Understanding Diabetes: Screening, Prevention and Management

November is recognized as Diabetes Awareness Month, a time to raise awareness about a condition that affects millions of Americans. In a recent interview Brian S. Rifkin, MD, with Hattiesburg Clinic Nephrology shared his personal experience with diabetes and offered insights into screening, prevention, management and the impact this condition has on Mississippians.

According to Dr. Rifkin, “The reason that we care about diabetes is because elevated blood sugars over time do lead to damage in your body, including your heart, your nerves and your kidneys.”

Diabetes occurs when your body cannot properly regulate blood sugar, which can lead to serious health complications if left untreated. There are two main types of diabetes: Type 1 (insulin dependence), an autoimmune condition in which the body does not produce insulin and typically develops in children or young adults, requiring lifelong insulin therapy; and Type 2, the more common form, often linked to lifestyle factors such as diet, physical activity and body weight, which can often be managed or even prevented through healthy habits and early intervention.

“Some of the early signs of diabetes include things like increased thirst, tiredness, increased appetite and losing weight,” Rifkin said. “If you start developing symptoms, this is a good indicator to speak with your doctor about getting screened.”

It’s generally recommended to see your primary care provider for a diabetes screening at least once a year, though the frequency may vary depending on your individual risk factors, such as family history, age, weight, and other underlying health conditions.

One of the tests used to screen for and monitor diabetes is a Hemoglobin A1C. An A1C test is a blood test that looks at your blood sugar over the past three months. “An A1C test is important because individual blood test does not always tell us the whole story,” Rifkin said.  “Your blood sugar can vary throughout the day depending on what you eat, but an A1C can tell us about an average over that three-month period.”

For individuals without diabetes, a normal A1C level is typically around 5%. For those living with diabetes, the general goal is to keep A1C levels below 7%. In older adults, or those with other health conditions, an A1C level closer to 8% may still be considered within an acceptable range based on individual health needs. If you have diabetes, it is recommended to have your A1C checked every three to four months.

“If you suspect you have diabetes or are at risk, you should definitely talk to your doctor,” Rifkin said. “It’s also important to incorporate lifestyle changes like changing your eating habits and increasing your exercise. Also, we now have medications that are very useful and beneficial at preventing end-organ damage, like heart and kidney disease, if you get them incorporated early into your medication regimen.”  

For those living with diabetes, lifestyle changes play a key role in managing blood sugar—such as following a low-sugar diet, limiting pasta, breads, bagels, and junk foods, avoiding drinks with added sugars and exercising four to five times a week to support overall health.

There are four medications currently recommended for patients with diabetes including GLP-1; SGLT2; RAS inhibitors, which includes ACE inhibitors and ARBs; and the non-steroidal mineralocorticoid receptor antagonists. According to Rifkin, these four medications are being used together, and can significantly slow the decline of kidney function.

“Over my course of having diabetes for the last 30 years, one of the things that has impressed me the most, is that technology has advanced a lot.” Rifkin said. “Not just medications, but we now have technology where I have an insulin pump which delivers insulin continuously to me. I also have a CGM (continuous glucose monitor), which can read my blood sugar throughout the day.”

There are also pod devices that attach directly to the body and deliver insulin, making diabetes management much easier, especially for children with insulin-dependent diabetes.

Unfortunately, diabetes is very prevalent in Mississippi. According to Rifkin, it is believed that about 50% of people in the United States have prediabetes, which is a mildly elevated blood sugar. In Mississippi, these numbers are even higher which leads to more people having additional health conditions such as heart disease, kidney disease and nerve pain.

“There are always unique challenges when trying to manage diabetes. A lot of it is cultural; things that people eat that may not be good for diabetes,” Rifkin said. “Also, the lack of ability to find some place to exercise, so having parks and gyms that people can go to can sometimes be a challenge for people in rural areas.”

Another challenge Mississippians in rural areas face is having access to routine health care. According to Rifkin, access to regular routine care is very important to getting your diabetes under control to prevent things like heart attacks, strokes and kidney failure which could lead to dialysis.

“As a diabetic for 30 years, I’ve realized that diabetes is very complicated. It is not a sprint. It is a marathon,” Rifkin said. “Every day is different. Every time you go to eat something, every time you go to exercise, your blood sugar changes. It is sometimes not very predictable, and so having lots of data from a CGM can be extremely helpful.”

In the last five to ten years, the advances in technology and medications can help to slow down the end-organ damage, particularly with your heart and your kidneys, related to diabetes.

For more information about diabetes management and resources, visit Hattiesburg Clinic Diabetes Care. Follow the link to watch the full interview with Dr. Rifkin: https://youtu.be/onOL44vh6ek

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About Hattiesburg Clinic Nephrology:

Hattiesburg Clinic Nephrology offers a diagnostic work-up for adults with acute or chronic renal failure, nephrotic syndrome, diabetic nephrology, glomerular and interstitial nephritis, electrolyte and acid-base disturbances and hypertension.

About Hattiesburg Clinic:

Hattiesburg Clinic is Mississippi’s largest privately-owned, multispecialty clinic. Founded in 1963, Hattiesburg Clinic has expanded to include over 450 physicians and providers, along with 2,500 employees, serving patients across more than 17 counties in Mississippi. Hattiesburg Clinic is committed to being the health care provider of choice in the communities we serve.