Tip of the Iceberg

I always said that I would continue writing my blog if I had a topic that interested me and therefore the writing would just came easy.  Last week I was due to post a blog and sat down to begin writing.  I opened my computer up and the screen was cracked.  Apparently a new blog post wasn’t meant to be. (Funny enough I really didn’t have anything pressing to write about.  While I would’ve loved to rant about the new COKE ads, “Share a Coke with”, I knew I couldn’t write a whole blog ranting about how horrible soda is to our health.)   And then just like that the following week my next topic came to me. 

I have a lot of interesting discussions with my patients and this week didn’t disappoint.  I start off asking my patients why they’ve come to the education session and what their expectations are.  I have background information, i.e. bloodwork, diagnoses, etc. to know where to steer the discussion, but I like to make sure I’m covering topics that they feel are important.  This week felt like the week of prediabetes.  Some knew they had it while others did not – it makes it kind of hard to talk about a diagnosis when the people don’t even know they have it (yep, that’s why I ask for the reason for their visit).  While I represent just one clinic in America, the numbers are really startling.  One out of three adults have prediabetes.  90% of those that have prediabetes don’t even know that they have it.  Of those with prediabetes, 70% will develop diabetes in their lifetime.  Staggering. 

Experts say a “diabetes tsunami” is coming our way.  1 in 3 adults already have prediabetes.  Why?  One of the main reasons is that 2/3 of adults (and 1/3 of children) are overweight or obese, and we’re couch potatoes.  Type 2 diabetes develops because the body is resistant to insulin.  Insulin acts like a key that allows sugar to enter the cells, where it can be burned for fuel or stored for later.  However, in some people, the key struggles to open the lock.  This puts the pancreas into overdrive – to compensate for this insulin resistance the beta cells have to pump out more insulin just to keep up.  Over the years the beta cells wear out.  When this occurs this is when the blood sugar levels fall into the “diabetes” range.  Americans are headed towards this breaking point because of a couple of reasons:  we’re gaining weight at alarming rates (due to portion sizes, sugary beverages, and less exercise) and because of age.  Beta-cell failure occurs more rapidly with age. 

An article I was just reading this week even discussed this issue – “prediabetes doesn’t trigger much of a fuss in the doctor’s office.  A lot of healthcare professionals see the numbers are in the prediabetic range and simply tell the patient that their numbers are high.  They should go home and exercise and eat less.”  These clients I saw this week were referred to nutrition for education.  The only problem?  They had NO idea what their numbers needed to be and they weren’t sure when their follow-up was.  Granted some of the patients may have been told this but in the education/prevention world we call this the “Charlie Brown effect”.  They get their diagnosis and then all they hear is, “whaa whaa whaa whaa whaa”.  Believe me I’m trying to see where/what the disconnect is.  Bottom line I try and teach my patients all about the numbers.  Even though you all aren’t my patients you need to understand your numbers as well.  If you get a complete blood count, a CBC, that has all your bloodwork, pay attention to the blood glucose level and here’s what the numbers indicate:

                                       

The cutoffs for prediabetes and diabetes depend on whether your blood is tested after an eight-hour fast or without fasting.  If your blood glucose is after an eight-hour fast, and your glucose is between 100-125mg/dL that is considered prediabetes.  If your blood glucose after the eight-hour fast is 126mg/dL or higher, that is considered diabetes.  This is the first place I start with my patients, in understanding their numbers.  Diabetes is a continuum.  It cannot be reversed (contrary to what people may say).  Our goal should be to make sure that people don’t get diabetes and if someone already has diabetes, the goal should be to keep our numbers within normal limits to help prevent further complications – diabetes can affect you from your head to your toes.

How can we lower the risk of developing type 2 diabetes?  How can we help control type 2 diabetes if one already has it?

-The best way to dodge diabetes is to lose weight (or not gain) extra pounds.  Losing 7-10% of your current weight can cut your chances of developing type 2 diabetes in half.

-Do at least 30 minutes of brisk walking or other aerobic exercise every day.  Include strength training two or three times a week as well.  Working your muscles more often and making them work harder improves their ability to use insulin and absorb glucose.  Limit the time you spend sitting at work, at home, or in between.  (So glad I got rid of my 3-hour commute.  Phew!)

-Limit sweets, especially sugar-sweetened drinks.  The sugar you sip may add flab more than the sugar you chew.  Liquid calories don’t seem to lead to satiety and it’s easy to take in a large amount, easily.  Think your drink! 

-Fill up half your plate with vegetables and only a quarter with (preferably whole) grains.  Whole grains don’t have a magical nutrient that fights diabetes and improves health.  It’s the entire package – elements intake and working together – that’s important.  The bran and fiber in whole grains make it more difficult for digestive enzymes to break down the starches into glucose.  This leads to lower, slower increases in blood sugar and insulin.  As a result, they stress the body’s insulin-making machinery less, and may help prevent type 2 diabetes. 

-Replace saturated fat and trans fats with unsaturated fats to lower the risk of heart disease.  The unsaturated fats found in liquid vegetable oils, nuts, and seeds can help ward off type 2 diabetes.  Trans fats do just the opposite.  Trans fats are found in many margarines, packaged baked goods, fried foods in fast-food restaurants, and any product that lists “partially hydrogenated vegetable oil” on the label. 

The bottom line and the good news about diabetes:  it’s not inevitable.  Keep your weight – and especially your waist – under control, and spend more time on your feet than on your seat!