By Aaron Collins

Justin Conner was thirsty, urinating a lot, hungry a lot, tired a lot. His skin seemed drier than normal. He noticed over months, perhaps longer—he couldn’t recall when the symptoms started—that he had been craving sweets, although he really had not preferred them much in the past. Because he had no family history of diabetes, he had no context, no ready answer for why he was experiencing such unusual symptoms. And besides, his thoughts were often so fuzzy that he felt too disoriented to sort it all out. He became somewhat accustomed to feeling not all that well, to feeling light-headed.

Then, one July day after returning to work from a lunch break on his job at a food processing plant, he felt much dizzier than usual, the office began to spin, and he passed out. His coworkers called 9-1-1. Fortunately, he was seated at his desk, or a fall from blacking out could have added serious insult to injury.

Conner’s blood glucose had long been soaring out of control, unbeknownst to him. In addition to his hyperglycemia, as the condition is called, the explanation for what his body experienced that July day turned out to be a something he had never heard of, but a term that is well known to diabetics and the health care professionals who treat them: Diabetic Ketoacidosis, or DKA. Like nearly 5.7 million other Americans—one in four who have the disease—he was an undiagnosed diabetic.

The problem with DKA is that blood sugar gets too high, and the blood becomes too acidic, damaging the body’s cells. Left unchecked, DKA can lead to coma or death.

After Conner lost consciousness, the ambulance quickly arrived and Conner (whose name is changed to protect patient confidentiality) was en route to the emergency department. The acid (ketone) had built up significantly in his bloodstream, which caused his near-fatal close call and led to Conner being diagnosed with type 2 diabetes, in which a person’s cells fail to use insulin properly to transport blood sugar into them for nourishment.

Fortunately Conner’s condition was caught in time.

Once called adult-onset diabetes, the insulin resistance of type 2 diabetes mellitus afflicts nearly 90% of the 24 million people in the U.S. with diabetes. Type 1 diabetes is by far the less common, a condition in which the body does not produce enough insulin. In addition to Conner’s symptoms, other manifestations of hyperglycemia include nausea or vomiting, deep or rapid breathing, fruity-smelling breath, or unconsciousness.

According to LaNora Cook, RN, MSN, FNP, CDE, an Advanced Practice Nurse with Kaweah Delta, Conner’s case is all too common. Cook says the best course is to prevent onset in the first place, well before such emergency treatment becomes necessary. “Because onset for type 2 diabetes is gradual,” Cook said, “a person may not notice the continual increase in blood glucose over time. Our bodies adjust and we may not feel the change until detectable symptoms of diabetes become evident.”

Blood sugar is among the essential end products of digestion, typically derived from carbohydrate sources. That glucose is our fuel source that provides the energy required for our body to function. It is stored (as glycogen) in our liver, muscle, and fat tissue—in the liver and muscle as a product that can be converted back into glucose when we skip a meal or are stressed and need fuel, Cook said, and in our fat tissue so we have adequate stores to break down in case we don’t eat for days. But the excess glucose experienced by diabetics can quickly turn deadly.

Cook said that knowing your diabetes risk is essential to prevention. “It is not uncommon for someone to have had diabetes for ten years before they’re aware. That is ten missed years of prevention of health complications,” she said. She advises an annual screening.

Furthermore, she says, symptoms may be incorrectly explained away. Thirst and hunger are common experiences among non-diabetics and have lots of other explanations. So do headaches, blurred vision, and difficulty with concentration. Too much or too little caffeine? Advancing age? Adult onset ADD? There are so many ways to dismiss or self-diagnose, if a person notices his diabetes symptoms at all.

Much of what a diabetic can do to manage the disease is exactly what a healthy person can do to stave off its onset. Here are just a few proactive lifestyle changes you can make—before you must, should diabetes develop:

Consistency with meals and snacks. Eat at a fairly regular time. Do not skip meals. Be conscious of the amount you eat with an eye on how much physical activity you plan to undertake.

Daily physical activity. Regular activity and a physical exercise regimen are more important than ever, given how sedentary most of us have become. The more computer and TV hours spent, the less active we are, and that means we are not processing blood glucose efficiently. As that ability decreases, type 2 diabetes can manifest and worsen.

Alcohol intake. As with everything, moderation is the key. Limiting alcohol consumption can stave off the onset of diabetes. For the diabetic, alcohol is not the best choice to quench thirst. Not only is alcohol a carbohydrate source, but mixed drinks are often full of soda, fruit juices, or sweetened mixers. Some diabetes medications cannot be taken with alcohol safely. An alcoholic drink may be taken with a meal on certain occasions if planned. However, diabetics should discuss this in advance with their health care provider.

Glucose monitoring. It’s the rare person who has awareness of her blood pressure, but even fewer still know their blood glucose level. Glucose monitoring offers key information for diabetes prevention. But for diagnosed diabetics, this knowledge is mandatory. “Those on diabetes medications or insulin test (their glucose levels) numerous times throughout the day,” typically before and after each meal, Cook said. “Glucose monitoring provides a result of what the level is at that moment. Unless a person tests frequently they have no idea if their blood glucose is on it’s way up, down, or stable.” Cook said that glucose monitoring allows a person to make the best choices with regard to physical activity and food choices, and also indicates if or when their health care provider needs to adjust their diabetes medications.

Support groups and walking clubs. The lifestyle shifts for those with diabetes are major, if they are to manage the disease before the myriad related symptoms occur, such as heart, liver, kidney, and eye disease, among others. “For many, the change to healthier habits is unmanageable without the support and camaraderie of others in the same boat,” said Lydia Navarro, who teaches within a program that is sponsored by Kaweah Delta Medical Center’s Community Outreach Department. Her classes focus on ways to control and live with diabetes. Groups are conducted in both English and Spanish.

The importance of support groups cannot be overestimated, says one participant in attendance at a recent meeting. “If not for this group, I would no longer be living,” she said. The temptation to engage in negative behaviors is simply too tempting without peer support, she added.

Sick day management plan. While it is important to maintain a positive outlook and plan to remain healthy, it is also essential to prepare in advance for the illnesses that can result from hyperglycemia. Infections can result, and according to Cook, infections can also be the cause of the hyperglycemia. Diabetics must learn to cope with these and have an advance plan. Family members, friends, and coworkers can be key to successful management of these health complications in advance of their appearance.

Silent witness. Diabetics should have some kind of identification on their bodies at all times. An ID bracelet or other wearable emblem (the blue circle on white field is an international symbol of diabetes) will let emergency personnel know and can speak for you should you lose consciousness.

For more information, a number of Websites can be helpful:  HYPERLINK “http://www.diabetes.org” www.diabetes.org is just one of the authoritative sources online. But most importantly, if you have any of the symptoms above or have a family history of diabetes, contact your health care provider.

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