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Diabetes

Long-term diabetes prevention

04/11/2003

Question:

My brother was diagnosed with Type 2 diabetes at 40. I have been concerned about my risk for the disease (I`m ten years younger and have similar eating/exercise habits). My grandmother also had the disease. Because of some Type 2 symptoms I had like dry skin/rashes, I bought an inexpensive glucose tester and have been scoring 82 or 83 with my fasting levels so I presume that I don`t have diabetes yet. (Whew!) If I lose weight and exercise more in a prevention effort, would those levels likely go even lower? Is there any way for me to know or prove that I am doing enough, and am improving? If I do badly, will it slowly go up or will it just shoot up if I get the disease? (If, for example, I tested myself again every six months).

Answer:

You are asking a question that many people are interested in, namely how does the fact that diabetes results from an interaction between traits I inherit (genes) and what I do about diet and exercise lifestyle (environment) apply to me? How do I know when I am doing enough? How do I interpret blood sugar results and are there other tests to do? There are diet recommendations available on the web site of the American Diabetes Association for weight maintenance and weight reduction. Those recommendations are very similar to what would be considered a healthy balanced American diet, with particular attention to avoiding excessive fat and carbohydrate intake. There are advantages to increasing dietary fiber which slows the rate of food absorption from the intestine. Regular exercise not only helps to control weight but has many other benefits as well. If you are doing everything right, I would expect the blood sugar to remain fairly level at the value you gave, about 70-100, because your body considers that the best compromise between having enough sugar to provide fuel to those organs and tissues that need it while not causing excessive damage or loss of glucose and fluid in your urine. We all have differences in genetic make-up and there are complex mechanisms regulating body weight so it is not practical for all of us to reach an ideal body weight. However, if you make the effort to limit intake below the calorie level for weight maintenance until the target weight is achieved and maintain regular exercise, whether through work, chores or recreation, you would be helping yourself quite a bit. It is also important to teach those healthy lifestyle practices to your children. I would say an annual fasting blood glucose measured in a clinical lab rather than on a home glucose testing meter would be widely accepted as good surveillance. It is not common practice now to do glucose tolerance tests on a routine basis outside of research studies. There is likely to be some gradual rise in blood sugar and body weight prior to the diagnosis of type 2 diabetes in most instances. However, at the point at which there is marked deficiency of the hormone insulin there is likely to be weight loss. This may or may not precede the diagnosis of diabetes. Commonly, some superimposed other illness may make the blood sugar control worse and that may tip the scales towards the diabetes becoming apparent. In that setting, it may appear to be a more sudden onset. The message should be that there are important opportunities to take measures for diabetes prevention but the determining factors are not entirely under the individual`s control.

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Response by:

University of Cincinnati Robert M Cohen, MD
Professor of Clinical Medicine
Division of Endocrinology and Metabolism
Department of Internal Medicine
College of Medicine
University of Cincinnati
Robert M Cohen, MD