THE SPECIALIST: Dr. David Lam
An instructor of medicine at Mount Sinai, Dr. David Lam is an endocrinologist who specializes in treating patients with diabetes. Half of his practice is dedicated to Type 1 and Type 2 diabetes.
WHO’S AT RISK
Diabetes has been a mainstay of headline news for the past decade, with the International Diabetes Federation predicting that 1 in 10 people worldwide will have the disease by 2035.
“Diabetes is a disease of elevated blood sugar levels, also called blood glucose levels,” says Lam. “The majority of patients have Type 2 diabetes, in which the body is not as efficient as it used to be in processing glucose. In Type 1 diabetes, the body has entirely stopped producing insulin, which is the vehicle we use to process sugar.”
About 26 million Americans currently have diabetes, while another 79 million have pre-diabetes. “A huge portion of the population is affected,” says Lam. “Your risk of developing Type 2 diabetes — which is lifestyle-related — goes up with age. The latest research shows that nearly 27% of Americans over 65 have diabetes.”
For most patients, Type 2 diabetes develops gradually over time. “The underlying cause is insulin resistance. Insulin is the vehicle that allows us to process blood sugar,” says Lam. “As diabetes progresses, the body struggles to produce more and more insulin, but the blood sugar continues rising. As insulin resistance increases, the amount of insulin that used to suffice is no longer enough.”
One of the leading risk factors that contributes to insulin resistance is excess weight. “An increase in the amount of body fat leads to insulin resistance, due to changes happening at the molecular level,” says Lam. “Another major contributor is a sedentary lifestyle.”
Other risk factors for diabetes include things that are out of our control, like advancing age or a family history of the disease. Age 45 is when diabetes risk goes up.
SIGNS AND SYMPTOMS
Diabetes is a disease that progresses by stealth. “One of the scary things about diabetes is that there are no signs and symptoms until it’s gotten very bad,” says Lam. “People usually have no symptoms when their blood sugar is a little elevated, but when it’s extremely elevated, they experience increased urination that leads them to drink a lot of water because they are so dehydrated.”
In the long term, untreated diabetes can cause blindness, heart disease, stroke, limb amputation and premature death.
Primary-care physicians are the front line of diagnosing diabetes. “Doctors usually pick up elevated blood glucose as part of their routine blood work,” says Lam. “The next level of blood test is a hemoglobin A1c. Usually blood work alone is sufficient for diagnosis.”
When a patient’s blood work comes back at diabetic or pre-diabetic levels, the doctor always needs to take a health history. “The first steps are always taking a detailed review of the person’s eating and how much exercise they’re doing,” says Lam. “Regular physical activity makes a big difference and so does weight loss. The power of lifestyle modifications is remarkable.”
Some dietary changes can be easier than expected. “Often there are what we call glaring points of intervention — for instance, if you only eat rice all the time,” says Lam. “A big part of it is what the patient thinks is realistic. Can you cut down on the amount of bread you eat at every meal?”
Diabetes classes and nutrition consults are often part of the process of figuring out the diet that is right for each individual patient.
For patients with more severe cases, sometimes medication is called for immediately. “We start by talking about oral medications and injectable medications that are not insulin, but in some cases, insulin is the best answer right away,” says Lam. “It all depends on the severity of the disease when you are diagnosed.” Most doctors will want to see a diabetes patient at least every three months.
Having patients monitor their blood glucose on a regular basis is a cornerstone of effective treatment. “There are a lot of commercially available blood glucose machines that use a very small needle to get a very small amount of blood, effectively a finger prick,” says Lam. “Monitoring blood sugars helps patients realize how their blood sugar responds to certain foods, and helps the doctor guide future management.”
While diabetes can be an overwhelming diagnosis, there’s a lot patients can do to manage the disease. “Especially if it’s an early diagnosis, you have the power to be just as effective as a pharmaceutical drug,” says Lam. “And you don’t need to go out and become a Central Park runner. Even just 30 minutes of walking a day can make a tremendous difference.”
Doctors and researchers are working hard to improve the standard of care. “Recently, there have been some interesting discoveries about the molecular basis of insulin resistance, and on the practical level, there are newer oral medications coming out that open up a new class of medications that present more options,” says Lam.
“On the other hand, the popularity of bariatric surgery is rising, and what we’re finding is that a lot of metabolic changes happen in the body in addition to weight loss, even immediately after the surgery.”
QUESTIONS FOR YOUR DOCTOR
A good thing for everyone to ask is, “Am I at risk of diabetes?” If you are at risk, follow up by asking, “Should I be tested?” Another universal question is, “What do my numbers mean?” Everyone should know their blood pressure, cholesterol, A1c. If your numbers raise any suspicion, then ask, “What should my goals be?”
“Diabetes is not what everyone thinks. People jump to the end-stage complications,” says Lam. “But there’s so much we can do to prevent it from coming to that. Lifestyle interventions alone can sometimes prevent the progression of diabetes.”
WHAT YOU CAN DO
Get informed. The place to start your research is the American Diabetes Association (diabetes.org), which hosts a lot of tips for healthy living and menu planning.
Become a label reader. Everyone can benefit from reading the labels of packaged foods and reducing the portion of carbohydrates and starches.
Stay active. A vital step to preventing or managing diabetes is getting regular physical activity: 30 minutes a day, five days a week.
Get the whole family onboard. “After all, a diabetic-friendly diet is good for everyone,” says Lam. “So it’s a good idea to have everyone in the household follow it.”