Last week, I talked about the importance of getting your act together if you learn you have pre-diabetes. This is when your body can’t handle excess sugar (glucose) and something has gone wrong with the control system, namely insulin, which lowers glucose, from your pancreas, which produces insulin.
Remember, one adult in three is pre-diabetic and most don’t know they have it.
There are two types of diabetes, imaginatively called Type I and Type 2. It was pointed out to me by a concerned reader that I had used an out-of-date term for type 1, namely “Juvenile Diabetes”, so-called because this is an auto-immune disease which followed common children’s virus like mumps or cytomegalovirus. Type 1 has nothing to do with family history of diabetes, triggered by obesity, etc. One day your kid is fine, then she’s got a bad virus, then a couple of months later, the pediatrician tells you she’s diabetic. Since we now know that Type 1 can follow a bad COVID infection, “juvenile” does seem a bit passe. I pleaded guilty and did apologize to the reader.
Only about 5% of diabetics are Type 1.
Type 2 Diabetes is also termed “adult onset”, although the term is itself now dated as Type 2 is frequently being diagnosed in children and teenagers. When you see a schoolyard of roly-poly kids, you can bet a painful percent are either pre-diabetic or diabetic. Risks: family history, certain ethnic groups (Hispanics, Black Americans, American Indians), being overweight/obese (high BMI, check yours here, physical inactivity, carrying weight in abdomen. A third type of diabetes, called gestational diabetes, occurs during pregnancy and usually goes away after your baby is born. But, you need careful watching. Ten years down the road, you may develop pre-diabetes, and your child has a risk of becoming obese.
Ready for this? The number of diabetics has doubled in the past twenty years. There are now 37.3 million Americans with diabetes, 8.7 million of whom are unaware of their diagnosis. So how often should you be tested? If you are over 35, every three years. Test yourself more often if you are overweight, inactive, Hispanic or Black or have a history of diabetes in the family.
Best test: hemoglobin A1c which measures 3 months of your blood glucose. Your insurance company prefers a fasting (8 hours) blood sugar because it’s cheap, but the HbA1c is superior.
All right. Your hemoglobin A1c is 6.5 or higher and you’re told you’ve joined the other 37.3 million diabetics.
It’s not a “Why me, God?” diagnosis. You developed diabetes because you’ve been eating far too much unhealthy food from a profit oriented food industry that doesn’t care at all about depriving you of ten or more years of life and multiple chronic diabetic complications. Inactivity plus sugary and salty snacks weren’t forced upon you. Next week is Super Bowl Sunday. Look at your TV room after the game. Do you think Taylor Swift eats like you?
Here are the “non-medication” steps to take if you have been diagnosed with diabetes or pre-diabetes. First (and I can’t believe I located this Health Tip “You, the Wonderful One Hoss Shay” I wrote 14 years ago), it talks about “the rectangularization of longevity”. The “One Hoss Shay” is an old poem written by Oliver Wendell Holmes about the buggy the town’s deacon used for years and years. One day, after incredible longevity, it simply collapsed. That’s the way you want to leave this world, incredible longevity, no minimal replacement parts (drugs, surgery, etc.). Here’s a link to a copy of the original edition of the poem itself.
The graph I refer to in the Health Tip has been removed by the publisher. But your goal is a healthy life, free from chronic illnesses, doctors offices, and so forth until you’re 97 or so, and then bang-o, one morning, someone finds you dead. HOWEVER, as I said in my last Health Tip, with unchecked diabetes, you’ll be supporting the entire healthcare system from your late fifties, and depending on the severity of your diabetes and your willingness to cooperate, to your seventies or eighties.
To start, non medication:
Purchase a home Hemoglobin A1c monitor and check your HbA1c as often as your primary care provider recommends. These are very accurate devices, FDA approved. Purchase a home glucose monitor or a Freestyle Libre to hook to your Smartphone. Purchase a home blood pressure monitor and make sure your BP is consistently 135/85 or less (meds may be needed).
So far your investment is less than $100.
Have your cholesterol profile measured. Diabetics do best when their Total Cholesterol is below 150 and LDL (bad) cholesterol is below 60. This may necessitate (gasp!) statins.
Smoking makes all aspects of diabetes dramatically worse. We really don’t have that many smokers at WholeHealth Chicago, so I will skip to the two hardest steps.
Diabetes is a chronic illness brought on by unhealthy lifestyle choices (diet and inactivity) and some genetics. Unless you get it under control early, plan along the way on using the services of your primary care practitioner, along with an ophthalmologist (eyes), a nephrologist (kidney), podiatrist (feet), neurologist (nerves), vascular surgeon (blood vessels), endocrinologist (diabetes management).
Can’t do anything about your genetics, but meeting with a diabetic nutritional counselor and following his/her instructions for the rest of your life will change everything for you as the flab melts off and your HbA1c drops. Your nutritional counselor will be the most important person in your goal for a healthful longevity. The second most important will be that person you entrust your fitness training. You might say you can’t afford a personal fitness trainer (“Oh, nice Lexus parked in front. Yours?”), but you can join a group fitness program at a local YMCA.
Your best bet is to abandon sugar altogether. You can have a piece of fresh fruit for your dessert. Schedule with a nutritionist (at WholeHealth Chicago, that’s Tam Dickson-Meyer). Likewise, intense physical activity (not something ‘meditative’ like Yoga or t ’ai chi, but a Jane Fonda ‘feel the burn’, Orange Theory stuff, Pilates when combined with cardio is also good) 4-5 times a week. The Surgeon General recommends 150 minutes a week. That’s 30 minutes, 5 days a week.
Enough for today. Next week, a review of meds, costs (astonishing), and their smorgasbord of side effects.
Be well,
David Edelberg, MD
Hi Dr.E, could you please address the fact that anxiety makes blood sugar soar, as does depression and low thyroid. I was told 11 yrs ago that I was insulant resistant( FI too high), and started on metformin 2 gm /day. My TSH is still 3.6, and A1c gone from 5.3. when Functional med. Drs say 2..5 or less is optimum, and sure I would feel better if anyone would address thatat, but..I’m told it’s fine! Was told that the pancreas can compensate for high blood sugar for years. FI still too high, still v. Active/eat v.v well, which I always have! V .frustrating! Thank you!
Tina Hepworth