You can put the brakes on diabetes

Philip J. Goscienski, M.D.

January 2006

More than 40 million Americans have prediabetes but most are not yet aware of it. It's present when the blood sugar after a 12-hour fast is 100 milligrams per deciliter (expressed in medical shorthand as mg/dl) or more but not yet at 126 which designates frank diabetes. Few people are aware that they have prediabetes but even modestly increased blood sugar levels can cause damage to blood vessels throughout the body. By the time these persons cross the threshold to diabetes nearly half of them will already have one or more complications of the disease.

You can avoid crossing that threshold by taking some simple steps - literally. When a group of middle-aged persons with prediabetes walked for only 3½ hours per week and cut back their fat intake they cut their risk of diabetes by 58 percent. That was a better result than a similar group that took a prescription diabetes medicine.

About 18 million Americans have type 2 diabetes and nearly one third of them don't know it. Native Americans, African Americans, Hispanics and Asian Americans are at the highest risk of diabetes and among these groups it has truly reached epidemic levels. For the youngest generation, the term epidemic seems inadequate. The Centers for Disease Control and Prevention estimates that among African American children born in the year 2000, nearly half (49 percent) will suffer from type 2 diabetes as adults. For Hispanic girls the estimate is even higher - 53 percent - and it will surely climb as we pass mid-century. That is, unless we do something now.

The fact that type 2 diabetes is almost entirely preventable magnifies the tragedy. It has been said that genetic factors load the gun but lifestyle factors pull the trigger. In Native Americans, among whom there were virtually no reports of type 2 diabetes before World War One, it is now the second leading cause of death. No one can claim that their genes have changed in a single century.

Persons with prediabetes have no symptoms but they do have a significant warning sign: excess weight gain. Almost all victims of type 2 diabetes are overweight and more than half are obese.

The surest way to avoid prediabetes and type 2 diabetes is to maintain a normal weight by exercising daily (at least 30 minutes, and preferably 60). It doesn't have to be strenuous and it can be broken up into 2 or 3 sessions. Brisk walking will do nicely, although doing resistance exercises with weights or machines helps even more. Those who are already overweight may have to exercise more vigorously in order to shed those extra pounds and will need to change their eating habits as well.

Certainly diet matters but sugar is not the worst culprit. Our bodies do not deal well with refined grains. Foods such as baked goods made with white flour and refined cereals contribute to diabetes by allowing blood sugar to reach high levels repeatedly over many years. Daily damage leads to insulin resistance, a condition in which our body cells do not utilize blood glucose properly.

If you are overweight, have a family history of diabetes or belong to one of the racial groups at risk you should have your blood sugar checked every year. It may be the best investment you ever made.

Philip J. Goscienski, M.D. is the author of Health Secrets of the Stone Age, Better Life Publishers 2005. Contact him at