Diabetes is among the fastest-growing health conditions in the United States. Over 30 million adults have diabetes, with 1.5 million new cases each year. If you include prediabetes, which tends to lead to diabetes if untreated, over 100 million Americans are affected. Fortunately, most cases of diabetes can be treated or prevented through healthy eating, weight control and regular exercise. Since November is American Diabetes Month, this seems like a good time to raise awareness about the prevention, treatment and consequences of this serious medical condition.
Diabetes mellitus is a metabolic disorder characterized by high blood glucose (sugar) caused by a lack of insulin production or impaired insulin action. The lack of insulin production can be caused by an autoimmune disorder that damages the pancreas. This typically occurs during childhood, as in type 1 or “juvenile” diabetes, but it can occur in adults, a condition called latent autoimmune diabetes of adulthood (LADA). For both types, injected insulin is required to control blood glucose.
More commonly, diabetes is caused by the body’s cells not responding to the insulin that is produced, a condition called insulin resistance. This is called type 2 diabetes and is typically caused by some combination of obesity, particularly excess abdominal fat and physical inactivity.
Diabetes can be diagnosed based on a fasting blood glucose test, taken 8–12 hours after a meal, usually in the morning. Another test is an oral glucose tolerance test in which blood glucose is measured for two hours after drinking a special beverage containing glucose. This measures the body’s response to glucose. The hemoglobin A1c test is a long-term measure of blood glucose control. This is important because the higher the hemoglobin A1c level, the greater the risk of diabetes complications.
For most diabetics, the main treatment goal is to control blood glucose level to prevent serious complications including nerve damage, blindness, infection and amputation, heart attack and stroke. This is typically accomplished through a combination of diet, exercise and medications, with varying degrees of success. But “curing” diabetes is rare, so most patients require continued treatment.
Exercise is important for blood glucose control because exercise causes an increase in the uptake of glucose into cells and can improve glucose tolerance and insulin sensitivity. In addition, exercise has the added benefits of promoting weight loss and improving strength and fitness. Both aerobic and strength training are recommended, with a minimum goal of 30 minutes per day, every day.
Meal planning involves selecting healthy foods to help maintain consistent blood glucose levels while meeting energy needs for exercise and other activities. The dietary recommendations for preventing and treating diabetes are almost identical to the general recommendations for good health: Emphasize whole grains, fruits, vegetables, legumes and low-fat meat and dairy and reduce unhealthy fats, added sugars and salt.
The diet should also promote weight loss and weight maintenance, especially for overweight patients. The glycemic index (GI), a measure of how much a food raises blood glucose, can be helpful in dietary planning, but it is not the only meal planning tool that should be used.
Proper diet, blood glucose testing, medication use and regular exercise can improve blood glucose control, reduce the risk of other health problems and improve quality of life in diabetics. In those with prediabetes these efforts can delay the progression to diabetes and may even result in a return to normal blood glucose. In fact, diet and exercise have been shown to be more effective than medications in preventing diabetes. Plus, these lifestyle changes lead to weight loss and improved fitness, benefits that no medication can match.