More Americans than ever before have diabetes mellitus, a disorder characterized by elevated levels of blood sugar (glucose). About 29 million Americans (approximately 9.3% of the US population) are afflicted with the disease, according to the Centers for Disease Control and Prevention. More than eight million of these people don't even realize that they have it.

But that's not all. A staggering 86 million Americans show early signs of diabetes ("prediabetes") but don't know that they are a risk of developing the full-blown disease. This alarming trend is due, in part, to the ever-increasing number of Americans who are overweight, which sharply increases diabetes risk.

If you have been gaining weight, eating a lot of high-fat and high sugar foods and/or not getting much exercise, I'm afraid that you're already in danger of getting diabetes.

Even though this is a frightening scenario, there is some good news. If you identify the warning signs early enough, you can prevent diabetes from developing. If you already have diabetes, proper monitoring and healthful eating can help you control your glucose levels and avoid many of the disease's serious complications, such as heart failure, stroke, kidney failures, eye disease, nerve damage and/or amputation.

What is Diabetes?

Whenever we eat or drink, the food or liquid we ingest is broken down into nutrients that our bodies need to function. Glucose (a simple sugar that acts as the main energy source for our bodies) is one of the key nutrients. When glucose is absorbed into the blood stream, it stimulates the pancreas to produce insulin. This hormone transports glucose into our body's cell, where is is then converted to energy for immediate or later use.

· Type 1 (formerly known as juvenileonset) diabetes affects only about 10% of people with diabetes. Although the disorder usually develops in childhood or early adulthood (before age 30), an increasing number of adults are now being affected.

Researchers theorize that the increasing incidence of obesity in adults may accelerate the autoimmune destruction that characterizes type 1 diabetes-specifically; the body's immune system attacks and destroys the insulin producing cells of the pancreas.

People with type 1 diabetes need frequent doses of insulin, which is typically delivered by injection with thin needles, a pen that contains an insulin-filled cartridge or a small special "pump" that delivers a continuous dose of insulin.

· Type 2 (once known as adult-onset) diabetes affects 90% of people who suffer from the disease. Most cases occur during adulthood, and risk increases with age. In recent years, many overweight children and teenagers have been diagnosed with type 2 diabetes.

In type 2 diabetes, the pancreas produces insulin (sometimes more than the usual amounts), but fat and tissue cells are "resistant," preventing the hormone from doing what its supposed to do-which is to "unlock" cells so that blood glucose can enter.

Your risk of type 2 diabetes increases significantly if you eat a lot of foods that are high in simple carbohydrates (which are rapidly transformed into sugar) and foods that are low in dietary fiber (needed to slow the absorption of sugars from the food we eat and digest). Also, people who don't get much exercise are more likely to develop type 2 diabetes because of the insulin resistance that results from weight gain and an imbalance of stress hormones.

In addition to obesity, risk factors for type 2 diabetes include a family history of the disease (especially in parents or siblings) shaped body type...high blood pressure...high cholesterol...or, among women, a history of diabetes during pregnancy ("gestational diabetes," which usually disappears after delivery). People with type 2 diabetes who have difficulty controlling their glucose levels may require oral medication, such as metformin (Glucophage), and/or insulin injections.

Heading OFF Diabetes

Prediabetes affects 35% of Americans between the ages of 40 and 74. In these people, blood glucose levels are elevated but not enough to be considered type 2 diabetes. Detecting the telltale signs of prediabetes-which show up in blood tests-helps you prevent the full-blown disease. Without these measures, there's a good chance that a person diagnosed with prediabetes will develop type 2 diabetes within 10 years.

I advise my patients (and readers) to get yearly blood tests to help identify many early stage diseases, including diabetes. Diabetes related tests should include...

Fasting blood glucose to determine whether you are showing signs of prediabetes. Before you go to your doctor's office for the test, you will need to fast for at least eight hours. Then blood is drawn and sent to a lab for a measurement of the glucose concentration, which is expressed in milligrams of glucose per deciliter (mg/dL). A fasting level of 100 mg/dL to 125 mg/dL is considered prediabetes. (For more on the diagnostic criteria for diabetes, see "Test for Diabetes" on page four.)

Too often, patients who have glucose levels of 100 mg/dL to 115 mg/dL are told by their doctors that they don't have a problem. In my view, a fasting blood glucose level in this range indicates prediabetes. I consider my patients to be free of any immediate risk only if their glucose levels are in the range of 70 mg/dL to 86 mg/dL. If a patient's glucose level is 87 mg/dL to 100 mg/dL, I recommend some of the same strategies that I prescribe for people with prediabetes.

Oral glucose tolerance test can be used to check for prediabetes. After fasting for eight to 12 hours, a blood sample is taken to determine your fasting blood glucose level. Then your doctor will ask you to drink a solution with a high sugar content. After one, two and three hours, your doctor draws a blood sample and checks your glucose reading. A level of 140 mg/dL to 199 mg/dL for any of the readings indicates prediabetes. A reading of 200 mg/dL or above indicates diabetes.

I recommend that doctors also check insulin levels with the blood sample used for the glucose tolerance test. If insulin levels are abnormally high (15 to 20 microunits per milliliter or higher), it's a sign that you are developing insulin resistance-which is often a step on the road to diabetes.

Better Diabetes Monitoring

If you have diabetes, proper monitoring of your condition literally can save your life. Blood sugar levels can change dramatically within a matter of minutes, causing confusion, dizziness, fatigue and, in serious cases, a life-threatening coma. People with diabetes can easily measure their blood sugar levels with a small portable device that analyzes a drop of blood obtained by pricking a fingertip with a lancet. I recommend self-monitoring at least twice daily (upon awakening and 30 to 60 minutes after dinner). In addition, people with diabetes should make regular visits to their primary care doctors, have annual physicals and get yearly eye exams from their ophthalmologists.

Other tests for people with diabetes...

· Hemoglobin A1C. This test measures the amount of glucose sticking to the hemoglobin in red blood cells. It can be used as a marker of average blood glucose level over the past two to three months. Studies show that for every percentage point drop in A1C blood levels, risks for circulatory disorders as well as eye, kidney and nerve diseases drop by 40%. Most doctors say that a hemoglobin A1C reading below 7% is acceptable. However, I believe that a reading below 6% is more desirable, because it shows better blood glucose control. People with an A1C reading of 7% or less should have this test twice a year. If your reading is above 8%, you should have it every three months.

· Oxidative stress analysis. This test measures the amount of tissue damage, or "oxidative stress," caused by free radicals (harmful, negatively charged molecules). Few medical doctors know about oxidative stress testing, but I recommend it for patients with diabetes because they have high levels of oxidative stress, which accelerates the disease's progression. The markers of free radical activity can be measured by blood or urine tests. Elevated levels mean that the antioxidants that are normally produced in the body and ingested via foods and supplements are not effectively neutralizing the overabundance of free radicals.

Your doctor can use Genova Diagnostics (800-522-4762, for the test. It costs about $100, but most health insurers will cover it. People with diabetes should receive this test every six months until their values are normal.

· Cardiovascular markers. People with diabetes are more susceptible to heart disease (see Chapter 9). That's because elevated glucose levels accelerate the buildup of plaque in the arteries. For this reason, I recommend blood tests for homocysteine, C-reactive protein, fibrinogen, lipoprotein a, apolipoprotein a and b, and iron. Abnormal levels of these markers are linked to the development of heart disease. I recommend a baseline test and yearly follow-up testing for people who have abnormal readings for any of these markers. Most health insurers will cover the costs of these tests.

The Sugar Connection

Everyone knows that people who have diabetes or who are at risk for it should pay close attention to their diet. However, I'm convinced that few people realize just how damaging certain foods can be.

For example, about 20% of the average American's energy intake comes from foods such as burgers, pizza, chips, pastries and soft drinks. A study published in the American journal of Clinical Nutrition found that between 1980 and 1997, the average American's daily calorie consumption increased by 500 calories. Eighty percent of this increase was due to increases in carbohydrates, which include almost all sweet and starchy foods. During the same period, the prevalence of type 2 diabetes increased by 47% and the prevalence of obesity increased by 80%.

One of the worst culprits in the war on diabetes is the simple sugar fructose, which is naturally found in fruit and honey. Table sugar is half fructose (the other half is glucose, which is chemically the same as blood glucose). A type of fructose known as high-fructose corn syrup (HFCS) is especially harmful because it worsens insulin resistance. It has become the sweetener of choice for many soft drinks, ice creams, baked goods, candies/sweets, jams, yogurts and other sweetened products. My recommendation is to put a strict limit on your consumption of foods that contain HFCS. This can be done by reducing your intake of packaged, processed foods, avoiding drinks that are high in fructose and eating as many fresh foods as possible. (Natural sources of fructose, such as fruit and honey, can be safely consumed in moderation.)

There is one exception-some liquid nutritional supplements, such as liquid vitamin formulas, contain crystalline fructose, a natural sweetener that is far less processed than HFCS and is not believed to cause dramatic increases in insulin levels.

Symptoms of Diabetes

· Increased thirst

· Frequent urination (especially at night)

· Unexplained increase in appetite

· Fatigue

· Erection problems

· Blurred vision

· Tingling or numbness in the hands and/or feet

Test for Diabetes

You have diabetes if any one of the following test results occurs on at least two different days…

· A fasting blood glucose level 126 mg/dL or higher.

· A two-hour oral glucose tolerance test result of 200 mg/dL or higher.

· Symptoms of diabetes (see list above) combined with a random (nonfasting) blood glucose test of 200 mg/dL or higher.

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