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Diabetes: Prevention and Treatment

“All I had was a bologna sandwich on white bread and a glass of sweet tea and my glucose is 250!” So went a call from “Sue”, a patient this week who already knew she had impaired glucose tolerance (IGT) or “pre-diabetes”. Now it’s beginning to look like she may actually have full-blown type 2 diabetes. Her only symptoms had been some vision changes – sometimes her vision seemed a bit blurry and other times fine. After seeing her ophthalmologist, she noticed that the change in her glasses hadn’t fixed the problem. Her fasting blood sugar had been 110 (normal is below 100 and diabetic is above 125). Likewise, her HbA1C (the blood test that reflects a person’s average blood sugar over the previous 3 months) had been 6.1 – not yet in the clearly diabetic range (6.5 and up), but already in the IGT range.

​Like so many entering into diabetes, Sue had only subtle symptoms and her initial blood work had been fairly unimpressive. Also like so many in the early stages of diabetes, she had little feel for the impact of foods and drinks (like white bread and sweet tea) on her blood sugar. We had actually just had an appointment that morning where we had begun to discuss foods to limit, including “sweets” and “whites” – breads, pastas, potatoes, rice. We had prescribed a glucose meter to check her blood sugar. At this stage it was more as a teaching tool to check her glucose at various times such as fasting in the morning, after a meal, when her vision was blurry, and so on.

So, what now for Sue? She has four choices. One would be to let this diagnosis scare her and just try to ignore it and stick her head in the sand (or sugar bowl). Unfortunately, diabetes is a diagnosis that has a nasty habit of refusing to be ignored. Over time, if ignored, it will bring nerve, eye, heart, kidney, circulation, and brain injury, or, in some cases, put a person into the hospital with a diabetic coma (from extremely high blood sugar). Yah, not a good choice to try to ignore it. I don’t have many patients going this route, but I do have just a few who check things so infrequently and haphazardly that they are close to this. I always hope they’ll change their ways before the bad stuff really starts happening.

The second choice would be to not change her lifestyle but treat with medicines and monitor her sugar along with other important risk factors like blood pressure and cholesterol. This is certainly a better choice, but a bit expensive. It’s a little like trying to put out a fire while sprinkling gas (in this case, flammable sugar) on it.

A third choice would be for her to “tweak” her lifestyle and take medicines to make up for any shortfalls in her efforts. We’re getting better now. If she can perhaps lose 10 or 15 pounds out of the 50 extra that she has on board, that will help substantially. In terms of exercise, a study where the “exercise group” did a 30 minute walk five days a week showed an eleven year delay in the onset of diabetes compared with the “no exercise group” – a rather huge impact. Likewise, cutting out sweets (or substituting Splenda) and limiting whites (and substituting whole-grain alternatives as much as possible) can have a major impact. Even if Sue isn’t perfect in these efforts, it will have a significant effect on her diabetes and allow her to reduce the number of meds needed to control her diabetes well.

The final choice is certainly what I love to see. This is where the person really changes their life. They begin to learn the ins and outs of a healthy diabetic diet. They exercise six days a week and slowly work their way down to their ideal weight and maintain it. These folks, the few, the proud, the diabetic marines, are able to essentially eliminate the risk factors normally associated with diabetes while minimizing the medicines that may be needed. And they feel great. We have a man whose HbA1C was 12 – terrible! He became a “change your life” kind of guy and now has his HbA1C down in the 6’s with no diabetes meds. At our office, we follow people in all four categories, but the more we can encourage into this last category, the better we like it. So if diabetes is raising its ugly sugar-coated head in your life, don’t stick your head in the sugar; change your life – the rewards are sweet.

Andrew Smith, MD is board-certified in Family Medicine and practices at 1503 East Lamar Alexander Parkway, Maryville. Contact him at 982-0835

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The Syndrome That’s Sweeping the Nation

The Syndrome That’s Sweeping the Nation

The Syndrome That’s Sweeping the Nation

One of the most common and damaging diagnoses I see day in and day out is one whose name many of my readers have heard little about. It is a syndrome that is epidemic in the U.S. with a staggering 1/3 of adults meeting its diagnostic criteria. It parallels the rapid increase in overweight and obesity in the U.S. (with 2/3 of adults now falling in these categories). With obesity occurring in children and adolescents at three times the rate that was present in the 1960’s, this syndrome is also becoming more prevalent in these younger ages as well.

One “catches” the syndrome by lack of exercise, having a poor diet (especially one high in simple carbohydrates – sugars and starches), and putting on belly fat. Hours logged in front of the TV, computer, or video games sipping sweet drinks or beer and munching on carbs puts us on the fast lane to developing this malady. The condition we’re talking about is called metabolic syndrome.

Metabolic syndrome arises from insulin resistance in the body and increased fat deposition. Over time, as we fall into a lifestyle that has little regular exercise and lots of starchy or sugary meals, the insulin produced by our pancreas has less and less effect in the body. Eventually our blood sugar starts to rise, despite there being plenty of insulin circulating.

This situation has numerous negative effects on the body. That’s why metabolic syndrome is a risk factor for heart disease, stroke, diabetes, fatty liver, sleep apnea, and several cancers, including colon, kidney and breast. There is even some evidence that it accelerates cognitive (brain function) aging and deterioration.

How is this syndrome diagnosed – how do I know if I have it? The diagnosis is based on having at least 3 of the following 5 characteristics:

  • Fasting glucose ≥100 mg/dL (or on meds for diabetes or high blood sugar)
  • Blood pressure ≥130/85 mm Hg (or on meds for high blood pressure)
  • Triglycerides ≥150 mg/dL (or on meds for high triglycerides)
  • HDL-C (“good cholesterol”) < 40 mg/dL in men or < 50 mg/dL in women (or on meds)
  • Waist circumference ≥40 inches in men or ≥35 inches in women; if Asian American, ≥ 35 inches in men or ≥ 32 inches in women

Yes, metabolic syndrome can be treated with numerous medications that help reduce blood sugar, lower triglycerides and control high blood pressure. But that’s not the first way to go about this. The real core of treatment involves turning around the habits that got us there in the first place. A healthy low carb diet and a 30 minute brisk (3 to 4 mile per hour pace) walk 5-6 times per week (or the equivalent on a stationary bike, elliptical, swimming, etc.) producing a slow weight loss can typically cure, or greatly improve this syndrome. Of course the challenge is actually doing this and sticking with it. Finding a group or partner to do it with is hugely helpful here. And the health rewards are enormous as you begin to feel better, get your energy back, and minimize the long list of complications of metabolic syndrome.

Beyond the daunting personal impact of metabolic syndrome is the fact that if we try to treat it only with medicines, or if we just wait for all of its complications to show up and then treat them, it will absolutely overwhelm the health system in our country. So if you caught this syndrome, or see yourself heading that way, find a partner and start working on the self-cure. You may or may not need a little help from a medicine, but your efforts are the cornerstone of the cure. So don’t be trendy on this one; make the effort to help this popular syndrome pass you by.

Andrew Smith, MD is board-certified in Family Medicine and practices at 1503 East Lamar Alexander Parkway, Maryville. Contact him at 982-0835

 

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