PREVENTING DIABETES: ARE YOU AT RISK?

Diabetes is on the rise in the United States. In June 2008, the total number of Americans living with diabetes increased to nearly 24 million. This is a jump of more than 3 million people in two years, according to the Centers of Disease Control and Prevention.

In addition to the number of people diagnosed with diabetes, there are approximately 57 million people in the United States with pre-diabetes. This condition causes an increased risk for developing diabetes, and often these people do not even know about their risk. Pre-diabetes involves difficulty regulating blood sugar, with mild glucose elevations beyond the normal levels, but not at diabetic ranges. For people with pre-diabetes, the hormones that control blood sugar will often be out of balance. Insulin is one of these hormones; it helps to bring glucose out of the blood and into the cells to be used for energy. In people with pre-diabetes, insulin often has difficulty bringing blood sugar into the cells, a condition called insulin resistance. This will then lead to elevations of blood glucose, which can develop into diabetes.

Warning signs of diabetes include fatigue, increased thirst, increased hunger, tingling or numbness of hands or feet, and blurred vision. People with type I diabetes have insufficient insulin production; this type of diabetes usually begins in childhood, and will typically cause weight loss. Type II diabetics will have weight gain due to increased fat conversion from sugar, and decreased fat breakdown as a result of elevated insulin.

Because of the increase in diabetes prevalence, the American Diabetes Association (ADA) has recently released new recommendations for the prevention of diabetes. The ADA now advises that all overweight people over the age of 45 should be screened for diabetes. People with two or more risk factors for diabetes should be tested for this disease, regardless of whether the person has symptoms of diabetes. The American Academy of Family Physicians recommends that people with high cholesterol and high blood pressure are screened for type 2 diabetes as well.

Diabetes risk factors include obesity, high cholesterol, high blood pressure, a sedentary lifestyle, and a family history of diabetes. Obesity centralized around the abdomen is associated with elevated risk of diabetes. Women who have had gestational diabetes have about a 40% chance of developing diabetes after the pregnancy. There also is a genetic association with diabetes for people of Native American, Hispanic, or African American decent. People also have greater risk as they age, with increased occurrence of diabetes after the age of 60.

A few basic lifestyle changes can significantly impact your diabetes risk. In a study by the National Institutes of Health, 3,234 people with pre-diabetes were given either metformin, or specific dietary and exercise recommendations. The people in the diet and exercise group lost an average of 15 pounds, and reduced their risk of diabetes by 58%. The metformin group had a reduced risk of 31%.
You can reduce your risk of diabetes by following these guidelines: 

• Limit dietary consumption of refined sugar, white flour, pasta, and processed foods. 
• Exercise regularly, optimally for at least 30 minutes per day. 
• Eat a high fiber breakfast with at least 20 grams of protein, to boost your metabolism and stabilize your blood sugar throughout the day (example: a hard boiled egg, and a protein shake with ground flax seed). 
• Include 30-40 grams of fiber in your daily diet, preferably from leafy green vegetables and whole grains; supplement with flax seed, oat bran, or acacia fiber. 
• Get a diabetes screen from your doctor including cholesterol testing and a blood pressure check; if you are overweight but have not had high blood sugar on previous tests, ask for a pre-diabetes screen of insulin resistance and glucose tolerance.

If these recommendations for reducing your risk of diabetes seem overwhelming, start with one change at a time and commit to that change until it becomes a normal part of your lifestyle. Work with your doctor to determine the most effective way to reduce your risk and improve your overall health. Your doctor can be an advocate and a coach in helping you to achieve your health goals.

References:
ADA Updates Diabetes Care Standards: Recommendations Reflect 'Aggressive Approach,' Says FP Expert. Bittner, Barbara. AAFP News Now. 12 Feb 2008.
Am I at Risk for Type 2 Diabetes? Taking Steps to Lower Your Risk of Getting Diabetes. NIH Publication No. 07–4805. Dec 2006.
Number of People with Diabetes Increases to 24 Million. Centers for Disease Control and Prevention, Department of Health and Human Services. 24 June 2008.