Fitness and a healthy diet are a way of life now, and Sally is now trim at 138 pounds -- down from 210. More important, she lowered her blood sugar to normal levels and faces little risk of developing type 2 diabetes.
November is National Diabetes Awareness Month, and the American Diabetes Association estimates that 41 million people in the United States, age 40 to 74, have pre-diabetes. Many don't realize it. Recent research shows that damage to the heart and circulatory system may occur during pre-diabetes and lead to increased risk of developing Alzheimer's later in life.
"This isn't an epidemic -- it's a catastrophe," says Dr. Robert Rizza, the ADA's president of medicine and science. "This is a major challenge to our nation's health."
A Preventable Problem
Most people gradually lose sensitivity to insulin -- the key blood-sugar-regulating hormone -- as they age, but few succumb to type 2 diabetes as long as they maintain a healthy diet and weight and exercise regularly.
"Those are the big two -- too much food and not enough exercise," says Dr. Athena Philis-Tsimikas at the Whittier Institute for Diabetes/Scripps Health in La Joolla, California. "The trend of obesity parallels the trend of diabetes."
Moderation is key for pre-diabetics, who should strive to control the portion sizes of the foods they eat. Keep calories from fat under 30% and calories from saturated fat under 10%. Don't worry about indulging in an occasional piece of pie or a glass of wine. Periodic visits with a dietitian can keep you motivated.
Experts also say there's no need to adopt a strenuous exercise program or pare off every extra pound. A major clinical trial conducted over three years and published in 2002 found that people with pre-diabetes who walked or did other exercise 30 minutes per day five times per week and lost 7% of total weight reduced their risk of developing diabetes by 58%. The lifestyle changes were nearly twice as effective as taking metformin, a glucose-regulating pill.
Get Screened
Thirstiness, frequent urination, and feeling tired can be warning signs of borderline diabetes, but most people who have it experience no symptoms. Take the accompanying quiz to find out if you are at risk. Family doctors and clinics can administer a simple fasting blood glucose test to confirm pre-diabetes, defined as a blood glucose number between 100 and 126. If your blood sugar is normal, it's still a good idea to check it every three years. If you have pre-diabetes, make lifestyle changes and check your blood sugar every year.
"If you take care of yourself, chances are you'll do just fine," Dr. Rizza says. "It's within your control."
"I can tell by the way I feel that I'm under control," says Sally Neal, whose example has inspired friends and coworkers to get off their sofas and get moving again. "It's very rewarding to have someone look at me now and think I can do it, too."
Are You At Risk?
Take this test to see if you are at risk for having diabetes. Write in the points next to each statement that is true for you. If a statement is not true, write a zero. Then add all the points to get your total score.
- My weight is equal to or above that listed in the accompanying weight chart. 5 points.
- I am under 65 years of age and I get little or no exercise during a usual day. 5 points.
- I am between 45 and 64 years of age. 5 points.
- I am 65 years old or older. 9 points.
- I am a woman who has had a baby weighing more than nine pounds at birth. 1 point.
- I have a sister or brother with diabetes. 1 point.
- I have a parent with diabetes. 1 point.
3-9 Points: You are probably at low risk for having diabetes now. But keep an eye on things, especially if you are Hispanic/Latino, African-American, American Indian, Asian-American, or Pacific Islander. You may be at higher risk in the future.
10 or More Points: You are at greater risk for having diabetes. Only your health care provider can determine if you have diabetes. At your next office visit, find out for sure.
New Drugs Offer Hope
Four new drugs are generating a lot of optimism among the 21 million Americans who have type 2 diabetes.
The irony of most existing diabetes treatments is that they tend to cause weight gain. Byetta, introduced by Amylin Pharmaceuticals and Eli Lilly last year, contributes to significant weight loss. Also, animal studies suggest that the injectable drug may even help the pancreas regrow the cells that produce insulin.
Taken as pills, Merck's Januvia and Galvus, from the Swiss drug firm Novartis, are expected to receive FDA approval soon. The drugs appear to have fewer side effects that an older class of diabetes drugs and work by raising the levels of a natural hormone that causes the pancreas to produce more insulin.
Injected insulin has been the time-honored treatment for late-stage diabetes and the most potent method of controlling blood sugar. Pfizer's new inhalable insulin, Exubera, promises to be a welcome alternative for some of the more than 5 million diabetics who have to inject insulin every day.
Wrist Bone Connections
Despite how the nursery school rhyme goes, it turns out the wrist bone isn't only connected to the arm bone. British researchers recently examined the medical records of over 640,000 patients and made an interesting discovery. Those people who had carpal tunnel syndrome were significantly more likely to develop type 2 diabetes in the coming years. If you have been bothered by carpal tunnel, it's a good idea to have your doctor keep a close eye on your blood sugar as well.
When Weight Becomes a Risk Factor
If you're a woman who weighs more than the amount listed for your height, you're at risk for diabetes.
4'10" - 129
4'11" - 133
5'0" - 138
5'1" - 143
5'2" - 147
5'3" - 152
5'4" - 157
5'5" - 162
5'6" - 167
5'7" - 172
5'8" - 177
5'9" - 182
5'10" - 188
5'11" - 193
6'0" - 199
6'1" - 204
6'2" - 210
6'3" - 216
6'4" - 221
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