Complimentary Story
March 2025Diabetes is the one of the most common chronic conditions affecting Americans today. Physicians screen for this every day. The current recommended screening schedule is every three years. But is it really that simple and straight forward?
Glucose is the fuel of the body. Almost everything we eat needs to be turned into glucose to be used for cellular processes. This is just one of the many reasons that we need to be careful with our diet. As the computer programers say: “Garbage in, garbage out.” Our body is the ultimate refinery so we need to give it the best material to be healthy. Glucose is a small molecule and as such, it has free reign getting into cells. For some cells, glucose enters the cell by passive means, for others it is actively transported into the cell. Every cell uses glucose in one way or another. When glucose is elevated, it becomes toxic. Nerve cells are some of the most sensitive to the harmful effects of too much glucose in the body, but really, all of of our tissues are damaged by high glucose levels. That leads to bad things happening when the blood glucose is out of control for too long. We see damage to the kidney filtering units leading to kidney failure and the need for dialysis. Vascular damage occurs leading to heart attacks and strokes. Elevated levels of inflammation in this body leads to cancers. Diabetes just wrecks everything.
I won’t go into too much detail about what causes diabetes. There are genetic factors and likely exposure factors such as the chemicals we get exposed to in the environment. Unlikely is any influence of diet, though. Just because you eat sugar, doesn’t mean that you will be diabetic. Also, reactive hypoglycemia has nothing to do with becoming a diabetic in the future.
The normal range for fasting blood glucose was 70-110 years ago but has been changed to 70-100. I was told that was done to catch a few diabetics who could normalize their blood glucose with a long enough fast.
Then after this, the concept of “pre diabetes” was introduced. I am no fan of “pre” diagnoses. I think it opens up an opportunity for psychological and physical abuse of the patient and insurance. Maybe a kinder way to state that is that it allows Medicine to take more money from whomever is the payer, whether it is the patient directly or their insurance, which is paid for by the patient.
The blood glucose is measured with every chemistry profile. It always triggers as “high” when it is above 100. There is no distinction if the patient is fasting or not. The provider is left to deal with that number. Generally, any high value is sort of ignored when the test is done for purposes other than as part of the annual lab panel. If it is above 200, it is an automatic diagnosis of diabetes. If that was not known prior to the test being done, then we pay closer attention to it.
Fortunately, there are some additional tests that can be done when your screening test is above 100. The next most common test done in diabetes care is the hemoglobin A1c. While the glucose is more like a snapshot, the A1c is more like a video. Hemoglobin is the oxygen carrying part of the red blood cell. When hemoglobin is made, there is no glucose attached to it. As the blood cells circulate, glucose will stick to the hemoglobin and this can be measured as a percentage of the molecule that has glucose attached to it. The average life span of a red blood cell is 4 months. By calculating the average number of blood cells that are made every day and those that are lost or recycled every day the A1c value then reflects the average blood glucose reading over the past three months…to a point. Once glucose is attached to hemoglobin, it doesn’t come off. So a bad day or two can raise this value significantly without reflecting the true average blood glucose. The hemoglobin A1c should not be measured more often than every three months. It doesn’t change quickly for the better, because the red blood cells need to be replaced for that to happen. When medications or lifestyle issues are changed, it may take 6 months to fully reflect the improvement so patience may be required. Delaying appropriate changes though simply allows damage to accumulate.
Another blood test that is done infrequently by traditional allopathic doctors is the insulin level. I have typically done this to help decide if someone has Type 1 or Type 2 diabetes. I am seeing this test run more often by the functional medicine and naturopathic physicians that I share patients with. There is evidence that it can be elevated for up to 10 years before the blood glucose starts to be abnormal. Identifying one’s likelihood of going on to diabetes this early allows one to make lifestyle changes that hopefully delays the development of diabetes.
One new technology that I think is pretty exciting in diabetes care is the continuous glucose monitor. This sensor is about the size of a quarter and communicates with a reader. It is able to check blood glucose around the clock for 7-14 days. There are now versions that are available without a prescription and for the right person, can be used to see, in real time, what is happening to their blood glucose. Along the lines of screening, this can be valuable to see how high the glucose goes after meals, as a higher reading may signal more insulin resistance and the concern for diabetes beginning to develop. While the insulin level may be elevated in someone like this, I would imagine that seeing the sharp rise in one’s blood glucose would spur lifestyle changes to delay that diagnosis.
It is hard to discuss screening without adding some other thoughts about diabetes in general. You can’t really look at someone and tell that they are diabetic. Diabetes doesn’t really care if you are heavy or not. Weight may contribute to insulin resistance, it is not the sole factor that goes into the development of diabetes.
Lifestyle may contribute to the development of diabetes. By this I think the issue is more along the lines of the chemical exposures that we have accumulated over our lifetime. It seems clear to me that our exposure to the various organic chemicals (plastics, pesticides, herbicides and the like) while allowing remarkable advancements in so many areas, has had consequences.
Diabetes may be one of them. Diabetes has been described in medical writings for centuries so it is not a new phenomenon. Our longevity today clearly comes with some challenges that were not experienced by past generations. A new field in medicine has identified how exposure to these chemicals as well as other toxic exposures can change our genetics. I suspect as this becomes more clearly understood the relationship between our exposures and chronic disease will become more clear.
Lifestyle is also an important part of diabetes treatment and management. Eating well, exercise and weight loss, no matter how small, are only for the betterment of the patient. This is really an entirely different article. It should be noted that once a diabetic, always a diabetic. Someone who has been a diabetic and brought their glucose under control through lifestyle elements should be congratulated, but they have already shown that their body cannot process glucose correctly under all circumstances and at some point in time their glucose will rise again. The longer one can maintain their glucose this way, the better off they will be.
Diabetes is just one of the many health conditions that physicians screen for. In some ways, diabetes screening is less controversial than some of the other screening tests that I have reviewed recently. For a healthy person, the screening schedule is probably the only controversial part of this article. The current recommendation of every three years seems reasonable enough. But if you feel well and are low risk, it is ok to wait a bit longer before checking.
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