Diabetes is called the silent killer because overt symptoms are rare in the early stages of the disease.
“Most people have no symptoms at all,” says Richard Bergenstal, MD, past president of the American Diabetes Association and executive director of the International Diabetes Center in Minneapolis. “Only about 25 percent have vague symptoms that you wouldn’t associate with diabetes. The problem is, the longer diabetes is undiagnosed, the more at risk you are of cumulative exposure to high glucose levels. Just because you don’t have symptoms doesn’t mean it’s not doing harm.”
But there’s good news, says Bergenstal. Unlike many diseases, type 2 diabetes is largely preventable, and with the right changes in diet and lifestyle, most people can treat diabetes without any other intervention.
Diabetes mellitus is characterized by elevated blood sugar levels, either chronic or recurring. Left untreated, over time it can lead to kidney failure, blindness, heart disease, coma, and death.
There are two kinds of diabetes. Type 1, or insulin-dependent diabetes, usually starts in childhood or early adolescence. It’s caused by an autoimmune response that damages the part of the pancreas responsible for creating insulin—a hormone that helps cells absorb glucose and use it as fuel. When glucose builds up in the blood, it can damage the heart, blood vessels, nerves, eyes, and kidneys. Type 1 diabetes isn’t treatable by diet and lifestyle changes alone, but can be managed with regular shots of insulin and frequent blood glucose monitoring.
Type 2 diabetes is far more common and usually occurs in people over the age of 40. Unlike type 1 diabetes, where the body stops producing insulin, in type 2 diabetes the pancreas is still able to make insulin, but can’t produce enough to meet the body’s needs. Also, the body’s cells are unable to use insulin properly, a condition known as insulin resistance.
While type 2 diabetes has a strong genetic component, it’s thought to be caused mainly by lifestyle factors, including unhealthy diet, obesity, lack of exercise, inadequate sleep, and stress. In other words, it can be prevented and, in most cases, treated without drugs or medical intervention. The key is consistency, says Theresa Garnero, APRN, BC-ADM, MSN, CDE, author of Your First Year with Diabetes.
“Don’t try one or two quick-fix changes that you’ll only be able to stick with for a couple of weeks,” she says. “Follow a variety of do-able, realistic practices in diet and lifestyle that you can keep up with over the long run.” Read on for sane, healthy habits you can start right now to prevent or manage diabetes.
1. Lose a little weight
Excess weight is one of the greatest risk factors in diabetes, but you don’t have to get seriously skinny: shedding only seven percent of your body weight can reduce your risk by 58 percent. Even as little as a five percent reduction in weight also makes a significant difference.
Why does weight matter? “Excess weight blocks the action of insulin,” Bergenstal says, “and losing weight makes the cells more receptive to the actions of insulin.” In addition, he says, if you’re overweight for too long, it starts to wear on the pancreas. When that happens, not only will you have insulin resistance, you’ll also be unable to make as much insulin as you need to normalize blood sugar.
As anyone who’s tried (repeatedly) to shed pounds knows, it’s often easier said than done. “That’s because the calories-in, calories-out is only part of the story,” says Terry Grossman, MD, author of Transcend: Nine Steps to Living Well Forever. “All calories are not created equal; calories in the form of sugars and starches raise insulin and encourage your body to hold on to fat. For most people, especially for diabetics, the first step is cutting back rather sharply on the amount of simple sugars like fruit juice, white rice, potatoes, and pasta. They’re counterproductive to weight loss.”
Slimming foods include lean protein, high-fiber fruits and vegetables, and moderate amounts of healthy fats, says Grossman. And instead of sugar, try small amounts of stevia, a sweet-tasting South-American herb. It’s safer than alternative sweeteners, Grossman says, and may even help control blood glucose.
2. Move more
Studies have consistently shown that people who exercise regularly have a lower risk of diabetes: that applies for very modest workouts as well as more strenuous activities. In one study, people who exercised four hours a week, or about half an hour a day, reduced their risk of diabetes by 80 percent—even without losing weight. Other studies have found similar results.
You don’t have to run a marathon to reap the benefits. “If you can tolerate vigorous exercise, you’ll see more effects, especially in terms of cardiovascular health,” says Bergenstal. “But if you can’t, don’t let that stop you. The point is to move your body, even if you’re not necessarily raising your heart rate.”
Aim for about 30 minutes of movement, five times a week, says Bergenstal. If 30 minutes seems out of reach, break it into manageable segments: spending 10 minutes walking briskly in the morning, 10 minutes on your lunch hour, and 10 minutes walking around the block after dinner will yield the same benefits.
To make movement consistent, work activity into your daily life: run errands on your bike, park several blocks away from movie theaters or shopping malls and hoof it the rest of the way, go up and down a flight of stairs at a brisk pace for 10 to 15 minutes. And make exercise part of your social life, with walking groups or salsa lessons.
“Dancing is ideal,” says Garnero. “There’s something about moving to music, losing yourself in the lyrics, and spending time with friends that not only helps insulin levels, but also reduces stress and increases joy.”
3. Chill out
Type A personalities take note: being keyed up is deadly for diabetics. “Stress causes the release of hormones that impact insulin,” says Barnard. “It also affects sleep, and destroys resolve to eat in a healthful way. If you’re on deadline, stressed out, and rushing to get your work done, food is not a priority: you’ll eat whatever you need to get through the day.”
When you’re stressed, the body goes into a fight-or-flight response, releasing hormones and mobilizing glucose from the liver, muscles, and stored fat to help you respond to a dangerous situation, Grossman says. In prehistoric times, those hormones and additional blood glucose would allow you to run from danger or fight an attacking animal: you’d use them up in the process. But modern stress rarely involves physical danger, so the hormones and glucose hang around rather than being used up, and impact blood sugar levels for hours after the stressful event.
If you’re keyed up, natural anti-stress relievers can help:
• Get a massage: it may lower your glucose levels and can also treat diabetic neuropathy, nerve damage characterized by numbness, tingling, and pain.
• Try biofeedback: it’s been shown to help diabetics manage blood sugar.
• Zen out. Practicing mindfulness meditation can reduce stress and depression, lower blood pressure, and improve glucose response.
4. Enjoy the occasional glass of wine
Some studies suggest alcohol consumption can improve insulin sensitivity in people without diabetes, and moderate consumption may reduce the risk of diabetes by up to 30 percent.
Why does alcohol work? Besides the insulin-balancing effects, it may help keyed-up folks downshift. “Most people aren’t well-equipped to deal with stress, and a glass of wine might help them chill out,” says Garnero.
But there’s some controversy around those findings. “While alcohol may reduce the risk of heart disease, it increases the risk of breast cancer and some other cancers,” says Neal Barnard, MD, president and founder of the Physician’s Committee for Responsible Medicine and author of Dr. Neal Barnard’s Program for Reversing Diabetes. And alcohol can upset blood sugar up to 24 hours after drinking, says the American Diabetes Association.
If you do drink, “Keep it moderate and intermittent—about the equivalent of two or three glasses of wine a week,” Barnard says. Other tips: avoid sugary drinks or those mixed with sodas, sip slowly, mix alcoholic beverages with club soda or carbonated water, and never drink on an empty stomach. And if you’re not a drinker, don’t start, says Bernard. Find other ways to lower your risk.
5. Drive by the drive-through
It’s deadly for diabetics. In one long-term study, people who ate fast food more than twice a week had twice the rate of insulin resistance as those who drove through the drive through less often.
Fast foods are high in calories, sugar, and refined carbohydrates, says Hyman. This floods the body with a continual stream of glucose and increases the risk of insulin sensitivity. They’re also loaded with unhealthy fats, a significant but less-acknowledged risk factor for diabetes, says Barnard. If you’re ordering burgers, you’re increasing your risk even further: in one study, women who ate red meat five times a week or more had a
29 percent higher risk of diabetes than those who ate it less than once a week.
And fast-food meals, like most processed foods, are high in endocrine disruptors like added hormones, pesticides, and chemicals. “We know from studies that people who have higher levels of pesticides and chemicals in their system also have a higher risk of diabetes and insulin resistance,” Hyman says.