Brook Remote Care

Week 4 – Your Diagnosis: Type 2 diabetes

Purpose

Better understand type 2 diabetes and the complications that can arise without proper blood sugar control, plus problem solving for common challenges when dealing with diabetes day to day.

Time to read

10 minutes

WHAT IS DIABETES?

Diabetes is a chronic health condition. There are multiple types of diabetes, but we’ll focus on type 2 diabetes.

When someone has type 2 diabetes, their body’s relationship to a hormone called insulin is out of balance. Insulin is made by your pancreas, and it’s a hormone that helps you get energy from food.

When you eat food, that food is digested into simple sugars. Those sugars move from your digestive tract to your bloodstream, which causes a release of insulin. Insulin’s job is to move those sugars out of your blood and into your cells, where the sugar can be used for energy. Type 2 diabetes is a disease where insulin is not able to do its job, meaning insulin can’t move the sugars out of your blood. This causes the sugars to stay in your blood, which is why people with diabetes have high blood sugar. Sugar is useless to us in the blood, it must be moved into cells by insulin in order to give us energy. But why can’t insulin do its job when someone has diabetes? Let’s break it down further.

INSULIN IS THE KEY

Literally! Insulin is a molecule that has a specific shape to perfectly fit into receptors on the surface of your cells. These receptors act as “locks” to the doors that allow sugar to go from your bloodstream to your cells. Only then can the sugar be used as energy.

(Shown above: insulin opening the locked gate on cells, allowing glucose/sugar in)

WHY DOES THIS HAPPEN?

A. The locks on cells stop working as well

This phenomenon is called “insulin resistance.” The “locks” on cells are not sensing that insulin is present. They are resistant to being unlocked by the “key.” When this happens, the sugar in your bloodstream (which we get from food), is unable to get into cells, where it needs to go to be used as energy. The sugar builds up in the blood.

B. There are not enough keys (insulin) to open the locks

In type 2 diabetes, insulin resistance occurs (described above). Insulin is released when the body senses that there is sugar in the blood after a meal. However, because insulin resistance is occurring, sugar builds up in the blood with nowhere to go. The body senses that there is still too much sugar in the blood, and so it releases more and more insulin in response. The pancreas, which is the organ that makes and releases insulin, ends up working overtime. Eventually, the pancreas gets tired and cannot keep up with the body’s demand for more and more insulin as blood sugar remains high, meal after meal. This is often referred to as “pancreatic exhaustion.” When this happens, the pancreas stops working as well, and not enough insulin can be produced. The cycle continues in this way, with sugar building up in the blood and not being able to move into the cells.

HOW DOES DIABETES AFFECT MY BODY?

Bodies are not built to have high amounts of sugar present in the bloodstream for long lengths of time. Individual sugar molecules attach to red blood cells when there is excess sugar in the blood.

(Shown above: excess sugar in the bloodstream)

(Shown above: excess sugar in the bloodstream attaches to red blood cells over time)

Why is this a problem? Sugar molecules damage the delicate lining of the blood vessels as they flow through, sort of like something sharp scraping up against something fragile. This damage leads to long-term complications over time.

WHAT FACTORS INCREASE RISK FOR DIABETES?

Multiple factors can increase your risks for developing diabetes including:

  • A history of pre-diabetes

  • Weight gain particularly if you are overweight or obese

  • Family History

  • Age people 45 years of age or older are at higher risk

  • Not getting enough exercise (sedentary lifestyle)

  • A history of gestational diabetes

  • Race: African American, Hispanic/Latino American, American Indian, or Alaska Native (some Pacific Islanders and Asian Americans are also at higher risk)

HOW CAN I IMPROVE MY BLOOD SUGAR CONTROL?

Managing your blood sugar involves a multi-faceted approach that can include:

  • Test blood sugar regularly and track over time

  • Communicate results and symptom changes with your doctor

  • Make healthy food choices

  • Focus on portion control

  • Increase physical activity

  • Understand your medications

  • Manage your stress

  • Maintain a healthy weight

  • Choosing a healthy lifestyle. Other modules in this program will review these areas.

It’s important to note, everyone’s journey with diabetes is unique and you may find you are doing very well in some areas, whereas other areas might be a bit more challenging from time to time. Your Health Coach is here to help you navigate through these challenges and support you with a creation of a pathway forward.

RECOGNIZING AND TREATING HYPOGLYCEMIA

Hypoglycemia, or low blood sugar (less than 70 mg/dL), is serious and can even be fatal. Immediate action is important. The only way to know for sure if you’re experiencing hypoglycemia is to check your blood sugar.

When your blood sugar is low, you may experience symptoms like:

  • Shakiness

  • Dizziness

  • Confusion

  • Headaches

  • Blurry vision

  • Heart palpitations

  • Anxiety

  • Sweating

If you check your blood sugar and it’s below 70 mg/dL, use the “rule of 15” to treat your hypoglycemia. This means eating or drinking 15 grams of quick-digesting carbs, waiting 15 minutes, and then checking your blood sugar again.

If your blood sugar is still below 70 mg/dL or you still have symptoms, repeat with another 15 grams of quick-digesting carbs, waiting another 15 minutes, and then test again. If your blood sugar is still lower than 70 mg/dL after you treat it three times, call 911.

Once your blood sugar is above 70, eat a snack with complex carbs and protein (e.g. half a peanut butter sandwich on whole grain bread).

If you can’t check your blood sugar but feel symptoms, eat or drink 15 grams of carbs and check as soon as you can.

Here are some examples of 15 g of quick-digesting carbs:

  • 3 glucose tablets (available at drugstores)

  • 1 serving glucose gel (available at drugstores)

  • 4 – 5 Lifesavers candies

  • 4 ounces (½ cup) of juice or regular soda (not sugar-free)

  • 1 tablespoon sugar, honey, or jelly

  • 8 ounces (1 cup) of skim or 1% milk

COMMON QUESTIONS AND CHALLENGES

I’m getting high readings or my numbers are fluctuating a lot:

A pattern of high blood sugar readings should be shared with your doctor’s office. High readings can be influenced by: food portions and meal timing, stress levels, or a current infection or illness. Consistently high levels may require medication adjustments by your doctor’s office. Checking your sugar levels regularly and keeping a log (Brook app) can help you and your doctor improve your diabetes management.

When I cut back on my meal portions my sugars drop too low.

Your doctor may have asked you to cut back on your foods to lose weight or lower your blood sugar numbers. Depending on your medication regimen this can lead to hypoglycemia (low blood sugar) if we are not careful. You always want to make sure that you treat hypoglycemia properly. If you notice a pattern of low blood sugar values this should be communicated with your physician. Often doctors can easily lower the dose of the medication to prevent the low from occurring. Working with your Brook coach can help you even out your meal plan so that your diet better matches your medication regimen. 

I don’t know where to start or what changes to make?

Dealing with a chronic disease like diabetes can be overwhelming. Fortunately you are in the right place! It is always best to set realistic goals and choose lifestyle changes that are doable for you right now. Your Brook coach can support you by answering your questions and help you get started. Your doctor is also a great resource for this as well. The key is to start somewhere, you can adjust as you go along.

Why should I test, I feel fine?

Unfortunately, there are not always reliable symptoms that tell someone their blood sugars are high or low. The best way to tell is to test blood glucose levels several times and look for patterns.


NEXT STEPS

  1. Review your blood sugar testing protocol from your provider by going to Profile > Monitoring Protocols

  2. If you need a nudge from the Brook app to help you remember to take your blood sugar throughout the week, go to the bottom of the Monitoring Protocols page and click the ‘click here’ text to go to the Schedules & Reminders page. 

  3. Start monitoring your blood sugar with the device you’ve received from Brook. 

  4. Chat with your Care Team (your Brook Registered Nurse and Health Coaches) about your previous blood sugar readings or latest A1c so we can best track your improvement over time.


ADDITIONAL RESOURCES

Brook Guide PDF – Treating Hypoglycemia