Real Preventive Healthcare: Watching For Pre-Diabetes

Diabetes consumes fully 25 percent of Medicaid resources. Just one disease out of hundreds, eating up one quarter of that budget. And the numbers keep rising, with more and more people across all age groups developing the disease.

When you consider that diabetes is a largely preventable disease, it becomes all the more distressing. It's hard to imagine that a health care crisis of this magnitude could be allowed to develop in America. And if it arose from some other source, like the spread of some virus or other contagion, it's quite likely it would not have.

But Type II diabetes, generally speaking, is a lifestyle disease. It comes from how we eat and what we do. People do have genetic predispositions that make them more or less likely to develop the disease, but the illness won't develop without the right conditions. And when it comes to diet and health, that means the most wrong conditions: a poor diet of processed, high-carb foods and perpetually low activity levels.

Subtle and gradual changes in the American lifestyle over the last 50 years have set most of us up with circumstances that put our lives in that rut: we eat poorly and in greater quantities and our lives are geared more and more toward sedentary past-times. It's easy to slide inexorably toward diabetes without even noticing it, and many, many people are doing just that.

But with a little more awareness among the public and medical professionals, we could really turn the tide on this disease.

We call it "pre-diabetes" when a person has the complex of symptoms that indicate they're on their way to developing diabetes. When a person is in the pre-diabetic state, they've got higher-than-normal insulin levels because they've become resistant to the hormone that helps metabolize energy, so the body cranks into overdrive and chronically produces an excess of insulin in order to get the job done.

We can test for this. It's easily identifiable. And when we find that and the other conditions of pre-diabetes present, we can treat them, and stop the disease from developing.

But it isn't standard protocol to check for insulin levels. It's common to have blood tests, particularly for older patients. Most doctors will check a patient's blood sugar, and when the numbers come back high, often, this is the first hard evidence a doctor has that the patient is in trouble with their body chemistry.

But insulin levels rise years before abnormalities in blood sugar develop. We see high insulin levels in kids as young as 14 in our office. But if a patient is not specifically getting tested for it, that insulin resistance and their pre-diabetic condition may not show up in an exam, and such people may continue on in dangerous ignorance of their real risk.

So what can you do to identify the problem and possibly forestall disaster? If you're overweight, it's probably a good idea to ask your doctor to test your insulin levels, especially if there's a family history of diabetes.

If you've got pre-diabetes and you're insulin resistant, you should know that it's a reversible condition, and most of the time, it can be turned around without the use of medication, just through diet and exercise. You have an awful lot of control over whether or not this situation worsens for you.

The most significant differences you can make will come from changing the way you eat- and that's what you eat, as well as how much. Replacing your processed foods and added dietary sugar sources with whole grains, proteins and fresh fruits and vegetables will do more to improve your condition than cutting your calorie count in half, and eating the same stuff. And it will probably help you lose weight, too.

Yet even if for some reason, you're not concerned about your excess weight or your body image, but you really do want to get healthier, then consider this. Researchers recently made some dramatic findings in a controlled study looking at how exercise alone-without weight loss-would affect key health risk markers for diabetes, like those elevated insulin levels.

They had subjects in groups assigned to a diet-and-exercise weight-loss program, a diet-only weight-loss program, and a third group of subjects on a daily exercise program designed to burn about 500 calories, but they also increased their dietary intake by that same amount!

Of the three groups, naturally, the diet-and-exercise group had the greatest health improvement overall, but the weight-maintenance exercise group showed significant reductions in visceral fat and insulin resistance, key risk factors for diabetes. And these factors improved for them as much as for the group on a weight-loss diet, even though they didn't lose any weight. It just shows again that there's no one right way to do it, as long as you do it.

Many overweight people reach a point where they just accept that they're going to be heavy. As an aesthetic issue, they may not like the way they look, but they come to accept that their appearance doesn't bother them enough that they're willing to make the adjustments necessary to change that.

But when it comes to how they feel, that's another matter. People often regard their weight issue with inspired seriousness when they see how it's affecting their health, and many times, that's the impetus for a patient starting to exercise, adjusting the diet, and developing a real awareness about keeping disease at bay.

With simple conclusive testing possible for pre-diabetes, more people could get started on that sooner, and we could turn the tide on this debilitating, and often fatal disease.

THROUGH THICK & THIN:
Weight problems lead to health problems, and the epidemic of diabetes in America is among the most serious of these. But the conditions that lead to diabetes are easy to identify with appropriate medical testing, and easy to reverse with meaningful lifestyle changes.