November is Diabetes Awareness Month

November is Diabetes Awareness Month, a time to shed light on a condition that affects more than 34 million Americans and nearly 500 million people worldwide. Diabetes is a metabolic disorder that impacts the way the body processes glucose (sugar). When left unchecked, diabetes can lead to severe complications, including heart disease, stroke, cognitive decline and microvascular disease. The good news is that diabetes is largely preventable, and even when it is diagnosed, early intervention can prevent many of these complications.

As the core cause of insulin resistance, oxidative stress (caused by factors such as sleep apnea, hypertension, chronic stress, smoking, air pollution, etc.) is central to understanding the strong association between diabetes and cardiovascular disease. Insulin resistance occurs when oxidative stress impairs the ability of insulin receptors in muscle and fat cells to function properly, disrupting glucose uptake and leading to hyperglycemia. This cascade ultimately leads to beta cell exhaustion and uncontrolled blood sugar, which strongly links IR and diabetes to increased cardiovascular risk.

One of the most concerning aspects of diabetes, particularly Type 2 diabetes and insulin resistance, is its impact on the blood vessels, especially the smaller blood vessels or microvascular system. These microvessels are crucial for providing oxygen and nutrients to tissues throughout the body, including the eyes, kidneys and nerves. Insulin resistance and diabetes are known to cause chronic inflammation in the arteries, contributing to microvascular disease, which is characterized by damage to the smaller blood vessels

One When the body becomes insulin-resistant, it is unable to properly regulate blood glucose levels. This results in elevated insulin levels in the bloodstream. High insulin levels contribute to an inflammatory environment that can damage the endothelial cells lining the blood vessels. In the case of microvascular disease, this damage can result in the following:

• Endothelial Dysfunction: The endothelium (inner lining of blood vessels) becomes less able to regulate blood flow and prevent clotting, increasing the risk of vascular complications.

• Increased Permeability: Insulin resistance causes increased permeability of the small blood vessels, leading to leakage of proteins and fluids into surrounding tissues. This is particularly harmful to organs such as the eyes (retinopathy), kidneys (nephropathy), and nerves (neuropathy).

• Chronic Inflammation: Elevated insulin and glucose levels promote the release of pro-inflammatory cytokines, which contribute to the thickening of the blood vessel walls and further impair circulation. This results in the narrowing and eventual occlusion of these very small blood vessels, which is the hallmark of microvascular disease.

Microvascular disease is a common and often debilitating complication of uncontrolled diabetes and insulin resistance. The three most prominent microvascular complications are:

• Diabetic Retinopathy: Damage to the blood vessels of the retina, potentially leading to blindness.

• Diabetic Nephropathy: Kidney damage resulting from poor blood flow and filtration, often leading to kidney failure.

• Diabetic Neuropathy: Nerve damage caused by poor circulation, resulting in symptoms like numbness, tingling and pain, particularly in the feet and hands.

In addition to these conditions, insulin resistance and diabetes can also increase the risk of macrovascular diseases, such as heart disease and stroke, due to the broader effects of chronic inflammation and arterial damage.

Even if your lab results suggest that you’re at risk for diabetes or insulin resistance, the good news is that these conditions are preventable and, in most cases, reversible. Lifestyle changes are the cornerstone of diabetes prevention, and they can also help manage the condition if you’ve already been diagnosed.

Maintain a Healthy Weight: Weight loss, even as little as 5-10% of total body weight, can dramatically improve insulin sensitivity and lower blood sugar levels.

• Eat a Balanced Diet: Focus on a diet rich in fiber, lean proteins, healthy fats and non-starchy vegetables. Limit refined carbohydrates and processed sugars.

• Exercise Regularly: Physical activity improves insulin sensitivity and helps regulate blood sugar. Aim for at least 150 minutes of moderate exercise per week.

• Manage Stress: Chronic stress can elevate cortisol levels, which in turn worsens insulin resistance. Techniques such as mindfulness, yoga and deep breathing can be helpful.

• Consider Monitoring Tools: Continuous glucose monitors (CGMs) can provide real-time feedback on how your body responds to food and lifestyle changes, giving you valuable insights into managing blood sugar.