Diabetes: to Control or Not to Control? That Is the Question.

by Daniel J. Schimmel, OD

diabetes Nashville TN

This blog is for 3 types of people. Those who have diabetes. Those people who have a family history of diabetes yet do not have the disease themselves. Finally, that group of individuals who are genetically predisposed to diabetes with no signs, symptoms or family history. As a side note, these recommendations through scientific research hold true for many other diseases such as heart and vascular, dementia, Alzheimer and certain cancers. The focus though is on diabetes.

Let us talk first reality with some numbers. Remember that all these numbers and recommendations are close approximations as articles and journals may vary slightly. In 2016, about 29 million people had type 2 diabetes… While 76 million people are considered pre-diabetic. A 2014 report stated that diabetes was the leading cause of new cases of blindness in the age group 20 – 74 years of age. The National Eye Institute estimates that half of all Americans with diabetes have diabetic eye disease. Of those, nearly 5% have sight-threatening disease. The rates are higher for African Americans, Latino, and Native Americans.

The list of diabetic complications is long and none that anyone would choose to endure. This is a partial list for which diabetics have an increased risk; periodontal disease, diabetic foot which leads to neuropathy and difficulty walking, diabetic foot is also the leading cause of non-, traumatic foot amputation, heart attack, stroke, and as already mentioned eye complications. Nobody chooses these complications so what can be done to decrease the likelihood of development.

Type 2 diabetes is preventable and it accounts for 95% of all cases. These recommendations are easy to write or talk about but very difficult for someone to implement. Why? Because they deal with breaking old habits and learning new ones, lifestyle changes. The typical North American diet contains high amounts of processed, caloric dense food that offer little nutritional value and promotes weight gain. If you go out to eat the portion sizes are huge and growing. Children are consuming too many soft drinks and sugary beverages. Other foods that are high in carbohydrates include; bread, potatoes, pasta, corn, carrots, certain beans fresh fruits (some worse than others such as grapes) breakfast cereals, sweets and alcohol. So what the heck can I eat? Fish, turkey, beef, pork, chicken, eggs, salads, and other vegetables.  You can consume as much of these foods as you wish. Therefore, you will not get hungry as you do when eating a high carbohydrate diet. You may have to alter this selection for other health or religious reasons, but the point is that there are choices. You may not like them at first but refer back to the complication list for motivation.

Next is physical activity. Here are some suggestions. 150 minutes of walking per week reduces the risk of developing type 2 diabetes by 58% over 4 years and 38 % in 10 years. Have a goal of 5000 to 10,000 steps per day. Water exercises are easy on the body and a great workout. Sometimes you just have to be creative in thinking of exercising. You can sit in a chair and lift milk jugs every day for 20-30 minutes. Think of exercises you could perform and not make excuses why you cannot.

Weight is not the primary issue. There are plenty of thin people with diabetes. However, the risk of developing diabetes increases 7 times in overweight people and 20-40 times in obese people. The primary issue is exercise and carbohydrate intake. Usually if you do exercise and watch your carbs, you will also lose weight. Losing 7% to 10% of your current body weight can reduce your chances of developing type 2 diabetes by as much as 50%.

Don’t forget a good night sleep. There is a 3-fold increase in developing impaired glucose tolerance with less than 6 hours of sleep and twice the risk if greater than 9 hours. Sufficient Vitamin D levels (53ng/ml) may reduce risk by 80%.

Prevention starts at an early age. Children observe and learn their parents’ habits quickly and easily. So our duty is to teach them proper habits.

Finally, do what your doctor tells you to do. If you follow your doctor’s instructions and do the above, you should see results. If you do not see improvement, ask your doctor why. Know your Hemoglobin A1C. This is a number generated at your doctor’s office, which is a three-month average of your blood sugar. It is the number to know and your gauge for better or, hopefully not, worsening of your disease. These guidelines have and are changing but a goal for young people of 6.5 to 6.0 A!C and 7.0 for older people is reasonable. Know what your doctor’s goal is for you. A 6.0 A1C is about an average of 120 blood sugar, 6.5 about 135, and a 7.0 about 150. A1C of 8 is about 180.


In summary, a greater adherence to a healthy (predominantly plant based) diet, regular physical activity, avoidance of smoking, and moderate consumption of alcohol reduces the risk of developing type 2 diabetes (16% reduction FOR EACH LIFESTYLE FACTOR ). If you read about other diseases as mentioned earlier, they all include the same advice for prevention, or stabilization. So, we all do have a choice. It takes motivation, determination, help from family and friends persistence and patience. Learn to read food labels for how many carbs are in a certain portion size. Adjust your portion size accordingly. A1C’s that are in line with your age, you can have about 60 to 70 grams of carbs per meal. If above the goal, the further off you are the fewer the carbs, maybe only 40 grams of carbs per meal. From the first Indiana Jones movie, “choose wisely my son “.


Reference sources: National Institute of Health, National Eye Institute, wwweyeupdate.com, and The American Diabetic Association.


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