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Ask the Doc: Diabetes

Published October 2021 | In Fall 2021

Diabetes affects 1 in 10 Americans, but it’s still largely misunderstood by the general public. Sonalika Khachikian, M.D., explains the different types, factors that put you at risk and treatment options once you’re diagnosed.

Ask the Doc: Diabetes Media

What are the types of diabetes?

There are two main types; 1 and 2. Type 1 diabetes is an autoimmune disorder, which means your body is attacking the cells that produce insulin until your body can no longer produce it at all. Type 2 diabetes is when your body makes insulin but not enough, or your body isn’t using it correctly.

There are also lesser known forms of diabetes. One has to do with chronic pancreatic issues or can happen if you have your pancreas removed. Another is gestational diabetes, which happens during pregnancy and affects a small percentage of women.

What does it mean to be prediabetic? What are the risk factors?

The American Diabetes Association defines prediabetic as having a blood glucose level between 100-126, or an A1C of over 5.7 but less than 6.5 percent. Your A1C is an average of your blood sugar levels over the past three months.

Risk factors include insulin resistance — which means your body produces insulin but is resistant to it — obesity and polycystic ovary syndrome.

What are the health conditions associated with diabetes?

Having diabetes means you’re also at risk for heart disease, peripheral artery disease, cardiovascular disease and eye, kidney or nerve damage. Treating diabetes is all about keeping your blood sugar levels under control, but that’s really just a means to an end. The whole reason we’re doing that is to prevent further complications or impacts on your health.

Can lifestyle choices increase our risk of developing diabetes?

Some people are genetically predisposed to having or developing diabetes, so sometimes there isn’t a lot we can do. Generally speaking, however, watching your diet, limiting simple carbohydrates and exercising regularly can decrease your risk. The more you exercise, the more sensitive your body is to insulin, which means your body can use it more efficiently. You should aim to get at least 30 minutes of moderate exercise per day, or 150 minutes per week.

What role do genetics play in risk for diabetes?

There are certain genetics that mean you’re more likely to have or develop diabetes. Men are more likely to have type 1 diabetes than women, for example. While you can inherit risk factors for type 1 or type 2, we see type 2 diabetes run in the same family more often than type 1. Ethnicity can also be a factor; African Americans, Native Americans, Pacific Islanders and Asian Americans are at a higher risk than other groups.

Dr. Khachikian is a board-certified endocrinologist skilled in the diagnosis and treatment of type 1 and type 2 diabetes. She enjoys teaching her patients how to care for themselves on a daily basis to improve their overall health and staying current on new technologies such as insulin pumps and sensors.

What do you think is the biggest misconception about diabetes?

One of the biggest misconceptions I hear from people who don’t have diabetes is they think treatment is a one-size-fits-all approach, or that changing just one thing will fix it. Everyone is different, and the way their body responds will determine the course of treatment we pursue. I also have many people who think that having diabetes means you can never have certain things again, like a chocolate cupcake. You can still have a cupcake once in a while, or to celebrate a special occasion. It’s about balance, and knowing how your body responds.

For my patients, a misconception I see a lot is that having to go on insulin means they’ve failed, which is entirely inaccurate. Diabetes is a progressive disease, so even if you do everything right, you may still need to go on insulin. You have done nothing wrong, and it isn’t the end of the world; we just have to adjust your treatment.

How is diabetes treated? How do diet and exercise factor in?

The world of diabetes treatment has opened up so much in the past five years. For example, the options we now have for getting people the insulin they need have changed drastically. We have much more flexibility now to put you on a system that matches your specific needs, such as using a long-acting insulin that will last for 36 hours, or a fast-acting one that will take immediate effect after you’ve eaten.

Another incredible change has been continuous blood glucose monitors. Not only do they relieve the need for pricking your fingers, they give us so much more insight and data about diabetes and help us find new ways of managing it.

How do diet and exercise factor into treating diabetes?

Exercise is important, and for some people it can make a tremendous difference. However, diet is more important than exercise overall. Eating healthy meals and snacks throughout the day that keep your blood sugar levels in control, and knowing what foods will spike your blood sugar, is very important.

To learn more about diabetes education and treatment options at Monument Health, visit