Diabetes is a complex disease whose hallmark is elevated blood sugars. Persistently uncontrolled diabetes causes devastating and costly complications. My former patients knew that I would pay any price, whether it involved medication or not, to keep their blood sugars in the normal range. No matter what it costs to keep blood sugars normal, let’s be honest: It costs a lot more not to. We continue to see skyrocketing costs of medical care for patients with diabetes and associated complications. But prevention is not just the most economical approach; it’s also the most humane one. 

People tend to categorize diabetes (type 2, the most common) in three groups, two of which they suspect are not as concerning. Consider, for example, diet-controlled diabetes. They’re not really sure if this is even worth mentioning, but they’ll say something just in case. “My sister has something, I’m not sure, but she doesn’t have to take anything as long as she eats right.” “Diet-controlled diabetes?” “I think so.” 

The second group is diabetes controlled by oral medications. Patients aren’t sure if this is really diabetes either, but they want to be sure they don’t skip by it, just in case. “I think my dad has diabetes, but he just takes a pill.” When I reply with “Well, okay, that’s good to know,” they nod, and then look relieved to have done the right thing by mentioning it.

Then there’s insulin-requiring diabetes. No one doubts that this is the real deal. They may not understand the difference between type 1 and type 2 diabetes, but you cannot argue with the fact that this treatment involves the purchase of large quantities of needles. 

Here’s what’s important: they are all diabetes. They all matter; they all mean business. That’s the bad news. But the good news is this: As long as you do whatever is necessary to keep your sugars in the normal range, it doesn’t matter what you call it. 

As long as you keep your blood sugars more or less in the normal range, your risk of significant complications remains very close to normal, and much closer to normal than poorly controlled abnormal blood sugars. What we call it —whether diet-controlled diabetes or type 2 diabetes — has more to do with how we keep those blood sugars normal than anything else. Calling it “diabetes” only means that our bodies can’t do it automatically anymore, and that we need to involve ourselves intentionally in the process. If you are doing this successfully, and your blood sugars are trending in the normal range, you can be very proud of yourself. 

Remember: whatever it takes. Have the attitude that you will pay ANY price to keep your blood sugars in the normal range. Next week I’ll write more about what that might look like.