Friday, September 18, 2009

Reduce Your Diabetes Risk

By Sheryl Kraft, November & December 2008

Millions of Americans have dangerously high blood sugar—and most don’t know it. Here are steps you can take to stay healthy

For years Steve Segerman’s doctor had warned him to lose weight. But the New Jersey insurance sales representative had other priorities. Faced with mounting career pressures, Segerman, a self-confessed emotional eater, turned to fattening comfort foods such as chips and cookies.

Then, at 53, Segerman was diagnosed with elevated blood sugar, the mark of a little-known but surprisingly common condition called prediabetes. Still, he let the weight stay on. “I didn’t see any obvious health issues related to my weight gain, even though they were right in front of me,” he says.

But six months later, blurry vision and fatigue sent Segerman back to the doctor’s office, where another blood test revealed his condition had progressed to full-blown type 2 diabetes. That’s not unusual: people with prediabetes are as much as 15 times more likely to develop type 2 diabetes than are people who have normal glucose levels. And that means they’re 15 times more likely to suffer the heart and kidney disease, eye problems, and other complications that diabetes can cause.

If Segerman had taken steps earlier to lose weight and exercise, he might have avoided getting diabetes. But it still wasn’t too late to turn things around. He changed his diet, shedding more than 20 pounds, and began exercising regularly. At least three days each week, he walked, either on a treadmill or on local roads. His symptoms abated, his blood sugar levels moved closer to normal, and his diabetes was brought under control. Says Segerman, “It’s amazing that doing so little can do so much.”

About 57 million Americans have prediabetes—and most don’t know they have it. While everybody’s blood sugar goes up after eating, those with prediabetes have blood sugar levels that go up considerably higher than normal and often remain so long after eating. That’s a concern, because the physical damage of elevated blood sugar begins well before the condition reaches the level at which diabetes is diagnosed. This is why doctors are focusing more and more on discovering high blood sugar early—and on controlling blood sugar to keep it in the normal range. “The earlier you treat it, the lower the rate of complications,” says Om P. Ganda, M.D., associate professor of medicine at Harvard Medical School and senior physician at Boston’s Joslin Diabetes Center.

Educate Yourself

If you are new to a diagnosis of prediabetes or diabetes, these books can help you understand your condition and stay as healthy as possible.

Beating Diabetes by David M. Nathan, M.D., and Linda Delehanty (McGraw-Hill, 2006). The authors helped design the Diabetes Prevention Program study, which proved that diet and exercise can stave off diabetes in people who have impaired glucose tolerance. This guide offers what you need to do to prevent or manage the disease.

Diabetes for Dummies, third edition, by Alan L. Rubin, M.D. (For Dummies, 2008). Like all the “Dummies” books, this one is written for the person who knows next to nothing. It clearly lays out the basics for dealing with diabetes, including information on preventing it if you have prediabetes.

Living With Diabetes by Rosemarie Perrin and Seth Braunstein, M.D., editor (AARP Books/Sterling, 2007). An AARP Guide to enjoying your life while taking the best possible care of yourself, it has solid information about management, monitoring, and medications.
—Holly Zimmerman

So are you at risk for prediabetes? If you’re an average American over 45, you probably are, especially if you answer yes to any of the following questions:

Are you overweight? The more fatty tissue you have, the more resistant your cells become to insulin, a hormone that helps your body metabolize sugar and get it out of your bloodstream. And body shape is a significant factor: you’re at higher risk if you’re apple-shaped—storing fat around the middle—rather than pear-shaped.

Are you inactive? It’s not just that people who are sedentary are likely to be overweight. Exercise actually helps your body use insulin and process glucose. In fact, a lack of exercise impedes this process.

Are you genetically predisposed? If you have a parent or a sibling who has type 2 diabetes, this increases your risk for developing prediabetes. In addition, the condition is more common among certain ethnic groups: African Americans, Latinos, American Indians, and Asian Americans.

Are you numerically predisposed? Your risk of prediabetes rises if you have high blood pressure, low “good” HDL (high-density lipoprotein) cholesterol (35 milligrams per deciliter or less), or high triglycerides—fats—in the blood (250 mg/dL or more).

If you’re at risk, it’s important to be screened before you experience symptoms of prediabetes. If you’ve already developed symptoms—such as excessive thirst, frequent urination, and slow healing of sores—it’s even more important to be tested. “If we just wait for people to come in with symptoms, the body’s machinery is so messed up that it’s hard to do a good job with treating the illness,” explains John Buse, M.D., Ph.D., president, medicine and science, of the American Diabetes Association and professor at the University of North Carolina School of Medicine.

The standard screening test—a fasting plasma glucose test—measures blood sugar first thing in the morning, before breakfast. A more sensitive test, the oral glucose tolerance test, measures blood sugar both after fasting and two hours after consuming a glucose-rich drink. The manufacturer of a third—and simpler—test for diabetes and prediabetes is expected to seek FDA approval within the next six months: the VeraLight Scout system would use ultraviolet light to detect markers of diabetes and prediabetes in a patient’s skin, with no need for fasting or having blood drawn.

If you’ve had a screening test and your blood sugar was normal, guidelines suggest that you should have it checked again in three years. If your blood sugar was elevated, your doctor will probably recommend lifestyle changes. A typical recommendation would be to reduce your weight by 5 to 7 percent and to add physical activity: 150 minutes of moderate aerobic activity, such as walking, biking, or swimming, plus two or three weight-training workouts per week. What’s more, your physician might prescribe an oral diabetes drug to help your body process glucose more efficiently.

Want proof that being proactive will pay off? The Diabetes Prevention Program, a large study carried out by the National Institutes of Health, showed that lifestyle changes and medication can dramatically reduce the progression of prediabetes to type 2 diabetes. And, interestingly, lifestyle changes worked even better at preventing the disease than medication did; people 60 and older who made lifestyle changes reduced their risk by 71 percent.

So if you are at risk of prediabetes or if you already have it, heed the lessons of Steve Segerman’s case. No matter how busy you are, it’s worth making the time to take care of your health. This is one instance where—with discipline and with luck—you really can turn back the clock.

Sheryl Kraft is a health and fitness writer based in Wilton, Connecticut.

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