Diabetes 101 - Warfighter Wellness

Common Types of Diabetes

There are three main types of diabetes, though there may be upwards of 10 different types in total. The most common types develop differently, yet all impact blood glucose levels. Diabetes impacts insulin production and effectiveness. Insulin is a hormone that transports energy (glucose) to cells so your body can perform its duties. Without effective or enough insulin, blood glucose levels rise and your muscles, organs and brain don’t receive the energy they need.

Type 2 Diabetes (T2D)

T2D has three main causes: family history and genetics, overweight and obesity and physical inactivity. T2D develops when not enough insulin is produced in the body or the body becomes resistant to insulin. This leads to blood glucose levels rising and further resistance. Management may include changes to nutrition and exercise and/or medication (e.g., oral pills and injectable insulin). This is the most common type of diabetes.

Type 1 Diabetes (T1D)

T1D is an autoimmune condition, meaning there is no known cause. The body has an immune response to insulin-producing cells and eventually, insulin is no longer produced in the body. People living with T1D must take manually delivered insulin either through shots or an insulin pump to supplement what their body no longer makes. Management includes frequently checking glucose levels and taking insulin while considering a variety of influential factors.

Gestational Diabetes

Similar to T2D, there are a variety of factors that impact the development of gestational diabetes. This type of diabetes occurs during pregnancy and often ends once the baby is delivered. Blood glucose needs to be monitored, and medication may be prescribed to keep levels stable during pregnancy. Once you have one pregnancy with gestational diabetes, you are more likely to have it with any future pregnancies. Though not a guarantee, you are also at increased risk for developing T2D.

Measuring Glucose Levels

Glucometer

Discuss these glucose targets with your provider.

HbA1C Goal	Less than 7%	7-8%	8-8.5%
Fasting	80-130 mg/dL	90-150 mg/dL	100-180 mg/dL
After Meal	<180 mg/dL	N/A	N/A
Bedtime	90-150 mg/dL	100-180 mg/dL	110-200 mg/dL

Continuous Glucose Monitor (CGM):

“In range” glucose is typically considered 70-130 mg/dL before meals and <180 mg/dL two hours after meals. CGMs read glucose and consider ‘in range’ to be 70-180 mg/dL. Certain CGMs allow you to create your own glucose range to support target goals.

Out of Range Blood Glucose

High Blood Glucose: Hyperglycemia

**Levels >180 mg/dL are considered “high”.

If > 250 mg/dL, it is recommended you avoid exercise because glucose response may increase.
If > 300 mg/dL, it is considered “very high”.

High Blood Glucose is typically caused by:

Food type and amount
Inactivity
Certain medications
Illness
Stress

High Blood Glucose Symptoms

You may notice you feel differently when your blood glucose is high. It is suggested to test your glucose if are experiencing:

Extreme thirst
Blurry vision
Need to urinate
Drowsy
Hungry
Slow-healing wounds
Dry skin

High Blood Glucose Treatment

Drink plenty of water.
Check your blood glucose frequently.
Exercise or intentional movement if your levels are <240 mg/dL.
Take insulin using your correction factor if you have T1D.
Call your health care team if your levels are high for more than three days and you are unsure why.

Low Blood Glucose: Hypoglycemia

Low blood glucose is more common among those with T1D, insulin-dependent T2D, and gestational diabetes.

Low blood glucose can be thought of in ‘levels’:

Level 1: <70 mg/dL
Level 2: <54 mg/dL
Level 3: Emergency – any level at which you need assistance to treat.

Low Blood Glucose can be caused by:

Not eating enough
Being more active
Certain medications
Drinking alcohol
Insulin dosing not matching needs

Low Blood Glucose Symptoms

Check your glucose if you notice:

Fast heartbeat
Impaired vision
Hunger
Headache
Irritable
Weakness
Fatigue
Anxious
Dizziness
Sweating
Shaking

Low Blood Glucose Treatment

If your blood glucose is <70 mg/dL, you are experiencing a low. If you have T1D and use an insulin pump in automated mode, you may not need 15g of fast-acting carbs due to your pump suspending insulin delivery. Talk to your care team about best practices for low treatment on AID systems.

Rule of 15

Consume 15g of fast carbs. Consider 3-4 glucose tabs, ½-1 tube glucose gel, 4 oz. fruit juice or non-diet soda, 1 tbsp. of honey, an applesauce pouch or dried fruit. These foods tend to have a high sugar content that can increase your blood sugars quickly.

Wait 15 minutes. Sit down and stay awake while waiting to ensure you don’t burn extra energy or overtreat. Fast carbs usually take 10-15 minutes to hit your blood stream.

Monitor your blood glucose. Recheck your blood glucose after 15 minutes and monitor if they are increasing to in range.

Repeat steps 1 and 2 if your blood sugar is still <70 mg/dL. If your blood glucose is not increasing to a safe range, eat 15 g of fast carbohydrates and wait another 15 minutes.

Extreme Low Blood Glucose

Level 3, or extreme, low blood glucose is when someone else must assist with treatment as you may not be coherent. They should not attempt to give any treatment by mouth.

If prescribed, use your glucagon. This can be a shot or a nasal spray.
Dial 911 immediately if you do not have a prescription.
Tell your health care provider if you have ever had a blood glucose so low that someone else needed to help you.

A diabetes diagnosis is serious and treatable. As a Warfighter, T2D and gestational diabetes diagnoses involve careful monitoring that allows you to continue your duties in most cases. A T1D diagnosis typically leads to medical separation from service. No matter your diabetes diagnosis, taking care of yourself is a priority. Pay attention to the signs of high and low blood glucose and work closely with your care team so you can stay mission ready and fit to fight!