Resource
Type 2 Diabetes and Spina Bifida
Adequate treatment of pre-diabetes and diabetes can add years to the life of people with Spina Bifida, and is worth the effort.
What is Type 2 Diabetes?
Type 2 diabetes is a chronic condition that affects how the body uses insulin to metabolize glucose (sugar), the body’s main source of energy. It is the most common type of diabetes but is also the most preventable. Type 2 diabetes is more common in adults but can occur in children and adolescents.
Type 2 diabetes is due to a combination of impaired insulin secretion from the pancreas in response to increase blood glucose and insulin resistance so that glucose cannot get into the cells. Both causes lead to increase blood sugar. This process happens slowly and may initially be diagnosed as “pre-diabetes,” also called metabolic syndrome.
What is Prediabetes?
Prediabetes is state of higher-than-normal blood sugars and insulin resistance, but not high enough to be diagnosed as diabetes. The diagnosis of prediabetes is defined as a fasting blood glucose between 100-125 mg/dl or glycated hemoglobin (A1c) 5.7-6.4%. In prediabetes, the pancreas initially tries to make more insulin to control higher blood sugar levels. The high insulin levels can result to “acanthosis nigricans”- a dark velvety appearance of the skin at the back of the neck, axilla (arm pits), and other skin folds. Acanthosis nigricans is a “warning sign” that a person is at risk for type 2 diabetes. All people with acanthosis should be evaluated by a physician for type 2 diabetes with a blood test.
When Does Prediabetes Become Type 2 Diabetes?
As insulin resistance and impaired insulin secretion from the pancreas worsen, diabetes can result, with elevated blood sugars and glucose in urine. The diagnosis of type 2 diabetes is defined as fasting blood glucose > 126 mg/dl and/or a A1c > 6.5%. It must be treated promptly because elevated blood sugars can damage the kidneys, heart, and eyes and lead to increased urinary tract infections, nerve problems, and circulation problems.
What Causes Prediabetes and Type 2 Diabetes?
Obesity is the main cause of prediabetes and type 2 diabetes. When the body-mass-index (BMI) is within the 85th to 95th percentile, a person is considered overweight; and obesity occurs when BMI is greater than the 95th percentile. About 50% of children and adults with SB are obese.
People with SB are prone to obesity for the following reasons:
- some people with SB have a lower metabolic rate
- a sedentary lifestyle (no regular exercise)
- a diet with more processed foods and sugar
Other risk factors for type 2 diabetes include:
- family history of diabetes
- ethnicity (Latino/Hispanic, Black/African American, Native American, Pacific Islander, and South Asian individuals have a higher risk)
- older age (older than 45 years old but can occur in children as young as 8 years old)
- being physically active less than 3 times per week
- for women, polycystic ovarian syndrome, having diabetes during pregnancy, or having a baby weighing over 9 pounds at birth
How Does a Physician Evaluate for Diabetes and Prediabetes?
- A history should be taken for symptoms of diabetes:
- “Polydipsia, polyphagia, and polyuria” – drinking too much, eating too much, and urinating too much
- Low energy/fatigue
- An examination might include measurement of weight and height or arm span and an assessment for acanthosis
- Blood work might include:
- Comprehensive metabolic panel (includes liver enzymes and electrolytes)
- Fasting insulin level, c-peptide (evaluates insulin production)
- Lipid panel (evaluates cholesterol)
- Hemoglobin A1C test (indicates the body’s control of blood sugar over three months)
What Lifestyle Changes are Needed for Prevention and Treatment of Prediabetes and Type 2 Diabetes?
- Exercise 30-60 minutes at least 5 days per week. Exercise can decrease insulin resistance and help maintain healthy weight. Pushing your wheelchair or going for a walk and upper body or chair exercises count!
- Avoid foods that have more than 10 grams of added sugar by checking food labels.
- Everyone should limit sugary drinks particularly those at risk for obesity and diabetes. This includes sweetened fruit juices, sweetened iced tea, soda, or sweetened coffee.
- Eat three meals a day following the MyPlate.gov or tips from the American Diabetes Association (https://diabetes.org/food-nutrition) method.
- Limit snacking between meals (snack should not include sugary foods)
- Consult with a dietician for more formal guidance on healthy eating if needed.
How is Type 2 Diabetes treated?
- Exercise and healthy eating are important for everyone with diabetes.
- Have regular blood sugar checks at home or your physician’s office. Continuous glucose monitors may help control blood sugar levels better particularly if there is a risk for low blood sugar or difficulty in reaching target A1C range.
- Routine visits to the doctor are an important part of the treatment process-about every 3 months when sugar is not well controlled, and every 6 months when it is under control
- If the A1C is more than 7.0, medications are also indicated to help control blood sugar and prevent further damage to the body. Medications for diabetes are chosen with your doctor based on your other health risk factors and the side effects of medications.
Additional Resources:
By Gordon Worley, MD
Revised by Ellen Fremion, MD
This information does not constitute medical advice for any individual. As specific cases may vary from the general information presented here, SBA advises readers to consult a qualified medical or other professional on an individual basis.
