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Diabetes: More than just sugar overload?

  • Story Highlights
  • 57 million Americans have prediabetes and 24 million others have diabetes
  • A prediabetic's risks for complications are nearly as great as a diabetic's risk
  • In many cases, progression from prediabetes to type 2 diabetes can be prevented
  • Lifestyle changes --weight loss, eating better, exercise and good sleep-- are key
By Katy Koontz
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Health

I walk every day, eat a healthful diet, and have no diabetes in my immediate family. I'm not model skinny (truth be told, I've been known to pack on a few extra pounds), but I'm certainly not a couch potato or junk food addict. So, imagine my surprise when a routine blood test showed that my blood sugar was elevated and I was officially prediabetic.

Diabetes is not a painful disease early on, says one expert, so people don't realize how serious it is.

Diabetes is not a painful disease early on, says one expert, so people don't realize how serious it is.

Prediabetic, meaning I have higher-than-normal blood sugar levels that put me at risk of developing diabetes, the seventh-leading cause of death in the United States. Yikes!

The fact that I'm not alone doesn't make me feel any better -- 57 million Americans have prediabetes and another 24 million have diabetes (90 to 95 percent of all diabetes diagnosed is type 2, which typically appears in adults and is associated with obesity, physical inactivity, family history, and other factors). Being part of what's shaping up to be a diabetes epidemic in America isn't a club I want to join. Health.com: How to lower your risks for developing diabetes

Another wake-up call

It turns out that prediabetes isn't really "pre" anything, according to Mark Hyman, M.D., author of "UltraMetabolism" and "The UltraMind Solution: Fix Your Broken Brain by Healing Your Body First." "It's a danger in and of itself that sets off a whole cascade of problems," he says.

In fact, there's now evidence that a prediabetic patient's risks for eye, kidney, and nerve damage, as well as heart disease, are nearly as great as a diabetic's, says Alan J. Garber, M.D., chairman of the American Association of Clinical Endocrinologists task force that's currently writing new guidelines for managing prediabetes.

What's more, diabetes can be especially dangerous for mothers and their unborn children, potentially leading to miscarriage or birth defects. Women with diabetes are also at higher risk of having a heart attack at a younger age. And elevated insulin levels have been shown to put postmenopausal women at increased risk of developing breast cancer.

The more I learned about diabetes, the more determined I was to lower my blood sugar levels. But how? What was I doing wrong in my so-called healthy life? Here's what I found out that can help you, too.

I'm not alone in my surprise at having blood sugar troubles. Virginia Shreve was in the same boat when she went to a walk-in clinic with a bad backache and found out she had full-blown diabetes. "I had no clue," says the 52-year-old from Lynchburg, Virginia. During her exam, the doctor tested her blood sugar and found that it was 280. (A normal, nonfasting blood glucose level is less than 140 mg/dl.)

"I felt like a deer in the headlights," Shreve remembers. "I'd always been healthy. I knew thirst was a symptom, but I thought it was healthy that I was drinking so much water. And I'd been a good walker for years, so it wasn't like I never got any exercise."

When she returned to the doctor the following week, Shreve was given the results of her hemoglobin A1c test, which shows how blood glucose is controlled over two to three months. Normal for nondiabetics is 6 percent or lower -- but Shreve tested at 9.6, enough to require medication.

Diabetes symptoms include being hungrier than usual, urinating frequently, and losing weight without trying, as well as fatigue, irritability, blurred vision, tingling or numbness in hands or feet, persistent infections, and slow-healing cuts or bruises. But some people have no symptoms or don't equate the symptoms they do experience with diabetes.

"A lot of people feel fine with prediabetes or even when they're diagnosed with type 2 diabetes," says Sue Kirkman, M.D., of the American Diabetes Association. "It's not a painful disease early on, so people don't realize how serious diabetes is and what kind of bad complications it can cause."

Experts say the nation's obesity epidemic is certainly partly responsible for the rise in diabetes. "As weight climbs, so does diabetes risk," says Lauren Richter, D.O., a family practitioner at the Center for Integrative Medicine at the University of Maryland School of Medicine, in Baltimore. "My goal with patients is to get the people at risk to make lifestyle changes even before we notice higher blood sugar on a blood test because by the time we find diabetes, they've already lost 50 percent of the function of their pancreas."

Yet not everyone who gets type 2 diabetes has a sugar- or carb-laden diet, or is even overweight. Up to 20 percent of people with the disease have a normal weight. Genetics and environment play a part. And additional risk factors include a family history of diabetes, certain ethnic backgrounds, and having gestational diabetes or giving birth to a baby that weighs more than 9 pounds. The risks increase with age, too. And some studies suggest that environmental toxics, such as arsenic (sometimes found in drinking water and seafood), may be related to an increased risk for diabetes. Other factors (such as being stressed or sick, or taking certain medications, such as steroids) also affect blood sugar, and they can push you over into prediabetes or diabetes if you're already borderline.

The good news is that in many cases the progression from prediabetes to type 2 diabetes can be prevented with a few lifestyle changes. How? By losing 7 percent or more of your body weight, in addition to exercising and following a low-calorie, low-carbohydrate, high-fiber diet. Research has shown that people with prediabetes who took these steps had a 58 percent success rate in avoiding progressing to type 2 diabetes, AACE endocrinologist Garber says. Prescription medication -- such as metformin, acarbose, or thiazolidinediones -- may also be required for those in high-risk groups or those not successful with lifestyle changes. Health.com: 20 little ways to drop the pounds and keep them off

Even if you do end up taking meds, the ADA's Kirkman says, "don't think you can take a pill and then eat whatever you want. It's not a substitute for trying to be healthy."

Fighting stress and getting enough sleep may also help control blood sugar, an idea embraced by Richter, who has prediabetes. "For me, sleep is critical for managing stress and maintaining proper insulin levels," she says. "I get a minimum of seven hours, preferably eight, a night. I also get massages and acupuncture routinely -- I have one or the other every six weeks. This is not a luxury. If you're going to try to manage blood sugar, you have to manage stress."

Get moving

If you have diabetes or prediabetes, exercise does more than just help control your weight, says Tim Church, M.D., Ph.D., of the Pennington Biomedical Research Center in Baton Rouge, Louisiana, and co-author of "Move Yourself: The Cooper Clinic Medical Director's Guide to All the Healing Benefits of Exercise (Even a Little!)." "It increases muscle mass -- and healthier muscle is more responsive to insulin, lowering blood sugar levels."

How much do you need? Church recommends 30 minutes of moderate-intensity aerobic exercise (such as walking) at least five days a week and 20 to 30 minutes of resistance training one to two days a week. Combining aerobic exercise with resistance training yields a bigger drop in blood sugar than either type of exercise alone, according to a recent study. Health.com: Why getting rid of belly fat may lower type 2 diabetes risk

If you can exercise even more often, do it, says Nadine Uplinger, R.D., director of the Gutman Diabetes Institute at Albert Einstein Healthcare Network in Philadelphia, Pennsylvania. "We're finding that some people, especially those who may not be on any medication, need closer to an hour of aerobic exercise a day, seven days a week to combat diabetes." Also, strive for a body mass index of less than 25.

Eat healthier

Americans eat an average of 158 pounds of sugar per year. That, plus all the refined flour, bad carbs, and trans fats we eat, means we are overfed and undernourished. We consume too many calories and not enough nutrients, Hyman says: "Our diet is a huge contributor to diabetes." Health.com: Fiber, starch, fats, and serving sizes: Eat right advice for your diet

High fructose corn syrup is doubly problematic, he says, because it fails to stimulate leptin (the hormone that makes you feel full) and doesn't lessen ghrelin (a hormone that makes you hungry). The same is true of the fructose found naturally in fruit, but because it's not processed you still get a good dose of healthy fiber and antioxidants.

Whether HFCS is more harmful than table sugar is a matter of debate, but one thing is certain: It's in a lot of packaged foods, so much so that most Americans consume it in excess without even realizing it. It's hard to limit sugar to no more than 10 percent of your daily calories, as suggested by the World Health Organization, if you're eating processed foods, sugary treats, and low-fiber carbs. Instead, follow these healthy eating guidelines.

Balance your plate. Eating healthy to prevent diabetes is a balancing act, Uplinger says. "I encourage people to make half of their plate nonstarchy vegetables (broccoli, green beans), one quarter starch, and one quarter protein."

Pick whole foods. During digestion, all carbs break down into sugar -- raising blood sugar more than protein and fat do. But the carbs in processed foods are even more rapidly digested and so have a greater effect on blood sugar. "The more you refine foods, the more you take away their protective compounds, such as the antioxidants that help metabolize carbohydrates," says Kalidas Shetty, Ph.D., professor of food biotechnology at the University of Massachusetts in Amherst, Massachusetts. Plus, whole foods have more fiber, helping people with diabetes eat the 25 to 30 grams of fiber recommended daily by the ADA.

Use the glycemic index (GI). The glycemic index gives values from 0 to 100, according to how much a food raises blood sugar. High-GI foods (like white bread) are rapidly digested and cause significant spikes in blood sugar, while low-GI foods are more slowly digested and produce more gradual elevations in insulin levels and have less impact on blood sugar. Health.com: Foods with low glycemic index

"A good way to use the index is to aim for low-GI choices and avoid high-GI ones," says Jennie Brand-Miller, Ph.D., of the University of Sydney in Australia, one of the foremost GI experts and co-author of "The New Glucose Revolution for Diabetes." "Think slow-carb, not no-carb," she says. Select available low-GI options within food categories (like whole-grain or sourdough bread, or breakfast cereals like traditional oatmeal or natural muesli).

Eat more spices. Many spices, herbs, and seasonings -- including basil, cloves, cumin, garlic, ginger, mint, oregano, rosemary, thyme, and turmeric -- may help manage blood sugar levels. Cinnamon, Shetty says, appears to be particularly helpful in slowing sugar uptake and helping insulin receptors in the body work more effectively.

Know the truth about sugar-free. "There's this misconception that if something is sugar-free, it won't affect your blood sugar and you can eat all you want," Uplinger says. "But it's simply not true." These foods may not have sugar, but they still have carbs -- and some of them actually have more carbs than the normal foods they attempt to replace.

These changes can certainly be overwhelming. "But you didn't develop diabetes or prediabetes overnight, and you don't have to fix it overnight," says Donna Kay, co-author of "The Complete Diabetes Lifestyle." "Small changes you make every day add up to big, important changes over time. The more you can control diabetes, the less control diabetes will have over you."

A sweet ending

As for me, I developed a plan that included exercising more, in addition to eating more low-GI and high-fiber foods and fewer processed foods. I found a farmers' market where I could load up on fresh veggies and hormone-free grass-fed beef. Each morning for breakfast, I'd have a good, protein-rich breakfast of scrambled eggs and whole-wheat toast with natural peanut butter. Lunch would be my biggest meal. For dinner, I'd stick to just low-fat cottage cheese with some pistachio nuts. And for snacks, I'd eat half a protein bar at midmorning and the rest of it at midafternoon to make sure I hardly ever went more than three hours without eating some protein. (Many experts believe that balancing foods high in starch and sugar with protein can prevent blood sugar from spiking.)

I'd religiously read labels at the supermarket, too, refusing to buy anything with sugar listed in the first half of the ingredients. I'd sprinkle cinnamon on many foods and take cinnamon capsules. And if I wanted dessert, I'd have a no-sugar-added cup of pudding. For special treats I'd enjoy 2 ounces of very dark chocolate (at least 70 percent cocoa) or maybe a glass of dry red wine, both of which are high in healthful antioxidants.

After three months I dropped 20 pounds -- and now my blood sugar levels are normal. Even so, my doctor wants to keep an eye on me. I've been sobered by what I've learned. And I know now that staying healthy is a process, one I'll have to fine-tune for the rest of my life.

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Copyright Health Magazine 2009

All About DiabetesAmerican Diabetes AssociationGestational DiabetesType 2 Diabetes

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