisters can occur on the backs of fingers, hands, toes, feet and sometimes on legs or forearms. These sores look like burn blisters and often occur in people who have diabetic neuropathy. They are sometimes large, but they are painless and have no redness around them. They heal by themselves, usually without scars, in about three weeks. The only treatment is to bring blood sugar levels under control.
In gastroesophageal reflux disease (GERD), sometimes called heartburn, stomach acid and partially undigested food move backward through the esophagus, escaping from the stomach and through the esophageal sphincter that normally prevents such backsliding. This can occur as a symptom of gastroparesis, says Hiroshi Mashimo, MD, PhD, a gastroenterologist at Harvard Medical School. “If the stomach doesn’t empty, it’s likely to reflux up,” he says. GERD may also result from diabetes-related nerve damage affecting the esophageal sphincter, Mashimo adds. One caution: Some diseases, such as a yeast infection in the esophagus, can masquerade as GERD, so don’t brush off symptoms. We can’t treat the gastroparesis or esophageal sphincter problems that contribute to GERD, but antacids and other medications can help to reduce or neutralize stomach acids (see “PPIs the Right Way,” below).
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Start by trying these first three days of the plan, and then use a combination of these foods going forward. Review the list of foods that you should be eating from Step 2, and bring those healthy, diabetes-fighting foods into your diet as well. It may seem like a major change to your diet at first, but after some time you will begin to notice the positive effects these foods are having on your body.
Some studies show that certain plant foods may help your body fight inflammation and use insulin, a hormone that controls blood sugar. Cinnamon extracts can improve sugar metabolism, triggering insulin release, which also boosts cholesterol metabolism. Clove oil extracts (eugenol) have been found to help insulin work and to lower glucose, total cholesterol, LDL, and triglycerides. An unidentified compound in coffee (not caffeine) may enhance insulin sensitivity and lower the chances of developing type 2 diabetes.
Even as things stand now, there are a lot of people left out in the cold. A 2016 study, for instance, found that only 41,000 people with diabetes annually get bariatric surgery in the US—fewer than 5 percent of the total new cases diagnosed every year. And the longer someone has diabetes, studies have suggested, the less likely they are to go into remission if they eventually get surgery. Getting those numbers up will not only require changing the minds of insurers, but public opinion, too.
Family or personal history. Your risk increases if you have prediabetes — a precursor to type 2 diabetes — or if a close family member, such as a parent or sibling, has type 2 diabetes. You're also at greater risk if you had gestational diabetes during a previous pregnancy, if you delivered a very large baby or if you had an unexplained stillbirth.