I recently took care of a patient who, very unfortunately, had undiagnosed type II diabetes and presented in a state known as Hyperosmolar Hyperglycemic Nonketotic Syndrome (HHNS) – his blood sugar on presentation was ~1,000 mg/dL. HHNS is a very serious complication of untreated diabetes, but can happen to any type II diabetic with poor sugar control. I grew very fond of this patient and it is with him in mind that I share this information. -Jim
In the past decade, the incidence of diabetes in the U.S. has nearly doubled – this is due in large part to the obesity epidemic. Currently, it is estimated that the lifetime risk of developing diabetes is around 1 in 3 for males an 2 in 5 for females born after 2000. When you consider that type II diabetes has a strong genetic component – the risk for a child with two type II diabetic parents jumps to 50% – the odds are really stacked against us. Thankfully, there is an environmental component to the disease process, and there are steps you can take to prevent developing diabetes.
1. Stop smoking – Diabetes is increasingly recognized as a disease with a vascular component. Most of the complications that develop in diabetics are a direct result of small and large vessel disease – vision loss, kidney damage, heart attack, stroke. Smoking only accelerates vascular damage, and by quitting, you ease the workload on your heart and lungs and lower several down-stream risk factors for heart disease and stroke. It’s also been shown that diabetics have decreased antioxidant capacity, and quitting cigarettes (or never starting) will lower your free radical burden – also important in vascular disease.
2. Lose weight – According tot he Diabetes Prevention program, an NIH-funded study, weight loss may be the single most beneficial lifestyle change to reduce your risk of developing type II diabetes. Even if you have much more to lose, 10-15 pounds of weight loss can make a difference.
3. Stay active – Besides helping maintain a health weight and decreasing your overall risk of dying, exercising improves your insulin sensitivity – one of the key components of the pathogenesis of diabetes. Additionally, research shows that exercise helps to reduce your risk for other conditions like stroke, heart disease, osteoporosis, and even Alzheimer’s. If you have been inactive for a long period of time, “start low and go slow” – and speak with your doctor before beginning a new exercise program.
4. Improve your diet – I’ve had my issues with the USDA’s diet recommendations over the years, but eating healthy doesn’t have to be confusing – and a diet to lower your risk of diabetes is a real no-brainer. In general, cut back on soda, sweets, and processed foods; include whole grains, fish, and a variety of fruits and vegetables – and remember the importance of portion control. When grocery shopping, make a list and try to stick to it – and use my guide to navigating the supermarket to help you make better choices.
5. Understand your risk– Familiarizing yourself with your risk factors for developing diabetes not only serves as a reminder to make better choices, but may also allow you to nip pre-diabetes in the butt and avoid a visit to the emergency department like the gentleman above. Risk factors for pre-diabetes and diabetes, in addition to obesity & inactivity, include the following:
- having a first-degree relative with diabetes
- being older than 45
- certain ethnicities – African American, Alaska Native, American Indian, Asian American, Hispanic/Latino, or Pacific Islander
- having high blood pressure (>140/90 mmHg) or being treated for high blood pressure (something I commonly hear from patients is “I had high blood pressure, but not anymore because I take medicine”)
- having low HDL (<35 mg/dL) or high triglycerides (>250 mg/dL)
- having impaired fasting glucose (IFG) or impaired glucose tolerance (IGT) on previous testing by your doctor
- having other conditions associated with insulin resistance, such as polycystic ovary syndrome (PCOS) or gestational diabetes
- having a history of cardiovascular disease
When your doctor says you have pre-diabetes, it means your chances of developing overt type II diabetes is significantly increased. Know the signs & symptoms that diabetes presents with so that you can seek care before serious complications develop: frequent trips to the bathroom or excessive urination, increasing thirst, weakness & fatigue, numbness or tingling in the hands and feet, and blurred vision are common complaints.
If you have any questions about diabetes and your personal risk, don’t be afraid to ask your doctor. If you don’t have a personal doctor, try to take advantage of community screenings and local health fairs – it’s even more important to protect yourself if you don’t receive regular medical care.