Catch diabetes early, modify lifestyle
ABOUT THIS COLUMN
Greg Feinsinger of Carbondale, who retired in February from Glenwood Medical Associates after 41 years as a family physician, is writing a 10-week series of columns on critical health issues for the Post Independent. The columns will appear in Tuesday’s Body & More pages.
There are two types of diabetes, Type 1 and Type 2. Type 1 is an autoimmune disorder that often occurs in childhood or teenage years, and often in thin people.
Type 2 diabetes, or what we used to call adult-onset diabetes, is what this article will discuss. It is much more common than Type 1, and more than 102 million Americans have diabetes or pre-diabetes, although 34 million of them don’t know it, either because they haven’t had their blood sugar checked or because they were checked with unreliable tests. Type 2 diabetes usually occurs in people who are overweight, and now that many youngsters are overweight and are developing diabetes, we can no longer call it adult-onset diabetes.
Diabetes is much more that a blood sugar problem, because after several years, diabetics develop conditions such as eye damage, kidney damage, nerve damage causing pain and numbness in the legs and feet, heart attacks and strokes, peripheral vascular disease that can result in amputations, and more. So not only can diabetes shorten lifespan, but it also interferes with quality of life. Nobody wants to get diabetes, but what a lot of people don’t realize is that a large percentage of Type 2 diabetes is preventable.
Years before frank (no longer pre-) diabetes is diagnosed, usually on the basis of an elevated fasting blood sugar, pre-diabetes is occurring, but unfortunately is underdiagnosed by providers at the stage where it could be reversed. What occurs first in most cases is central obesity, meaning heaviness around the middle. If you are a Caucasian male and have a waist circumference of 40 inches or greater or female with a circumference of 35 inches or greater (measured at the area of greatest circumference rather than the belt size), this is a huge risk factor for having pre-diabetes or diabetes. Asians have lower cutoff points.
The problem with central obesity is that people with it have “visceral fat,” meaning fat around their internal organs. Humans are not meant to have this, and visceral fat is very toxic in that it causes insulin resistance, where tissues don’t use insulin like they should, resulting in an initial of insulin. Among the first signs of trouble we see in these people are high triglycerides and low HDL, so if the triglyceride/HDL ratio is 3.5 or greater in Caucasians or 3.0 in Hispanics, insulin resistance if clearly present.
It can take years before the fasting blood sugar becomes elevated and diabetes or pre-diabetes in finally diagnosed. By then, a lot of damage has occurred to the arteries, kidneys, nerves, and to the beta cells of the pancreas that secrete insulin. By then, it is impossible to reverse things.
So heart attack prevention doctors feel that if we suspect pre-diabetes for any reason (central obesity, high triglyceride/HDL ratio, etc.), we need to do a two-hour glucose tolerance test. The patient fasts for 12 hours, then drinks 75 grams of sugar in the lab, and has a blood sugar test one and two hours later. If the one-hour is 125 or greater and the two-hour 120 or greater, the diagnosis of pre-diabetes is confirmed. If the disease is caught at a very early stage, it is reversible. A1C is a good blood test for monitoring control of diabetes once diagnosed, but in spite of the recommendation in the current guidelines, is not a reliable test for diagnosing diabetes or pre-diabetes. If you think you might have pre-diabetes or diabetes, or have a family history of same, insist on the two-hour glucose tolerance test.
People on a plant-based, whole foods (unprocessed), low fat diet with no simple carbs (sugar, starch), do not get central obesity, insulin resistance, pre-diabetes or Type 2 diabetes, especially if they also exercise. (People on this diet also have a much lower rate of autoimmune diseases including Type 1 diabetes). And if we catch people with early pre-diabetes, we can nip it in the bud with this same diet. Plus exercise.
Medications can help, but lifestyle modification is much more effective and is free of side effects.
Dr. Feinsinger is a retired family physician who is available for free consultations about heart attack prevention, plant based nutrition, and other health issues. Call 379-5718 for an appointment.
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