Take Control of Your Diabetes Risk

John Whyte, MD, MPH

• Publisher: Harper Horizon
• Year: 2022
• ISBN:
  9780785240655
• Topic: Medicine
• Subtopic: Diseases & Allergies

From the Chief Medical Officer at WebMD, the world's largest provider of trusted health information, learn how to reduce your diabetes risk and change your mindset from I hope I don't get diabetes to I can prevent diabetes.

You have diabetes. Three words no one ever wants to hear, yet each year, over a million people in the United States alone do. So now what?

Take Control of Your Diabetes Risk shares straightforward information and equips you with strategies to help you on a journey to better health, including:

• Knowing the causes of the different types of diabetes
• Learning the role food, exercise, and sleep play
• Understanding the relationship between diabetes, heart disease, and cancer

You have the power to reclaim your life after a prediabetes or diabetes diagnosis--and this book will show you just how easy it is.

CHAPTER ONE

What Exactly Are Diabetes and Prediabetes?

TRUE OR FALSE?

1.Diabetes is the second leading cause of death in the United States.

2.Prediabetes affects more than 100 million Americans.

3.Type 2 diabetes is partly genetic.

4.Type 2 diabetes is uncommon in people younger than twenty-five years of age.

5.Obesity is a major cause of prediabetes.

(Answers at end of chapter)

YOU’RE NOT ALONE. Diabetes and prediabetes are quite common. More than 34 million Americans have diabetes—that’s nearly one out of every ten people (see Figure 1). In fact, more than 50 percent of our population has some type of diabetes or prediabetes, and more than 1.5 million people are diagnosed every single year. And the numbers are going up. As a nation and as individuals, we need to get our blood sugar under control. Sadly, we are headed in the wrong direction.

Figure 1

What’s particularly concerning is the number of people who don’t yet know they are affected. Of those who have diabetes, more than 20 percent are undiagnosed. Of the 88 million adults with prediabetes, a whopping 84 percent aren’t aware their blood sugar isn’t normal.

Undiagnosed: Of the 34.2 million adults with diabetes, 26.8 million were diagnosed, and 7.3 million were undiagnosed.

New cases: 1.5 million Americans are diagnosed with diabetes every year.

Nearly 1.6 million Americans have type 1 diabetes:

• 7.5 percent of non-Hispanic whites
• 9.2 percent of Asian Americans
• 12.5 percent of Hispanics
• 11.7 percent of non-Hispanic blacks
• 14.7 percent of American Indians/Alaskan Natives

What exactly is diabetes? And what do we mean by prediabetes?

Despite how common diabetes is, many people don’t really understand what’s happening in their body. Diabetes relates to how well your body controls blood sugar. I always tell people that diabetes isn’t complicated. You need to understand only two things—glucose and insulin. Once you know how these work together, you will have what you need to help manage or even reverse elevated blood sugar.

How do you feel when you haven’t eaten in a while? Tired. That’s because your cells need energy. Our bodies need energy to survive, and we get that energy primarily from glucose in food. When you eat or drink something, your body breaks down the carbohydrates into glucose, which is then absorbed into your bloodstream.

Your pancreas produces the hormone insulin to help your cells absorb glucose, so that they can use it as energy. Insulin also stores any excess glucose that you don’t use right away, mostly in your liver and muscle cells.

The right amounts of insulin and glucose are critical. The two perform a delicate balancing act that requires your body to calibrate the amount of each with expert precision. Too much or too little of either is bad.

We used to think there were only two types of diabetes, but we have now identified at least five types!

1. We have learned over the last few years that type 1 diabetes is an autoimmune disease in which your body attacks and destroys the islet cells of your pancreas, which are responsible for producing insulin. We also know that those who develop type 1 diabetes are genetically predisposed, and that lifestyle plays no role in its development. Type 1 diabetes can develop at any age, but it typically occurs in children and is diagnosed less commonly after one’s early thirties.
2. In type 2 diabetes, your body still produces insulin but, because your body has become resistant, it has lost its effectiveness (see Figure 2). To compensate, your body produces more insulin. Even though the insulin amount may be high, it’s actually not enough for the amount of glucose you have consumed as well as the amount your body is making, because of your cells’ resistance to it. Your liver also produces more glucose, since your cells are not able to utilize glucose effectively. Type 2 represents more than 90 percent of all cases of diabetes.
   Early in my training, I only saw type 2 diabetes being diagnosed in adults. In fact, we used to call it Adult Onset Diabetes. In recent years, however, it has become more common in teenagers. Genetics do play a role but not as much as most people think. Our genes don’t change much over decades—it takes generations. Unlike type 1 diabetes, lifestyle plays a significant role in this type of diabetes. The rise in type 2 cases in young people is directly related to lifestyle—with obesity playing the biggest role. We even created a new word—“diabesity”—to express the relationship between obesity and diabetes.
   
   Figure 2
3. Nearly one in twenty pregnant women develops Gestational Diabetes, likely the result of a combination of factors: less insulin is produced, weight gain makes the insulin that is produced less effective, and various other placental hormones reduce the ability of insulin to do its job. Fifty percent of women with gestational diabetes will develop diabetes within ten to twenty years of their pregnancy.
4. Maturity Onset Diabetes of the Young (MODY) is a rare type of inherited diabetes caused by a genetic mutation. It occurs in people under the age of thirty who typically have a family history of diabetes in more than one generation. MODY is often misdiagnosed as type 1 or type 2: it is diagnosed in young adults, as type 2 is, but it prevents the beta cells from secreting enough insulin, as type 1 does. If you have a parent who has this condition, you have a 50 percent chance of developing MODY. Weight and lifestyle do not play a role.
5. Latent Onset Diabetes in Adults (LADA) is also rare, and, because it combines features of type 1 and type 2, it can also be misdiagnosed. People sometimes call it Type One and a Half Diabetes! As in type 1, your pancreas stops producing insulin, probably due to autoantibodies, but it doesn’t stop all of a sudden at an early age. Rather, as in type 2, insulin gradually becomes less effective, often resulting in a diagnosis after age thirty. People diagnosed with LADA will often suffer other autoimmune conditions such as ulcerative colitis, Crohn’s disease, multiple sclerosis, or rheumatoid arthritis. Your doctor may be able to check by looking for certain antibodies and measuring C-peptide.

Some diseases, such as pancreatic cancer and hemochromatosis, also destroy the cells of the pancreas and cause diabetes—sometimes referred to as secondary diabetes. Others, such as pheochromocytoma, disrupt the way you release insulin. Cushing’s disease and acromegaly can also present with elevated blood sugar. Testing for and treating the underlying disease will likely resolve the episodes of elevated blood sugar.

Some chronic medication use can also cause diabetes, sometimes by causing weight gain, and other times by directly impairing the pancreas. These include glucocorticoids, which reduce insulin sensitivity and cause the liver to produce more glucose, statins, and some antipsychotic and high blood pressure medications.

Finally, there’s prediabetes. This is a condition of elevated blood sugar that is likely to become type 2 diabetes if changes aren’t made. Nearly everyone who has type 2 diabetes has had prediabetes, although they may not have realized it. One of the goals of this book is to help prevent you from progressing to diabetes if you’ve been told you have this condition.

Just a reminder: In this book, we are talking about prediabetes and type 2 diabetes. Even though some of the guidance discussed will be helpful for your overall health, the recommendations don’t specifically apply to other types of diabetes.

Are You At Risk?

Prediabetes and type 2 diabetes do not occur randomly. Rather, certain factors and behaviors increase your risk. Some you can’t control—age, race, and family history—but most you can. Your weight, and high blood pressure or high cholesterol, can increase your risk. Being inactive plays a big role. If you suffer from depression, that can increase your risk. If you have heart disease, you are more likely to develop diabetes, and if you have diabetes, you are more likely to develop heart disease. The good news is that if you reduce your risk of one, you reduce your risk of both.

Several online risk calculators can help you calculate your risk. It’s a good idea to take a test to see the impact of different factors. The Centers for Disease Control and Prevention (CDC) and the American Diabetes Association (ADA) have one of the best:

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