• Angel Alfaro | MD

Pre-Diabetes : Could you have it?


You’ve heard of diabetes, but what exactly is pre-diabetes and why does it matter? Many conditions begin to manifest themselves before they result in end organ damage. The job of wellness promotion and disease prevention is to recognize that prior to all of a sudden developing a disease, there is a “pre” period. So if there is a period prior to developing a disease, then there is a period to make some changes and potentially prevent that disease.

Though many diseases, including type 2 diabetes have genetic predisposition, it does not mean that diabetes is built into your genetic code. Think of DNA (the genome) as the blueprints and directions on how to make a house while epigenetics (the epigenome) are like the contractor who can decide to change those plans and put in an extra window or two. Epigenetics do not change your DNA, but they do alter how the DNA is utilized and can turn certain genes on or off, giving a different phenotype (the observable characteristics). Check out this fact sheet from the National Institute of Health’s, National Human Genome Research Institute for further discussion of epigenetics. I just wanted to introduce the idea, because what we do or do not do to our bodies changes our epigenome, which then changes the expression of our DNA. Just more evidence that lifestyle really is important when it comes to living well.

As a reminder, type 2 diabetes mellitus is a disease in which we have abundant insulin (at least at first), but we are insulin-resistant, meaning our tissues are not using insulin correctly. Almost all of our cells use glucose for energy and require insulin to get glucose into the cells. If the tissues cannot utilize that insulin, glucose cannot get into the cells, resulting in high levels of sugar in the blood stream and little in the cells that need it. The kidney filters our blood stream and when there is a high level of sugar in the blood, the kidneys help to get rid of it. As the kidneys get rid of sugar, excess water goes with it; this is why a person would have symptoms of frequent urination, thirst (from dehydration), dry skin (fluid moving out of cells to balance the high sugars) and fatigue (just not enough energy).

For just a second, think of a science experiment you may have done as a child; making sugar crystals by putting sugar into water and making a supersaturated solution. The sugar crystalizes on the string as the water evaporates and voila, there you go, Rock Candy! Now, think about that same science experiment happening in your cells and tissues. Certainly the process is more complex, but I hope you are starting to see the point. Too much sugar can wreak havoc on all of our body systems. Think of all the tiny blood vessels as those strings with the sugar on them. Where you find those tiny vessels, you find the long term complications from uncontrolled diabetes: kidney failure, blindness, and nerve damage (numbness and tingling in fingers and toes).

So….if we know that according to the CDC and American Diabetes Association, there are 29.1 million Americans with diabetes and there are 1.4 million Americans diagnosed every year. Shouldn’t we do something about it? As a nation we spend $250 billion dollars every year with newer estimates over $300 billion. I ask you, how can we sustain this? Shouldn’t we focus on prevention, rather than trying to care for this after the fact?

Pre-diabetes essentially is having an elevated blood sugar that is outside the normal, but not quite high enough to meet the definition of diabetes. We find that people can have elevated blood sugars for years before they are officially diagnosed with diabetes and are already beginning to show signs of the long term complications.

I recently heard a radio ad that prompted me to write on this topic. The radio ad was asking you to count your risk factors on your hands and as I listened further it provided the website DoIHavePrediabetes.org. You can go to this website and check out your risks.

Risk factors for pre-diabestes and subsequent diabetes (from CDC website):

  • age, especially after 45 years of age;

  • being overweight or obese;

  • a family history of diabetes; having an African American, Hispanic/Latino, American Indian, Asian American, or Pacific Islander racial or ethnic background;

  • a history of diabetes while pregnant (gestational diabetes) or having given birth to a baby weighing nine pounds or more;

  • being physically active less than three times a week

You can change the course of your life and prevent illness. There are many resources for lifestyle changes and the government is well aware that we need to change our focus from reactive to proactive when it comes to health and wellness.

We will continue to explore this topic on my blog as I am very passionate about it, just think if we could prevent or significantly decrease the incidence of diabetes we would all be better off.

Things you can do:

  1. Maintain a healthy weight

  2. Lose weight if you are overweight, even 10 to 15 pounds is significant for reducing risks

  3. Increase physical activity. This doesn’t have to be exercise, just get active by walking more, taking the stairs, stand at your desk instead of sit, count your steps, etc.

  4. Eat healthier. We are eating for life, so give yourself the benefit of wholesome delicious ingredients. This is not a diet and it is NOT punishment.

  5. Decrease highly processed foods, these generally have a lot of sugars, saturated fats and chemicals.

  6. Quit smoking. I know it is hard, but try. I’m sure you have tackled hard things in your life. As Winston Churchill said.. “If you’re going through Hell, keep going.”

There are so many opinions and controversies on carbohydrates, wheat, full fat diets, vegan, Paleo, etc. Don’t worry, we’ll address these and much more.

I’ll be going on a trip to Australia, New Zealand and Fiji and will be away for a couple of weeks. I’ll write more when I get back and hope to share some insights about what other countries are doing to maintain a healthy lifestyle.

Thanks for stopping by and always,

Live Well!

Dr. A

References

  1. Epigenomics Fact Sheet from the National Human Genome Research Institute. https://www.genome.gov/27532724/epigenomics-fact-sheet/

  2. Facts about Type 2 http://www.diabetes.org/diabetes-basics/type-2/facts-about-type-2.html?loc=db-slabnav

  3. About Diabetes. World Health Organization http://www.who.int/diabetes/action_online/basics/en/index3.html

  4. 2014 National Diabetes Statistics Report http://www.cdc.gov/diabetes/data/statistics/2014StatisticsReport.html

  5. Statistics about Diabetes http://www.diabetes.org/diabetes-basics/statistics/

  6. Pre-diabetes http://www.cdc.gov/diabetes/basics/prediabetes.html


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