You’ve only just been diagnosed with diabetes, or you’re a friend or family member who is hoping to better care for somebody else. There is so much information to contend with, even in simply understanding the concept of such a disease. The complications and details become even more varied when you’re past the age of fifty. In these articles, we’ll provide a broad base of knowledge. This section explores the details of diagnosis—including risks like sugar, the APOE gene (which is also associated with Alzheimer’s disease), and weight gain—along with ways to help prevent and improve control of diabetes through healthy daily habits and awareness. The first step to wellness is through education and understanding, and it’s never too late in your life to take the first step.
The Dangers of Diabetes
have diabetes mellitus, a disorder characterized by elevated levels of blood sugar (glucose). About twenty-nine million Americans (approximately 9.3 percent of the U.S. population) are afflicted with the disease, according to the Centers for Disease Control and Prevention. More than eight million of these people don’t even realize that they have it. But that’s not all. A staggering eighty-six million Americans show early signs of diabetes (“prediabetes”) but don’t know that they are at risk of developing the full-blown disease. This alarming trend is due, in part, to the ever-increasing number of Americans who are overweight, which sharply increases diabetes risk. If you have been gaining weight, eating a lot of high-fat and high-sugar foods, and/or not getting much exercise, I’m afraid that you’re already in danger of getting diabetes. Even though this is a frightening scenario, there is some good news. If you identify the warning signs early enough, you can prevent diabetes from developing. If you already have diabetes, proper monitoring and healthful eating can help you control your glucose levels and avoid many of the disease’s serious complications, such as heart failure, stroke, kidney failure, eye disease, nerve damage, and/or amputation.
WHAT IS DIABETES?
Whenever we eat or drink, the food or liquid we ingest is broken down into nutrients that our bodies need to function. Glucose (a simple sugar that acts as the main energy source for our bodies) is one of the key nutrients. When glucose is absorbed into the bloodstream, it stimulates the pancreas to produce insulin. This hormone transports glucose into our body’s cells, where it is then converted to energy for immediate or later use. There are two main types of diabetes.
Type 1 (formerly known as juvenile-onset) diabetes affects only about 10 percent of people with diabetes. Although the disorder usually develops in childhood or early adulthood (before age thirty), an increasing number of adults are now being affected. Researchers theorize that the increasing incidence of obesity in adults may accelerate the autoimmune destruction that characterizes type 1 diabetes— specifically, the body’s immune system attacks and destroys the insulinproducing cells of the pancreas. People with type 1 diabetes need frequent doses of insulin, which is typically delivered by injection with thin needles, a pen that contains an insulin-filled cartridge, or a small special “pump” that delivers a continuous dose of insulin.
Type 2 (once known as adult-onset) diabetes affects 90 percent of people who suffer from the disease.
Most cases occur during adulthood, and risk increases with age. In recent years, many overweight children and teenagers have been diagnosed with type 2 diabetes. In type 2 diabetes, the pancreas produces insulin (sometimes more than the usual amounts), but fat and tissue cells are resistant, preventing the hormone from doing what it’s supposed to do—which is to unlock cells so that blood glucose can enter. Your risk of type 2 diabetes increases significantly if you eat a lot of foods that are high in simple carbohydrates (which are rapidly transformed into sugar) and foods that are low in dietary fiber (needed to slow the absorption of sugars from the food we eat and digest). Also, people who don’t get much exercise are more likely to develop type 2 diabetes because of the insulin resistance that results from weight gain and an imbalance of stress hormones. In addition to obesity, risk factors for type 2 diabetes include a family history of the disease (especially in parents or siblings), apple-shaped body type, high blood pressure, high cholesterol, or, among women, a history of diabetes during pregnancy (gestational diabetes, which usually disappears after delivery). People with type 2 diabetes who have difficulty controlling their glucose levels may require oral medication, such as metformin and/or insulin injections.
HEADING OFF DIABETES
Prediabetes affects 35 percent of Americans between the ages of forty and seventy-four—well into your older years. In these people, blood glucose levels are elevated but not enough to be considered type 2 diabetes. Detecting the telltale signs of prediabetes—which show up in blood tests—helps you prevent the full-blown disease. Without these measures, there’s a good chance that a person diagnosed with prediabetes will develop type 2 diabetes within ten years. I advise my patients (and readers) to get yearly blood tests to help identify many early-stage diseases, including diabetes. Diabetes-related tests should include fasting blood glucose to determine whether you are showing signs of prediabetes. Before you go to your doctor’s office for the test, you will need to fast for at least eight hours. Then blood is drawn and sent to a lab for a measurement of the glucose concentration, which is expressed in milligrams of glucose per deciliter (mg/dL). A fasting level of 100 to 125 mg/dL is considered prediabetes. (For more on the diagnostic criteria for diabetes, see “Test for Diabetes” on page 6.)
Too often, patients who have glucose levels of 100 to 115 mg/dL are told by their doctors that they don’t have a problem. In my view, a fasting blood glucose level in this range indicates prediabetes. I consider my patients to be free of any immediate risk only if their glucose levels are in the range of 70 to 86 mg/dL. If a patient’s glucose level is 87 to 100 mg/dL, I recommend some of the same strategies that I prescribe for people with prediabetes. An oral glucose tolerance test can be used to check for prediabetes. After fasting for eight to twelve hours, a blood sample is taken to determine your fasting blood glucose level. Then your doctor will ask you to drink a solution with a high sugar content. After one, two, and three hours, your doctor draws a blood sample and checks your glucose reading. A level of 140 to 199 mg/dL for any of the readings indicates prediabetes. A reading of 200 mg/dL or above indicates diabetes. I recommend that doctors also check insulin levels with the blood sample used for the glucose tolerance test. If insulin levels are abnormally high (15 to 20 microunits per milliliter or higher), it’s a sign that you are developing insulin resistance—which is often a step on the road to diabetes.
The Best Way to Prevent Diabetes—No Drugs Needed
Approximately 9.3 percent of Americans have diabetes; the percentage of Americans age sixty-five and older remains high, at 25.9 percent, or 11.8 million people (diagnosed and undiagnosed). So if your doctor ever tells you (or has already told you) that you have prediabetes, you’d be wise to consider it a serious red flag. It means that your blood sugar level is higher than normal— though not yet quite high enough to be classified as diabetes—because your pancreas isn’t making enough insulin and/or your cells have become resistant to the action of insulin. A whopping 35 percent of American adults now have prediabetes. Nearly one-third of them will go on to develop full-blown diabetes, with all its attendant risks for cardiovascular problems, kidney failure, nerve damage, blindness, amputation, and death. That’s why researchers have been working hard to figure out the best way to keep prediabetes from progressing to diabetes. And according to an encouraging new study, one particular approach involving some fairly quick action has emerged as the winner—slashing prediabetic patients’ risk for diabetes by an impressive 85 percent, without relying on drugs.
NEW LOOK AT THE NUMBERS
The new study draws on data from the National Diabetes Prevention Program, the largest diabetes prevention study in the United States, which began back in 1996. The program included 3,041 adults who had prediabetes and were at least somewhat overweight. Participants were randomly divided into three groups. One group was given a twice-daily oral placebo and general lifestyle modification recommendations about the importance of healthful eating, losing weight, and exercising. A second group was given twice-daily oral metformin (a drug that prevents the liver from producing too much glucose) and those same lifestyle recommendations.
The third group was enrolled in an intensive lifestyle modification program, with the goal of losing at least 7 percent of their body weight and exercising at moderate intensity for at least 150 minutes each week. The original analysis of the data, done after 3.2 years, showed that intensive lifestyle modification reduced diabetes risk by 58 percent, and metformin use reduced diabetes risk by 31 percent, as compared with the placebo group. Updated analysis: Researchers wanted to know whether those odds could be improved even further, so they did a new analysis, this time looking specifically at what happened in the first six months after prediabetes patients began treatment and then following up for ten years. What they found:
- At the six-month mark, almost everyone (92 percent) in the intensive lifestyle-modification group had lost weight, while more than 25 percent in the metformin group (and nearly 50 percent in the placebo group) had gained weight. The average percentage of body weight lost in each group was 7.2 percent in the lifestyle group, 2.4 percent in the metformin group, and 0.4 percent in the placebo group. Ten years later, most of those in the lifestyle group had maintained their substantial weight loss—quite an accomplishment, given how common it is for lost pounds to be regained.
- In the intensive lifestyle-modification group, those who lost 10 percent or more of their body weight in the first six months reduced their diabetes risk by an impressive 85 percent. But even those who fell short of the 7 percent weight loss goal benefited. For instance, those who lost 5 percent to 6.9 percent of their body weight reduced their risk by 54 percent, and those who lost just 3 percent to 4.9 percent reduced their risk by 38 percent.
If you have prediabetes: Don’t assume that diabetes is an inevitable part of your future, and don’t assume that you necessarily have to take drugs. By taking action now, you can greatly reduce your risk of developing this deadly disease. So talk with your doctor about joining a program designed to help people with prediabetes adopt healthful dietary and exercise habits that will promote safe, speedy, and permanent weight loss.