Nearly half of American adults have either pre-diabetes or diabetes, according to a new report from the American Diabetic Association (ADA)—almost one in every two people over the age of 20. That's a scary stat considering diabetes is the seventh leading cause of death in America. And it’s a contributing factor in almost four times as many mortality cases. (Diabetes and pre-diabetes raise your risk of heart attacks, stroke, high blood pressure, blindness, amputations, and cancer.) Even more: “Most people don’t know they have pre-diabetes or diabetes for years,” says Jill Weisenberger, R.D., and author of Diabetes Weight Loss Week by Week.
Diabetes Versus Pre-Diabetes
Pre-diabetes has no symptoms, and the warning signs of type 2 may be very subtle, often things you can blame on other problems—headaches, fatigue, unusual hunger—so you may not know it’s diabetes for a long time, Weisenberger says. The most obvious sign is excessive thirst and excessive urination, because your body is filtering out the high blood sugar, but even that is easy for most people to overlook.
So what is diabetes exactly? Diabetes is marked by low levels of insulin, which cause high blood sugar. Insulin is a hormone produced by the pancreas that is responsible for taking digested carbohydrates, proteins, and fats, and either using them for energy or storing them for later use, Weisenberger explains. In pre-diabetes, your body has started to build up a resistance to the insulin, but your blood sugar levels aren’t elevated enough for most tests to flag. It’s often a silent trouble: According to the Centers for Disease Control and Prevention, up to 30 percent of people with pre-diabetes will develop type 2 diabetes within five years if they don’t make any lifestyle changes.
Type 2 is where the disease gets serious: Your cells are no longer able to use insulin properly and your pancreas stops producing enough of the hormone. Once these cells are burnt out, they’re a lot harder to repair, which is why treating diabetes early is paramount. “The earliest stages of insulin resistance are your greatest windows for complete reversal,” Weisenberger says. “By the time you have full-blown type 2, some of your cells have already lost the ability to ever produce insulin again, so it’s harder to recover.” People with type 2, though, do go into remission, either full or partial, but it’s harder to achieve.
While your genetics do play a role in your risk, your genes are not your fate, Weisenberger adds. Reversal and remission are possible with—and only with—a lifestyle overhaul. ”There are three things to help treat diabetes: maintaining a healthy body weight, being physically active, and eating healthy foods,” she explains.
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Obesity is directly linked to developing diabetes: In a recent study published in Annals of Internal Medicine, researchers found that the rise in diabetic women directly parallels the rise in obesity. “We think of body fat as something that just sits on our hips and thighs and makes our clothes tight, but it’s not inert—it’s actually putting off inflammatory hormones, increasing inflammation and insulin resistance in the body,” she explains. When your waist circumference exceeds 35 inches, your risk for insulin resistance and type 2 diabetes increases, even if your BMI falls within the normal range, according to the National Institute of Health (NIH).
What to Do
The good news? Every pound you shed helps: People with pre-diabetes who lose just 10 percent of their body weight within six months of diagnosis dramatically reduced their risk of developing type 2 diabetes over the next three years, according to researchers at Johns Hopkins University.
As for exercise and a healthy diet, luckily those can help with weight loss as well as diabetes risk. “Most American’s diets are full of inflammatory foods and loads of carbs in a single sitting,” Weisenberger says. To lower your risk or increase likelihood of remission, stock your plate with anti-inflammatory foods, namely fruits, vegetables, whole grains, beans, and nuts, she suggests. And if you’re going to cheat, don’t overdo it: The more you eat at once, the higher your blood sugar rises, so a box of donuts will definitely send your levels skyrocketing, but half a donut in one sitting may be okay, she adds.
Regular exercise and activity—like walking around on your lunch break—can help keep your inflammation levels down too, she says. And don’t doubt small efforts: Getting sounder shuteye can lower your risk (the NIH reports that untreated sleep problems can increase the risk of type 2 diabetes), but even just drinking an extra cup of coffee a day can lower your risk long term, according to Harvard researchers.
So if pre-diabetes has no symptoms, and diabetes symptoms can be easily overlooked, how do you know if you’re in trouble? Based on research and ADA recommendations, most doctors include a diabetes and pre-diabetes test in your routine blood work once you hit 45 years old. Since the likelihood of developing diabetes increases with age, be sure to request the full lab workup if your doc doesn’t bring it up, Weisenberger says. If you’re younger but overweight and have a family history of the disease, ask about testing. “We all need to be our own best advocates, so don’t ever hesitate in asking your doctor about your risk for a disease,” Weisenberger adds.