The World Health Organization states that the incidence of diabetes has risen globally, from 108 million in 1980 to 422 million cases in 2014.
Globally and in the U.S., diabetes is the seventh leading cause of death. 23.4% OF the U.S. population or 7.3 million of the U.S. population are living with undiagnosed diabetes indicating the need for increased awareness and education around diabetes, especially as there is a growing prevalence of obesity, particularly childhood obesity.
Diabetes is a chronic illness in which the body does not produce insulin or a sufficient volume of insulin to use efficiently.
Insulin is a peptide hormone that is responsible for regulating the glucose that we obtain from consuming food. Insulin is produced in the pancreas. When we consume food, it allows your body to take glucose (sugar) from food for instant energy, as well as storing glucose in the cells for future use.
There are three types of diabetes:
Type 1 Diabetes is an autoimmune disorder in which the immune system attacks beta cells in the pancreas, causing the pancreas to produce little to no insulin.
10% of Americans are diagnosed with type 1 diabetes.
Type 1 Diabetes is characterized by the body’s inability to produce enough insulin. Daily insulin injections must be taken by those who suffer from type 1 diabetes. Originally, type 1 diabetes was known as juvenile or childhood onset diabetes due to the high prevalence rate among children. Today, it is known that type 1 diabetes can develop at any point of your life.
Symptoms include: Increased thirst, extreme hunger, dry mouth, frequent urination, unexplained weight loss, fatigue, blurred vision, headaches, peripheral neuropathy, mood changes.
Type 2 diabetes occurs through insulin resistance. When the body cannot regulate insulin levels, blood glucose levels may rise outside of healthy boundaries.
90% of Americans are diagnosed with type 2 diabetes.
Type 2 Diabetes is characterized by the body’s ineffective use of the all important insulin for regulating blood sugar. Type 2 diabetes was formerly known as non-insulin dependent or adult onset diabetes. It is now known that type 2 diabetes may occur in children. Type 2 diabetes results due to lifestyle factors such as nutrition and the level of activity.
Symptoms include: Increased thirst, increased hunger, dry mouth, frequent urination, unexplained weight loss, fatigue, blurred vision, headaches, darkened skin, slow healing lesions and increased level of infections.
Gestational diabetes occurs when the body cannot produce a sufficient volume of insulin to maintain high blood sugar levels that may occur during pregnancy, particularly in the latter half of a pregnancy. Gestational Diabetes is defined as a glucose intolerance disorder that arises during pregnancy. Gestational Diabetes increases the risk of high blood pressure, postnatal depression and the need for a C-section.
Symptoms include: There are often no symptoms associated with gestational diabetes which is why it is often recommended to test blood sugar levels during pregnancy.
The rising numbers of children that are overweight or obese is contributing to the number of type 2 diabetes cases, particularly in the United States.
Today, most of the world’s population lives in a country where the cause of death is being overweight or obese as opposed to being underweight, according to the World Health Organization.
340 million children were classified as overweight or obese in 2016.
20% of U.S. children and adolescents aged 5-19 suffer from obesity.
Living With Diabetes: An Interview With Christel Oerum
Your publication is aptly titled "Diabetes Strong" - how did you get started on this?
Diabetes Strong is a website for people living with diabetes, by people living with diabetes. It came about because I, as an active woman living with type 1 diabetes, couldn’t find any easily accessible resources online on how to successfully balance diabetes, exercise, and nutrition. It started out as a small blog where I documented my own experience living and working out with diabetes and in 3 years have grown to a full-fledged website with several contributors and over 300,000 visitors per month.
For people who don't know, what is diabetes?
There are many types of diabetes, with the two main types being type 1 and type 2 diabetes. In the US, there are more than 30 million people living with diabetes and the majority live with type 2 diabetes. What all types of diabetes have in common is that they result in elevated blood sugars, which in many ways can be terribly damaging to the body.
Type 2 diabetes is a metabolic disease where the body either doesn’t produce enough insulin or the body isn’t effective at using the insulin produced. Some people can get their blood sugars back to normal ranges through exercise and diet, while others will need medication. The medication types range from tablets to injected insulin. A doctor will determine the right treatment option.
While type 2 diabetes sometimes can be treated without insulin, Type 1 diabetes is an autoimmune disease that results in the body not producing insulin and, consequently, people living with type 1 diabetes must monitor their blood sugar and adjust it with insulin. Insulin is the hormone that transports energy from the bloodstream into the cells, and without insulin, your body is essentially starving. There’s no cure for type 1 diabetes, no other treatments than insulin, and most people living with type 1 diabetes will die within a few days without insulin. Insulin is a fickle hormone and too much or too little can be fatal.
What were the main symptoms you were experiencing before you found out you had diabetes?
I was diagnosed with type 1 diabetes when I was 19 years old. My body was still producing some insulin (it can take a while before the body stops the production completely) but not enough to give my body enough energy to function normally or keep my blood sugars in a normal range.
I didn’t end up in the hospital with DKA (Diabetic Ketoacidosis), which is a common way to diagnose type 1 diabetes.
I was showing many of the symptoms like extreme thirst, frequent urination, weight loss, and fatigue. My family started to worry when I kept falling asleep and needing to nap at family gatherings, and they urged me to see my PCP. I did, and was diagnosed with diabetes after a simple blood test in the office.
What is your goal with Diabetes Strong?
I want to make sure that everyone living with diabetes has the right resources to be active and healthy living with diabetes freely available. Living with diabetes is a 24/7 job, and it can be overwhelming, taxing, stressful, and often very lonely. I don’t want anyone to feel like that. I want people to be able to go online and quickly find the support they need, either in writing on Diabetesstrong.com or in our Diabetes Strong community on Facebook.
How do you deal with diabetes on a daily basis?
I think your personality has a lot to do with how you tackle diabetes on a daily basis and how frustrated you become. I always just dealt with it. It’s not like I have a choice! That doesn’t mean that I don’t have moments where I feel sorry for myself or annoyed to have to be my own pancreatic system, but my logical mindset quickly takes over. I know I’m lucky to be like this, for some it’s mentally much harder.
Diabetes management can be hard because we don’t have full information. I need to consider everything when managing my blood sugars. It’s not just what my blood sugar is right now and what I am going to eat, it’s also what was my blood sugar was earlier, when I last took insulin, what kind of activity am I doing now and later, if I am stressed out, If I’m properly hydrated, if I’m sick, etc., The list of things to consider when managing diabetes goes on and on, and as mentioned, I don’t always know the answers, so I have to guess. After 20 years with diabetes, you get better at guessing, but you won’t get it right every time.
As for the practical day to day diabetes management, I use the diabetes tools that are right for me at this stage of my life. I manually test my blood sugar but I also wear a continuous glucose monitor (CGM), a device that sends my blood sugar readings to my phone in real-time. That was a gamechanger for me because I all of the sudden can see what’s going on with my blood sugars at any time, even when I am sleeping. Now at least that part of the puzzle is clearer.
How do you think exercise helps you to manage your diagnoses?
Exercise is good for anyone, but for us living with diabetes, it can also be an integrated part of our diabetes management. When we exercise, our insulin sensitivity improves, meaning that the body becomes more efficient at using the insulin we have available. That means that I don’t have to inject as much insulin as if I didn’t exercise, which means that my diabetes becomes a little easier to manage.
That being said, until I fully understood exactly how exercise affected my body, exercise did not make my diabetes easier to manage, it actually made it harder. And that’s something I often come across when I interact with others living with diabetes. It goes back to what I mentioned before about not having full information and how that complicates life with diabetes. Exercise can be dangerous if you don’t understand how to adjust your diabetes management since it can intensify the impact of the injected insulin and drive blood sugars dangerously low. That fear of going too low (which can be fatal) is something that prevents some people living with diabetes from exercising and one of the main reasons why I find it so important to provide an online resource about how to exercise safely and effectively with diabetes in the form of Diabetes Strong.
What was it like when you found out? What was the first thing that went through your mind?
My diagnosis was not optimal in the sense that I left my PCP’s office thinking I’d been handed a death sentence.
I didn’t know anyone with diabetes, and my PCP failed at explaining it. I’m lucky to have a mom who could explain it to me (she’s a nurse) when I came home, and I later received really good care at a diabetes clinic. The nurse I met at that clinic was the first to tell me never to let diabetes stand in my way. And I’ve been living my life that way ever since
What advice would you give to someone who has just found out that they have diabetes?
Don’t expect to be perfect, you can only do the best with the tools you have available. Diabetes is going to be a lifelong, albeit unwanted, partner so learn as much as you can from your medical team and from the diabetes community, and make sure you early on take charge of your own care. And if you want to climb a mountain, run a marathon, become a parent or whatever else you can think off, you most likely can find a way to make that happen.
How did diabetes affect your training in the beginning?
Frustration and a lot of head scratching is probably the best way to describe it. When I got more serious about training, I was training for a bikini bodybuilding show, so I did resistance training and cardio. Those two types of exercise (anaerobic versus aerobic) will affect blood sugars very differently, and to keep blood sugars in range, you need to apply different strategies. But no one had ever told me this.
At that time, I didn’t have a CGM, only tested my blood sugar every few hours, and quite honestly had no clue what was going on. That’s when I started to look for resources online and didn’t find any. So I started experimenting and being very diligent about testing my blood sugar and keeping track of what I ate and when. After a while, patterns emerged and those observations were the beginning of Diabetes Strong. We don’t all have to start from scratch, so I use all my waking hours communicating how to exercise safely and effectively with diabetes.
How do you find a way to balance your dietary requirements and training?
I don’t believe there is such a thing as a “Diabetic Diet” you have to follow. I eat according to my goals. However, some foods can make diabetes management more or less challenging. In general, I try to stay with low/medium glycemic carbohydrates, always combined with a protein. I know that many people like clearer guidelines than that, so I have meal plan examples on the website. I also try to eat smaller meals since I find that easier to manage from a blood sugar perspective.
What advice would you have given yourself on finding out that you had diabetes?
Keep living your life and stop trying to be perfect.
How do you manage your condition now?
I’ve now been living with type 1 diabetes for over 20 years and my diabetes management has evolved and so has the available technology.
I started out with very little knowledge of it all and just managed with insulin shots and a blood glucose meter for many years. One day I realized that although I was doing well, and my medical team was happy, I was actually not as tightly controlled as I could be. So I started paying more attention to how different foods impacted my blood sugar and I managed to reduce the amount of blood sugar fluctuations.
During the last 5-6 years, exercise has become a larger part of my diabetes management. It will of course never replace my insulin, but by incorporating daily exercise, I find that my blood sugars become more predictable and consequently easier to manage. I’m sure my management will continue to evolve as I learn more and more technology becomes available.
What words do you live by?
There is (almost) nothing you can’t do with diabetes as long as you have the right attitude, knowledge, and access to the proper treatment option