Diabetes: Not Just Someone Else's Problem

Diabetes: It's Not Someone Else's Problem

By Jack Challem

The numbers are sobering, a wake-up call for each and everyone of us. According to the Centers for Disease Control and Prevention, 21 million Americans have diabetes and, by various estimates, 70 million have some form of prediabetes. A study in the Journal of the American Medical Association grimly predicted that one of every three Americans born in the year 2000 will eventually develop diabetes.

Being overweight is the most obvious risk factor for diabetes and prediabetes, and two-thirds of Americans are now either overweight or obese. So looking in the mirror is probably the fastest way of gauging your risk of diabetes. Other clues include feeling physically fatigued and fuzzy brained. Long term, prediabetes and diabetes rocket your risk of heart attack, stroke, Alzheimer's disease, and cancer right through the stratosphere.

It's scary stuff, and we no longer have the time to be complacent. Odds are that it's no longer someone else's problem. It's yours.

Three Tests that Could Save Your Life

Go to your doc for routine blood tests, and both of you could easily miss the real signs of trouble. If your fasting glucose is anywhere between 60 and 110 mg/dl, there's a good chance your doctor will say your blood sugar is normal. The trouble is that this normal range is wide enough to drive a truck through. Other tests can tell you and your physician a lot more.

An ideal glucose range is between 75 and 85 mg/dl, but don't let good numbers go to your head too quickly. Healthy-looking numbers could actually be a "false normal." The reason is that people can often pump out plenty of insulin, a hormone that will keep your glucose levels in the normal range. But elevated insulin levels, a condition called hyperinsulinemia, is a smoking gun: they increase your risk of prediabetes and diabetes by a whopping eight times!

Three tests can help sort out your real risk. Your doc may be hesitate doing the second or third tests, and your insurer may be reluctant to pay for them. But look at it this way: your life may depend on them. So insist, and be pushy if you have to.

1. Fasting glucose. A "normal" fasting glucose level may not be good enough. A recent study in the New England Journal of Medicine found that high-normal glucose levels were far more hazardous than low-normal levels, especially when combined with elevated triglyceride levels. Researchers found that men with high-normal glucose levels of 91 to 99, plus triglycerides over 150 mg/dl, were more than eight times more likely to develop diabetes within a few years. Men with glucose levels less than 86 mg/dl and triglyceride lower than 150 mg/dl had the least risk of diabetes. Both glucose and triglyceride tests are part of routine blood chemistries, so these numbers are easy to check. (By the way, fasting glucose beween 100-125 mg/dl indicates prediabetes, and fasting glucose is 126 mg/dl or higher indicates diabetes.)

2. Fasting insulin. The conventional view is that fasting insulin between 6 and 35 mcIU/ml is normal. But the truth is that the higher your insulin, the harder your body is working to keep glucose levels down. Fasting insulin under 7 mcIU/ml is ideal, and up to 10 mcIU/ml is good. But higher levels point to trouble. If your fasting insulin is greater than 15 mcIU/ml, it's a sign of looming problems; and if it's higher than 25 mcIU/ml, you're probably prediabetic, even if your glucose is normal.

3. Hemoglobin A_1c.This test, commonly abbreviated as HbA_1c, provides a snapshot of your average glucose levels over the previous six weeks. HbA_1c levels are measured in "percent," and normal is considered 4.5 percent to 5.7 percent. Having an HbA_1c level of 7 percent or higher is considered a sign of very high blood sugar levels and full-blown diabetes. The lower end of the range, 4.5 to 5.0 percent is healthiest.

By themselves, these tests won't save your life. Tests can only give you a head's up of where your health is heading. But they can be a real motivator for improving your eating habits, taking helpful supplements, and exercising.

Diabetes Meal Makeovers: A Perfect Day's Meals

Trying to figure out what to eat to manage your glucose levels? Here are some dietary guidelines to follow and a sample menu plan.

• First, emphasize quality proteins that are also low in saturated fats. These include fish, chicken, and turkey. Protein stabilizes blood sugar and reduces appetite. (Note: legumes have a lot of carbs relative to protein.)

• Second, eat fiber-rich, nonstarchy vegetables and fruits. They include salad greens, tomatoes, cucumbers, broccoli, cauliflower, spinach, mushrooms, and green beans, as well as raspberries, blueberries, and kiwifruit. Fiber also controls blood sugar and reduces appetite.

• Third, use healthy cooking oils, such as olive oil and macadamia nut oil. Opt for oil-and-vinegar dressing (e.g., balsamic vinaigrette). Recent studies have found that vinegar can reduce appetite and glucose and insulin levels.

Avoid any foods that are deep-fried or contain "partially hydrogenated vegetable oils." All deep-fried foods will contain these dangerous oils. In the grovery store read the fine print on labels. Make or order salads without croutons, stay away from potatoes, and cut way back (or eliminate) breads, pastas, and pizzas. If your weight and blood sugar are under control, you can eat unprocessed rice varieties (e.g., brown, purple, and red), nuts, and an occasional sweet potato or yam.

Tip: Always eat breakfast, ideally with some type of protein. That protein could be an egg or a slice of turkey or chicken. People who skip breakfast eat more throughout the day and have higher cholesterol levels.

Breakfast

Instead of cereal and milk, or skipping breakfast, try this:

Two eggs scrambled with in a little olive oil, with diced onions, bell peppers, and mushrooms. Season with oregano. Dice the veggies ahead of time, such as on a Saturday, and store them refrigerated in plastic containers. You can also cook two or three breakfasts on Sunday morning—cover and refrigerate them immediately, then reheat them in the microwave oven for a fast breakfast on Monday and Tuesday mornings.

Lunch

Instead of a burger and fries, try this:

Chicken Caesar salad, sans croutons. Look for a dressing made with olive oil, but without sugar or partially hydrogenated vegetable oil. If you're not sure about salad-dressing ingredients at a restaurant, substitute olive oil and balsamic vinegar.

Dinner

Instead of spaghetti and meatballs, try this:

Filet of Alaskan salmon, baked, broiled, or pan-fried in olive oil. (All Alaskan salmon is wild, not farmed.) It should cook in eight to 12 minutes, depending on thickness. Season it with basil and oregano. Enjoy steamed veggies, such as cauliflower, on the side. For a small amount of carb, cook brown or purple rice or wild rice (the latter is a grass, not a rice). Alternative: pan fry the salmon with a small amount of pesto sauce.

For another fast dinner, try this: rinse several fillets of sole, dredge them in red rice flower (available at many health food stores), and pan fry with a little olive oil, one minute per side.

Dessert

Instead of ice cream or chocolate, try this:

One handful of unsalted cashews and organic raisins, or two pitted dated filled with peanut butter, almond butter, or cream cheese.

Mealtime Tip: So, What d'ya Drink?

Trying to figure out what to drink with your meal? Consider making flavorful iced-herbal teas, such as Celestial Seasonings' Red Zinger or Bigelow's Green Tea with Peach. Simply add two or three teabags to a pitcher of water and allow to brew on your kitchen counter for two to eight hours. Another option is sparkling mineral water with a wedge of lemon, lime, or orange.

Scientific References

Narayan KMV, Boyle JP, Thompson TJ, et al. Lifetime risk for diabetes mellitus in the United States. JAMA, 2003;290:1884-1890.

Zavaroni I, Bonini L, Gasparini P, et al. Hyperinsulinemia in a normal population as a predictor of non-insulin-dependent diabetes mellitus, hypertension, and coronary heart disease: the Barilla factor revisited. Metabolism, 1999;48:989-994.

Tirosh A, Shai I, Tekes-Manova D, et al. Normal fasting plasma glucose levels and type 2 diabetes in young men. New England Journal of Medicine, 2005;353:1454-1462.

Khaw KT, Wareham N, Bingham S, et al. Association of hemoglobin A_1c with cardiovascular disease and mortality in adults: the European prospective investigation into cancer in Norfolk. Annals of Internal Medicine, 2004;141:413-420.

Leeman M, Ostman E, Bjorck I. Vinegar dressing and cold storage of potatoes lowers postprandial glycaemic andinsulinaemic responses in healthy subjects. European Journal of Clinical Nutrition, 2005: epublication ahead of print.

Ostman E, Granfeldt Y, Persson L, et al. Vinegar supplementation lowers glucose and insulin responses and increases satiety after a bread meal in healthy subjects. European Journal of Clinical Nutrition, 2005;59;983-988.

Farshchi HR, Taylor MA, Macdonald IA. Deleterious effects of omitting breakfast on insulin sensivitiy and fasting lipid profiles in health lean women. American Journal of Clinical Nutrition, 2005;81:388-396.