Understanding Diabetes, Pre-Diabetes and What to Do If You Have It
Diabetes is a metabolic disease, meaning it affects how we process, create and store energy in the body. In the last decade, the cases of people living with diabetes jumped almost 50 percent and it is one of the chronic disease that is growing rapidly in this country and is now the 7th leading cause of death. If you look at the numbers, they are staggering. In 2015, 30.3 million Americans, or 9.4% of the population, had diabetes. Approximately 1.25 million American children and adults have type 1 diabetes. Of the 30.3 million adults with diabetes, 23.1 million were diagnosed, and 7.2 million were undiagnosed. The percentage of Americans age 65 and older with diabetes remains high, at 25.2%, or 12.0 million seniors (diagnosed and undiagnosed). 1.5 million Americans are diagnosed with diabetes every year. An estimated 33.9% of U.S. adults aged 18 years or older (84.1 million people) had prediabetes in 2015, based on their fasting glucose or A1C level. Nearly half (48.3%) of adults aged 65 years or older had prediabetes. If you look at the risk factors for the people with diabetes, it is very eye-opening and revealing. Risk factor data for 2011–2014 for U.S. adults aged 18 years or older with diagnosed diabetes indicated the following, Diabetics are:
- Smokers-15.9%, and 34.5% had quit smoking but had a history of smoking at least 100 cigarettes in their lifetime.
- Overweight and Obese– 87.5% of adults were overweight or obese, defined as a body mass index (BMI) of 25 kg/m2 or higher. Specifically, 26.1% of adults were overweight (BMI of 25.0 to less than 30.0 kg/m2). 43.5% of adults had obesity (BMI of 30.0 to less than 40.0 kg/m2). 17.8% of adults had severe obesity (BMI of 40.0 kg/m2 or higher).
- Physically Inactive– 40.8% of adults were physically inactive, defined as getting less than 10 minutes a week of moderate or vigorous activity in each of the physical activity categories of work, leisure time, and transportation.
- High Blood Pressure– 73.6% of adults had systolic blood pressure of 140 mm Hg or higher or diastolic blood pressure of 90 mm Hg or higher, or they were on prescription medication for high blood pressure.
- High Cholesterol (Hyperlipidemia)- 58.2% of adults aged 21 years or older with no self-reported cardiovascular disease but who were eligible for statin therapy were on a lipid-lowering medication. 9% of adults aged 21 years or older with self-reported cardiovascular disease who were thus eligible for statin therapy were on a lipid-lowering medication.
- High Blood Glucose (Hyperglycemia)- 15.6% of adults had an A1C value higher than 9%.
So, what is Diabetes and Pre-Diabetes and how does it affect our bodies? To answer that, you first need to understand the role of insulin in your body. When you eat, your body turns food into sugars, or glucose. At that point, your pancreas releases insulin. Insulin serves as a “key” to open your cells, to allow the glucose to enter — and allow you to use the glucose for energy. But with diabetes, this system does not work. Several major things can go wrong – causing the onset of diabetes. Type 1 and type 2 diabetes are the most common forms of the disease, but there are also other kinds, such as gestational diabetes, which occurs during pregnancy, as well as other forms. With type 1 diabetes, the body’s immune system attacks part of its own pancreas. Scientists are not sure why. But the immune system mistakenly sees the insulin-producing cells in the pancreas as foreign and destroys them. This attack is known as “autoimmune” disease. The most common form of diabetes is called type 2, or non-insulin dependent diabetes. This is also called “adult onset” diabetes, since it typically develops after age 35. However, a growing number of younger people are now developing type 2 diabetes. People with type 2 can produce some of their own insulin. Often, it’s not enough. And sometimes, the insulin will try to serve as the “key” to open the body’s cells, to allow the glucose to enter. But the key won’t work. The cells won’t open. This is called insulin resistance. Your cells are resistant to the effect of insulin to shuttle in glucose. If you receive a prediabetes diagnosis, it means you have a higher-than-normal blood sugar level that’s not high enough to be diagnostic for diabetes. The Long-term complications of diabetes develop gradually. The longer you have diabetes — and the less controlled your blood sugar — the higher the risk of complications. Eventually, diabetes complications may be disabling or even life-threatening.
The possible complications of diabetes include:
- Cardiovascular disease
- Nerve damage (neuropathy)
- Kidney damage (nephropathy)
- Eye damage (retinopathy)
- Foot damage
- Skin conditions
- Hearing impairment
- Alzheimer’s disease
There are 3 main labs tests that we look at to diagnose diabetes and/or pre-diabetes: Fasting Glucose, Fasting Insulin and HbA1C (hemoglobin A1C). If your fasting glucose level is from 100 to 125 mg/dL (5.6 to 6.9 mmol/L) is considered prediabetes. If it’s 126 mg/dL (7 mmol/L) or higher on two separate tests, you have diabetes. Glycated Hemoglobin (HbA1c) is hemoglobin (the oxygen carrying protein in your bloodstream) with a sugar attached to it. An A1C level of 6.5 percent or higher on two separate tests indicates that you have diabetes. An A1C between 5.7 and 6.4 percent indicates prediabetes. Below 5.7 is considered normal although we like to see it as close to 5.0 as possible. Finally, Insulin is the hormone secreted by your pancreas and should be around 5 mg/dl and never raise over 15 mg/dl or you are producing too much insulin to meet the demand of reducing your blood sugar. Eventually if you tax your pancreas to hard over time, it will stop working and you will become diabetic. It is important to remember that the body can only store small amounts of blood sugar in the muscles and liver as something called “glycogen”. The process of burning sugar for fuel is called “aerobic glycolysis” and this is what happens when you exercise aerobically. Your body coverts sugar and oxygen to something called ATP. Think of is as the body’s fuel system. However, if you “over-fill” the tank with sugar and refined carbs especially is the engine isn’t running and your body is sedentary, the sugar will spill over because your body can’t handle that much sugar at once. The body converts the excess sugar to its storable form called fat (triglycerides). Your body only has about 1 teaspoon of sugar in the bloodstream at one time and the rest must be converted and stored. The more sugar you eat without burning it, the more it spills over and is stored as fat. Therefore, you can now see why we have such a problem with obesity in this country. Also, our body shapes are changing such that more and more people are developing “visceral fat” or deep fat, which is different form subcutaneous fat. It is deep fat around your “viscera” (your organs) and it crushes your organs and produces all kinds of inflammatory chemicals such as cytokines and estrogens. Visceral fat is the result of insulin resistance, i.e. when your insulin is not working to get the sugar into the cells. Over the past few generations of Americans, we are seeing the natural and beautiful statuesque human body change from a muscular and lean body, to an overweight and plump body type. Imagine a roman statue of an “obese” god or soldier? The underlying problem and primary cause of diabetes and pre-diabetes is that we eat way too much sugar and refined carbohydrates. Two hundred years ago, the average American ate only 2 pounds of sugar a year. In 1970, we ate 123 pounds of sugar per year. Today, the average American consumes almost 152 pounds of sugar in one year. This is equal to 3 pounds (6 cups) of sugar consumed in one week! We should be getting no more than 3-6 tsp. of sugar per day (12 to 25 grams) and yet the average American is consuming close to 20 tsp. of sugar per day (over 80 grams). Part of the problem of sugar consumption is what we consider sugar. We tend to think of sugar as the white stuff we put in our coffee or bake with. But to understand where the sugar in our diets is coming from you should consider that nearly 70 percent of the calories from added sugars that Americans eat on a daily basis come from processed foods like breads, jams, cakes and ice cream. Added sugars can also be found in things like tomato sauce, condiments and salad dressings, and multigrain crackers and cereals. So, what can, and should we do if we are moving towards or are affected by diabetes, pre-diabetes or are just concerned that we are consuming too much sugar and refined carbohydrates? Dr. Mark Hyman, M.D. is one of the foremost authorities on what sugar does to the body. Here are his recommendations for lowering your blood sugar and dealing with pre or full-blown diabetes.
- Eat whole, fresh foods. Food is information that controls your gene expression, hormones, and metabolism. Choose low-glycemic real foods including fresh vegetables, fruits, legumes, non-gluten grains, nuts, seeds, and high-quality animal protein.
- Remove all sweeteners. Far from the free pass some people consider them, artificial sweeteners can raise insulin levels and contribute to insulin resistance. Care found sucralose (Splenda) could raise glucose and insulin levels. Give up sugar but also stevia, aspartame, sucralose, sugar alcohols like xylitol and malitol, and all of the other heavily used and marketed sweeteners unless you want to slow down your metabolism, gain weight, and increase insulin resistance. Many of us have lost touch with what constitutes “sweet,” and we must retrain our taste buds to appreciate the natural sweetness of, say, natural vanilla or roasted almonds.
- Control inflammation. Dietary sugars of all kinds and refined vegetable oils are the biggest contributors to inflammation. They increase insulin levels and turn on genes that lead to chronic inflammation, creating a downward spiral into more inflammation, poor blood sugar control, and chronic disease. Besides removing the offending foods, address food sensitivities and allergies to control inflammation. Incorporate plenty of anti-inflammatory foods including wild-caught fish, freshly ground flax seed, and fish oil.
- Increase fiber-rich foods. Whereas our Paleolithic ancestors got 50 – 100 grams of fiber a day, we now average less than 15 grams. Studies show high-fiber foods can be as effective as diabetes medications to lower blood sugar without the side effects. Fiber slows sugar absorption into the bloodstream from the gut. Eat a wide variety of fiber-rich plant-based foods including nuts, seeds, fruits, vegetables, and legumes.
- Get enough sleep. A study in The Journal of Clinical Endocrinology and Metabolism found in healthy subjects, even a partial night of poor sleep contributes to insulin resistance. Make sleep a top priority to normalize insulin levels. Avoid eating three hours before bed and take an UltraBath to raise your body temperature and relax your muscles. Go to bed and wake up at consistent times, only use your bed for sleep and sex, and try herbal therapies or melatonin if necessary.
- Address nutrient deficiencies. A number of nutrients play a role in insulin management, including vitamin D, chromium, magnesium, and alpha lipoic acid. Deficiencies in any nutrient can stall your biochemical machinery, knocking your blood sugar levels out of balance and making you more insulin resistant.
- Incorporate the right exercise. Exercise might be the most powerful medicine to manage blood sugar levels and make your cells more insulin sensitive. When it comes to exercise, time becomes a huge hurdle for many people. That’s why I recommend high-intensity interval training (HIIT), also called burst training, which you can do in just minutes a day. A study in the Journal of Obesity found among its other benefits, burst training helped decrease fasting insulin and reduce insulin resistance.Combining burst training with weight resistance provides the most effective, efficient way to normalize blood sugar and insulin levels.
- Control stress levels. Chronic stress elevates cortisol, your main stress hormone. Increased cortisol levels elevate blood sugar and promote the accumulation of belly fat that I commonly see in patients with insulin resistance or diabetes. You can’t eliminate stress, but you can reduce its impact. Find what works for you. That might be meditation, yoga, deep breathing, or exercise.
Of course, all the above recommendations are a part of an 8 Week lifestyle modification program that we developed and run in our office called 8WW (8 weeks to wellness). We regularly see full blown type-II diabetics get rid of their diabetes and their medications after completing the program. We recently had a gentleman who was a diabetic lose 34lbs., 6 inches of visceral fat and his HbA1C went from 8.7 to 6.2 after 8WW. If you or a loved one has diabetes, pre-diabetes and have any of the above risk factors, please join us for one of our 8WW orientations at our office. We hold them weekly and it could change and save you from a life of pre-diabetes or diabetes!