Dr. Liana Billings (NorthShore)
Most of the time pre-diabetes does not have actual symptoms that you can feel. Pre-diabetes can be assessed by doing a blood test to check the blood glucose level or checking a Hemoglobin A1c. A fasting glucose 100-125 or a HbA1c from 5.8 to 6.4% is in the pre-diabetes range. Being diagnosed with pre-diabetes indicates that an individual is at risk of developing diabetes in the future. Fortunately, regular exercise, weight loss (7%-10% of body weight), and a healthy diet can reduce the risk of developing diabetes. Diabetes may have symptoms such as increased thirst, increased urination, increased hunger or weight loss. The diagnosis of diabetes is also made by a blood test. A fasting blood glucose greater than 125 or an A1c 6.5% and higher indicates diabetes.

Dr. Liana Billings (NorthShore)
Type 1 and Type 2 diabetes both cause hyperglycemia (elevated blood glucose). Type 1 and Type 2 diabetes cause hyperglycemia for different reasons. Type 1 diabetes is categorized as an autoimmune illness. This means that the body views the insulin-producing cells in the pancreas (beta-cells) as foreign. The body destroys the insulin-producing cells. A person with type 1 diabetes does not make insulin. Type 2 diabetes is caused by a combination of insulin resistance and some insulin deficiency. This means that a person with type 2 diabetes will make insulin, but the body does not use it efficiently. Insulin is required for the body to lower the blood glucose (sugar) and allow the different organs to use glucose. If the body doesn't make insulin or if the body is resistant to insulin, the blood glucose is elevated. The symptoms can be similar in both types of diabetes - elevated blood glucose, increased thirst/appetite/urination.

Dr. Liana Billings (NorthShore)
Diabetes can be difficult to control and frustrating at times, but fortunately, we have lots of tools to offer. If someone is having difficulty controlling the blood glucose, you may want to considering seeing a diabetes specialist (endocrinologist). Checking blood glucose regularly before each insulin injection and sharing these readings, your diet, and activity level with your doctor can help your doctor make adjustments to the medications. Reviewing your diet with a dietician can be helpful. Also, now we have more technology that can help monitor blood glucose levels called continuous glucose monitors or other new anti-diabetes medications may be helpful. Genetic testing is being researched in type 1 and type 2 diabetes, but is not yet used in the clinic. There are certain rarer forms of diabetes that may warrant genetic testing in people diagnosed with diabetes under the age of 30 who have a BMI less than 30 and a parent or child with diabete

Dr. Liana Billings (NorthShore)
With advancements in the types of insulin we can use and our ability to monitor blood glucose, people with type 1 diabetes can control their blood glucose. We know that controlling blood glucose to an HbA1c less than 7% (average overall blood glucose of 160), can reduce diabetes-related complications from developing over time. Elevated glucose can cause damage to the eyes, nerves, heart, and kidneys. By controlling the blood glucose, have a good cholesterol level, and making sure the blood pressure is good, we can prevent these complications and people with type 1 diabetes and can live a normal life expectancy.

Dr. Liana Billings (NorthShore)
High blood glucose can cause problems with several organs in the body. These include the heart, eyes, nerves, kidneys, and blood flow to the feet. The most serious problems could be a heart attack, blindness, kidney failure, non-healing ulcers on the feet that could result in the need for amputation toes or a foot. The good news is that by controlling blood glucose levels and making sure that the cholesterol level and blood pressure are good, we can prevent these serious consequences from happening.

Dr. Liana Billings (NorthShore)
Diabetic dermopathy is thought to be caused by problems in the little blood vessels that go to the skin in people with diabetes. The skin gets damaged and becomes hyperpigmented (dark spots). There is no treatment for it at this point. The spots can go away on their own or can persist.

Dr. Liana Billings (NorthShore)
If the glucose levels are still elevated and he is now underweight, I recommend that he talk to his doctor. It is important to make sure that the diagnosis of type 2 diabetes (rather than type 1 diabetes) is correct. Choosing snacks or supplementing meals with protein/fat, rather than carbohydrates, can help him feel full. An example could be a portion of nuts (almonds, cashews), unsweetened nut butters, eggs, lean meats, cheese, cut vegetables and a low carb dip (e.g.sour cream, cream cheese). I always tell my patients that if they are going to choose a carbohydrate - choose one that will give you good nutrition. For example, an apple provides fiber, blueberries have vitamins and anti-oxidants, etc. Some of the higher protein foods have more fat, so watch the portion size. Also eat slowly and be mindful of when you feel full. And stay well hydrated with unsweetened beverages (e.g water).

Dr. Liana Billings (NorthShore)
Prevention is key to stopping the diabetes epidemic! Some people have an increased risk of getting diabetes, but the great news is that we can prevent it! The large studies have shown the following can reduce progression to type 2 diabetes for people at-risk: 1) weight loss 7-10% of body weight, 2) 150 minutes of aerobic exercise per week, 3) healthy well rounded diet with fruits and vegetables. Metformin is a medicine that can prevent diabetes that can be discussed with your doctor. More and more research is showing that sleep quality and quantity affects glucose levels, blood pressure, etc. 8-9 hours of good quality sleep is important. If you have trouble with sleep, there are sleep doctors available that can do an evaluation. And thank you for sending in your questions!