March 27, 2013

Diabetes Prevention – T2DM – Part 1

Part 1 of 2 Parts

Can type 2 diabetes be prevented? This is a question I am often asked in emails and the answer does depend on many factors. Not surprisingly, the answer is both yes and no. It depends on too many variables such as: are you predisposed or genetically at risk (family history of diabetes), are you overweight to obese, do you smoke, have you been injured in the pancreas, have you been on steroids for medical reasons (hip replacement, had chronic back pain, etc.) where you have needed steroids for extended periods of time, or have you led a sedentary lifestyle. Researchers are discovering that sometimes these risks do not exist, but people still develop type 2 diabetes.

I have also been exposed to people that are morbidly obese, yet they have not developed diabetes. Thus, you can see that the question does not yield a yes or no response. Generally, the risks in the above paragraph will hold true, but don't count on it. Still if you are over weight, it will be an advantage for you to lose weight and exercise if you are medically able. Do exercise if your doctor sees no medical problems preventing this.

Even the American Diabetes Association (ADA) is strongly advising people who are at risk for diabetes to lose weight and exercise as a means of preventing type 2 diabetes. It is wise not to follow the weight loss plans from the ADA, as they are not proven to work. Until the ADA separates their organization from the USDA and the Department of Health and Human Services (HHS) and the information they dispense, losing weight will become a problem of preventing weight gain. High carbohydrate/low fat foods will generally cause most people to gain weight or make it next to impossible to lose weight.

The following are important and worth quoting. “The risk for developing diabetes increases in certain cases such as the following.
1. Genetics: People with a close relative with type 2 diabetes are at higher risk.
2. Ethnic background: For example, the actual prevalence of diabetes in the Caucasian population of the US is about 7.1% while in the African American population, it increases to about 12.6%. Approximately 8.4% of Asian Americans and 11.6% of Hispanic Americans are affected. In a well studied group of Native Americans, the Pima Indians, the prevalence increases to almost 35%.
3. Birth weight: There is a relationship between birth weight and developing diabetes, and it's the opposite of what you'd intuitively think. The lower the birth weight the higher the risk of type 2 diabetes. At the other end of the spectrum, a very high birth weight (over 8.8 pounds or 4 kg) also is associated with an increased risk. Additionally, mothers of infants who had a higher birth weight (over 9 pounds) are at increased risk for developing diabetes.
4. Metabolic syndrome: People who have the metabolic syndrome are at especially high risk for developing diabetes.
5. Obesity: Obesity is probably the most impressive risk factor and in most situations the most controllable. This is in part due to the fact that obesity increases the body's resistance to insulin. Studies have shown that reversal of obesity through weight reduction improves insulin sensitivity and regulation of blood sugar. However, the distribution of fat is important. The classic "pear" shape person (smaller waist than hips) has a lower risk of developing diabetes than the "apple" shape person (larger around the waist). The exact reason for this difference is unknown, but it is thought to have something to do with the metabolic activity of the fat tissue in different areas of the body.”

Thanks to endocrinologists that are making use of their education to routinely look for indicators of problems in blood glucose metabolism that can be seen years before the onset of diabetes, we now have hope of delaying diabetes in patients who are at high risk for developing diabetes.

Some of the red flags that may indicate risk if diabetes include irregular menses. The lengthening of menstrual cycles in obese women especially those who had cycles greater than 40 days indicates twice the risk of developing diabetes as those whose cycle was every 26 to 31 days. This is thought to be linked to polycystic ovary disease, which is known to be associated with insulin resistance. Insulin resistance is thought to be a precursor for type 2 diabetes.

Another red flag is impaired fasting glucose. This is being considered because of the expansion of the at risk definition to people with fasting glucose levels from 100 mg/dl to 125 mg/dl for developing type 2 diabetes. It is also known that these people are at an increased risk for heart disease and stroke.

Three other red flags are late to the list and are now better understood; include inflammation and endothelial dysfunction (abnormal response of the inner lining of blood vessels) and retinal artery narrowing (narrowing of the tiny blood vessels in the back of the eye). The inflammation marker known as C-reactive protein has been shown to be increased in women at risk for developing the metabolic syndrome, and in both men and women at risk for developing type 2 diabetes.

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