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Cases of diabetes have skyrocketed in the past decade, and the disease is showing up more in younger people, too. While a higher percentage of men have diabetes, the outcome for women is worse. Not only are they at a greater risk of dying from the disorder, they're also more likely to develop heart disease and high blood pressure.
Given the fact that more than one out of three people in this country have the abnormally high blood sugar that signals prediabetes, it's time for you to reassess your risk. That's why we pulled together this crash course on blood sugar basics.What Is Diabetes, Anyway?
Your body's main source of energy is glucose, a type of sugar that circulates in your blood. (Some of it comes from food but some is also made in your liver.) During digestion, glucose is released into your bloodstream. Then your pancreas responds by producing insulin, a hormone that lets the glucose into your cells so they can use it or store it. But when something interferes with that process, you get diabetes. The type you have is based on what goes wrong.
In type 1 diabetes, your pancreas makes little or no insulin. That means the glucose can't be used and it just builds up in your bloodstream, which is dangerous to your health. Type 1 is caused by an autoimmune disorder that makes the body attack its own cells, damaging the pancreas. Usually diagnosed in kids or young adults, this type represents less than 10 percent of cases. Although heredity plays a small role, experts don't know exactly what triggers the disorder. Those who have it need to take insulin every day and monitor their blood sugar for life.
In type 2 diabetes, your body does make insulin -- at least initially -- but it's not enough because you've developed resistance to its effects. So again, the glucose builds up in your bloodstream, forcing your pancreas to try to produce more insulin to let the sugar into your cells. But your body won't let your insulin do its job; eventually the pancreas gets exhausted from working so hard and starts to wear out. Roughly 24 million Americans have type 2 diabetes, which typically takes years to develop. "If you don't take action early, you cross the line from prediabetes to type 2 diabetes. At that point you may have already lost half or more of your insulin-making capacity," says certified diabetes educator Hope Warshaw, R.D., author of Diabetes Meal Planning Made Easy. Often, diet and lifestyle changes, and sometimes oral medication, can slow or stop the progression of type 2, but some people also need insulin injections.
Gestational diabetes is a type of insulin resistance that develops during pregnancy. The problem usually goes away after childbirth but boosts the mother's odds of developing type 2 later in life by about 50 percent. It affects as many as 18 percent of pregnant women.Does Eating Too Much Sugar Cause Diabetes?
It's not that simple, but here's what we know. Genes are partly to blame: Type 2 diabetes tends to run in families and affects certain ethnic groups more than others. Getting older also bumps up the risk, and so does being inactive. Experts agree that too much body fat, especially around the waist, plays a key role. Eating too many processed, simple carbs -- the sugary stuff like sodas, candy, cookies, white bread, rice and pasta -- can contribute to belly fat, says New York City cardiologist Holly Andersen, M.D., a member of the LHJ Medical Advisory Board. (But complex carbs, such as whole grains and certain veggies, can be helpful.) Other experts say overall calories and high dietary fat may also contribute to insulin resistance. It's a complex disease and you can't just blame it on eating too much candy.What Are The Symptoms?
You've probably heard that the big warning signs are being really thirsty and having to pee all the time. But the classic red flags typically show up only after a lot of damage has been done. "Early on, especially in the prediabetes phase, most people have no symptoms at all," says Gerald Bernstein, M.D., director of the diabetes management program at Beth Israel Medical Center in New York City.How Will I Know If I Have It?
A blood test is the only way to find out. According to the American Diabetes Association (ADA), you should probably get a glucose test if you're overweight -- meaning your BMI is at or above 25, which would be 150 pounds on a woman who?s 5-foot-5 -- and have a risk factor such as family history, a sedentary lifestyle or heart disease. Otherwise, if you're over 45 you should be tested about every three years.Which Test Is Best?
In 2010 the ADA began recommending the A1C Test. It determines your average blood sugar over the past three months and doesn't require fasting for hours beforehand. Once the results are in, ask for the number. If your level is between 5.7 and 6.4 percent, you have prediabetes; 6.5 percent or higher means you have diabetes. As the number goes up, so does your risk. You should know it because even a high normal result is cause for concern, says Dr. Bernstein.
A fasting blood glucose test is a less expensive option, but you can't eat for eight hours before the test so you need to plan ahead. You should get this test if you're pregnant because the A1C isn't accurate during pregnancy or soon thereafter. A fasting blood glucose of 100 to 125 mg/dL is considered prediabetes, and 126 mg/dL or higher means you have diabetes.How Can I Avoid Diabetes?
1. Lose weight and get more active
You don't have to hit your ideal weight. People who drop just 5 to 7 percent of their body weight and exercise for 30 minutes five days a week can cut their odds of becoming diabetic by more than half. Focus on avoiding foods with added sugars. "Americans are swallowing more than 22 teaspoons of added sugars a day," Warshaw says. One good place to start? Cut back on sweetened drinks like soda and iced tea.
2. Try medication.
If you have prediabetes, you can talk to your doctor about taking the drug metformin, says Dr. Bernstein. In a clinical trial of 3,200 people with prediabetes, this oral medication reduced the risk of developing diabetes by nearly a third.A Reader's Story "I ignored my diabetes risk for months"
At an appointment on Christmas Eve a few years ago, my doctor started talking about my blood sugar, my A1C (I had no clue what that was) and my weight. When I heard "type 2 diabetes," I started to cry. Merry Christmas to me. So what did I do? Well, it was the holidays and I'm human, so I ignored it for months. My father controlled his type 2 diabetes with diet, but his brother needs insulin shots. I guess my family history should have told me something, but I went into denial mode. My doctor wouldn't let it go, though, and I finally decided I'd better do something. My husband had a heart attack last year, so now we're both trying to get healthy. I still love to cook, and I love to eat, but we're grilling a lot more instead of frying, eating a lot of veggies and cutting way back on pasta and things like that. I know what I really need to do is lose weight and start exercising, though. It's definitely not easy at age 51. Even with the small changes I've made so far, my A1C has come down from 7.5 to around 6.2, so I've been lucky. My goal is to stay off medication -- and to be around to play and spend time with my grandchildren.
- Lisa Kneggs, Plano, Texas
Originally published in Ladies' Home Journal, September 2012.