Preventing or Delaying Type 2 Diabetes

Posted By SHL Librarian

Presented by: Bryant Lin, MD
Clinical Assistant Professor, Medicine – General Medicine Disciplines
Stanford University Medical Center
October 2, 2014

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One in four U.S. people is prediabetic. That means they have a tripled risk of developing diabetes. There are ways to stop that from happening, and Bryant Lin, MD, is spreading the word.

You could say Lin has some expertise in how to prevent diabetes – because he’s working on it himself. He has such a strong family history of diabetes – his mother, her six siblings, and both her parents had it – that he knows it’s a risk for him too.

“It’s one of the big diseases,” Lin, clinical assistant professor of medicine at Stanford University, told an audience attending his community talk presented by the Stanford Health Library.

One in 11 U.S. people has diabetes. If that progresses to severe stages, it can lead to blindness, heart disease, kidney failure and even death, said Lin, who is also medical director of the Consultative Medical Clinic at Stanford.

But that doesn’t have to happen. People can protect themselves from prediabetes. If they don’t act early enough to avoid prediabetes, they can still stop or delay the onset of diabetes.

The first step is recognizing it. Most people don’t get as much advance warning from their family history as Lin did. About 90 percent of the time people don’t know they are prediabetic. Even 40 percent of people with early-stage diabetes don’t know it. There are often few symptoms at this stage.

So it pays to recognize the telltale signs: feeling extremely thirsty a lot, needing to urinate often and sometimes extreme fatigue. Seeing a doctor for routine care can be a good time to get a blood test to check.

The tests measure a person’s blood-sugar level. A higher level can be the tip-off that prediabetes or diabetes has started. One common test, for A1C, measures how much sugar “sticks” to hemoglobin molecules in the bloodstream, Lin said. Another test measures fasting plasma glucose levels.

People can take stock for themselves of their possible risk for diabetes. The American Diabetes Association offers an online test to estimate individual risk. Being overweight, not getting exercise and showing high-blood sugar levels when pregnant (called gestational diabetes) can all increase the chance of diabetes. Older age also increases the risk.

Lin illustrated how individual factors can add up to a heightened risk of diabetes by describing his own personal score for risk factors: strong family history, 40-something age, and some extra weight he’s trying to lose.

The good news is that anyone can reduce their risks if he or she is willing to make changes. The main way is to eat healthy food that helps lower blood sugar levels. The second, equally important way is to keep a healthy weight, which may mean getting some exercise to lose pounds.

To prevent or minimize diabetes, Lin said, healthy eating boils down to three steps: cut calories, reduce carbohydrates and eat more vegetables. Reading food labels on packages can help calculate calories and carbohydrates. The FDA has consumer tips for getting the most from the labels.

Some carbohydrates are worse than others for people who want to lower blood sugar and lose weight. Carbohydrates that are rich in starches and sugars, including potatoes and many desserts, are foods to avoid. Other carbohydrates like beans and legumes contain fiber that makes them healthier choices.

Lin said no single diet plan works for everyone. Low-carbohydrate, high-protein diets can be ok – if people are careful not to overdo it. “It’s very easy with a high-protein diet to get too much fat and not enough fiber,” he said. “We really can’t live on a pure protein diet.”

Other diets rely on a glycemic index – which restricts carbohydrates known to raise blood sugar levels rapidly while allowing other carbs that don’t. Still another diet — called the Paleo because it resembles what people ate during the Paleolithic era 10,000 years ago – is “fine, if it works for you,” Lin said.

The bottom line is get adequate nutrition while keeping overall calories down. That’s not a simple task.

“Most of us are horrible at estimating our calorie intake,” Lin said. He illustrated the challenge with his own personal record of what he ate on two separate days. On the good day, he took in about 1,400 calories in meals with lots of veggies. On the bad day, he ate more than 2,000 calories from foods heavy on carbohydrates.

Losing weight is hard, Lin said. Even eating what seems like a healthy snack can sneak in a lot of calories. A 16-ounce fruit smoothie, for example, can pack almost 300 calories. It takes almost 30 minutes of jogging in place to burn that many calories, Lin said.

Artificial sweeteners may seem like a good option for cutting calories and sugar, but recent research has raised questions about whether they can hurt more than help. Studies in mice that were fed artificial sweeteners showed they developed changes in their digestive system that led to glucose resistance — a big risk factor for diabetes. Follow-up studies in people given artificial sweeteners showed a similar pattern. “The jury’s still out” on this question, Lin said. But he acknowledged, “I’ve stopped drinking diet Coke.”

Exercise can be an essential ally for people who want to prevent or control diabetes by losing weight. Lin recommended the standard two-part guideline for what’s enough: brisk walking (or its equivalent) for 30 minutes daily, five times a week, plus strength training with hand weights, resistance bands or calisthenics two times weekly.

Aerobic exercise, like running, jogging or race-walking, gets the heart beating faster and can burn more calories faster. Anaerobic exercise that stops and starts, like tennis or badminton, is also good. Fitness gadgets that measure exertion or calories burned may suit some people but not others. “If you don’t find it helpful, don’t use it,” Lin said.

Dieting and exercise can be difficult for many people to maintain. Lin gave three tips for those who want to make it stick.

First, keep it simple. Set one or two main goals for dieting or exercise. Second, get specific: decide to eat two pieces of fruit a day rather than just promising “I will eat healthier.”

Third, Lin said: “Write it down. Then remind yourself.”

Using all those strategies, Lin said, can enable people to beat the odds: “You can prevent or delay diabetes,” he said.

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About Dr. Lin