Preventing Diabetes in a Fast-Paced, High-Tech World

My colleagues call the high rate of obesity in this country the modern plague. Death isn’t instant, the way it was when plague struck Europe during the Middle Ages. Rather, this modern plague kills by a slow and steady decline, beginning with diabetes and ending with heart attack, stroke or kidney failure.

If you don’t believe me, take a look at the maps public health officials publish that show large parts of the country with epidemic proportions of obesity and diabetes. The story is even worse in North Carolina and other parts of the Southeast where in many counties obesity rates are as high as 30 percent and diabetes rates top 11 percent.

Around here, for example, more than 9 percent of adults in Yadkin, Stokes and Davidson counties have diabetes. I know what those figures mean because I see the results in my office at Wake Forest Baptist Health, where I am a doctor in general internal medicine.

At Wake Forest Baptist, I am surrounded by the latest in technology and cutting-edge research. I believe in these tremendous advances, but I also know that the solution to the modern-day plague lies in prevention. According to the latest studies, more than 90 percent of adult onset diabetes, also known as Type 2 diabetes, can be prevented with diet and exercise.

What is Diabetes?

First, a quick lesson on diabetes. Type 1 diabetes begins in childhood, in patients whose pancreas stops producing insulin that regulates sugar levels. Diet alone doesn’t control this kind of diabetes. These patients need insulin.

The kind of diabetes that’s diagnosed in adults is different. With Type 2 diabetes, the pancreas still produces insulin but the body has grown resistant and the normal glucose processing cycle breaks down. For reasons we don’t completely understand, obesity interferes with the way cells process insulin. Because of that, obesity is the leading cause of Type 2 diabetes.

It’s important to get your sugar levels tested during regular medical exams, especially if you’re overweight or have a family history of Type 2 diabetes. A fasting blood sugar level of 100 or lower is considered normal. Levels between 100 and 125 put a patient at risk for diabetes. Above 126 is considered diabetes.

Unregulated glucose levels lead to a series of complicated medical problems: clogged arteries, heart disease, stroke, kidney failure, blindness, amputation and more. That’s the slow and steady march of the modern plague.

A number of medications help control glucose levels. If diet and exercise fail, I don’t hesitate to prescribe them. But I prefer that my patients try prevention first. I know prevention works. The research demonstrates that and so do my patients. I had a 50-year-old patient recently who was on the verge of needing medication. He lost 25 pounds in 6 months. That was enough to bring his sugar level down below the diabetic range.

But I’ve been at this long enough to know that it’s easier to preach prevention than to practice it. Many of my patients tell me that they don’t have time for exercise. They work 2 jobs, or they work at night and their days are filled with family obligations. Maybe they can’t afford to join a gym. And many of my older patients also suffer from arthritis, which makes walking and other forms of exercise painful.

“Start easy,” I tell my patients. “If your life is that full, let’s think of things you can do in the context of the day. Use the stairs at work. Cut down on snacking. What would it look like not to grab a cookie but have an apple instead?”

The Long-Term Implications of Being Overweight

I ask my patients to think about the long term. You’re 30 pounds overweight today. What does that mean for your life 10 years from now? For an overweight 60-year-old woman with high blood pressure and pre-diabetic blood sugar levels that might mean she won’t be well enough to enjoy her time with her infant grandchild.

“Ten years from now you won’t be able to enjoy going to Disney World with your grandchild,” I tell her. “You’ll want to be able to walk around. If you don’t make some changes now, you’re going to miss out on some important events.”

It’s easy for my patients to grow discouraged. And I’ll confess that I get discouraged, too. But then I think about what it means to face a lifetime of heart disease. I think about my patients debilitated by stroke and those whose lives are consumed by a schedule of kidney dialysis. I urge my patients to take the long view.

Take a walk. Eat a salad for lunch. Cut down on fried foods. Take the stairs. And don’t worry about losing weight all at once. Take it slowly. Behavior change is difficult. Find a friend or family member who will encourage you.

“I’m not interested in what you weigh a year from now,” I say. “I’m interested in what you weigh 5, 10 years from now.”