Understanding Diabetes Mellitus: A Doctors Guide

Diabetes can feel overwhelming, but understanding the basics can help you take charge of your health. Let’s break it down together — simply, clearly, and in a way that makes sense:

What Is Insulin?

Insulin is a hormone, or messenger molecule, made by your pancreas (which is an organ in your belly). Insulin's main job is to tell your body’s cells to pick up glucose (sugar) from your blood and use it for energy. Think of insulin like a key that unlocks your cells to let the sugar in.

Without enough insulin, or if your body doesn’t respond to it properly, sugar stays in your blood. Over time, high blood sugar can cause damage throughout your body. This is called diabetes.

The Two Main Types of Diabetes

Type 1 Diabetes:
In Type 1 diabetes, the body's immune system attacks the cells in the pancreas that make insulin. People with Type 1 diabetes produce little or no insulin and need to take insulin every day to survive.

Type 2 Diabetes:
In Type 2 diabetes, the body either doesn’t make enough insulin or doesn’t use it properly. This is called “insulin resistance.” Type 2 is much more common and can often be managed with lifestyle changes and medications. Type 2 is technically curable, whereas Type 1 is not.

Diet for Diabetes Control

Managing your diet is one of the most important tools for controlling diabetes.

What to eat:

• High-fiber foods like vegetables, fruits, legumes (beans, lentils), and whole grains.

• Healthy fats like olive oil, nuts, and avocados.

• Lean proteins like fish, chicken, and tofu.

What to avoid:

• Processed foods (like packaged snacks and fast food)

• Sugary drinks (soda, sweetened coffee drinks, juices)

• Foods made with refined carbohydrates (white bread, pastries)

Keeping your meals balanced — a mix of protein, healthy fat, and fiber — can help keep your blood sugars stable.

Exercise for Diabetes Control

Exercise is a powerful tool for diabetes!

When your muscles are working, they can absorb glucose from your blood without needing insulin. This means that even if your body isn't responding well to insulin, exercise can "bypass" that problem. One of my favorite tips: Take a short 10-minute walk after every meal. It doesn’t have to be intense — even a casual stroll can help lower your blood sugar levels.

Exercise also improves insulin sensitivity, directly counteracting the effects of type 2 diabetes!

How to Track Blood Sugars

The first step to getting control of your blood sugars is tracking them! The main way we track blood sugar is with a lab test called Hemoglobin A1c.

• Hemoglobin A1c measures your average blood sugar over the last 3 months.

• For most people, we aim for an A1c of less than 7%.

• In very elderly patients, we often aim for less than 8% to avoid the risks of low blood sugar.

Other ways to monitor blood sugars:

• Home blood sugar testing:

  • Once or twice daily if you are on long-acting insulin.

  • Before meals and at bedtime (called "ACHS") if you are on a basal-bolus insulin regimen (basal = long-acting insulin; bolus = short-acting insulin at meals).

• Continuous glucose monitors (CGMs):

  • These are small devices worn on the skin that check your blood sugar all day.

  • They have become very popular in the last 5 years, especially for people with harder-to-control diabetes.

Complications of Diabetes and Screening

Unfortunately, high blood sugars over time can damage important parts of the body. That’s why regular screening is so important, even if you feel fine.

Common complications include:

• Kidney disease: Diabetes is a leading cause of kidney failure.

• Eye disease (retinopathy): Can lead to blindness if untreated.

• Nerve damage (neuropathy): Causes numbness, tingling, or pain, especially in the feet.

• Heart disease and stroke: Diabetes greatly increases the risk of heart problems.

Screening tests we recommend:

• Annual urine test (urine microalbumin) to check for early kidney damage.

• Yearly dilated eye exam with an eye specialist.

• Foot exams at every primary care visit to check for nerve damage.

• Blood pressure and cholesterol checks to reduce the risk of heart disease.

Catching these issues early can make a big difference in protecting your health!

Diabetes Medications

There are many different medicines for diabetes. Here are some of the most common:

Metformin:

• First-line medication for Type 2 diabetes.

• Helps lower blood sugar and may also cause modest weight loss.

• Common side effect: stomach upset, but symptoms usually improve over time.

• Some exciting research shows metformin may even lower overall death risk in healthy people! (more research is necessary to substantiate this)

Glipizide:

• Affordable and effective.

• Usually taken with meals.

• Works well but has a higher risk of causing low blood sugar compared to some other meds.

GLP-1 Receptor Agonists (like Ozempic):

• Very effective for both blood sugar control and weight loss.

• Common side effect: nausea or stomach upset.

• Relatively new and expensive

SGLT2 Inhibitors (like Jardiance):

• Help you “pee out” extra sugar.

• Very helpful for people with heart issues because they also reduce extra fluid in the body.

• Main risk: higher chance of urinary tract infections (UTIs). Bacteria love sugar!

Insulin:

• Comes in different types — long-acting and short-acting.

• Long-acting insulin is used once or twice a day to provide steady coverage.

• Short-acting insulin is given with meals to handle the sugar spikes after eating.

• People with Type 1 diabetes always need insulin. Some people with Type 2 diabetes may need insulin if their A1c is very high (typically over 10%) or if other medications aren't enough.

Final Thoughts

There’s no one-size-fits-all plan for diabetes. What works for one person might not work for another. Your goals and treatments should be tailored to your body, your lifestyle, and your needs.

Work closely with your doctor to set the right plan for you — together, you can find the best way to keep your blood sugars under control and live a healthy, active life!

By Ziya Aktig, MD