The stories I've heard and the questions people ask during education sessions are the inspiration for my blog posts. I know for sure that I have learned as much or more than I've taught over the years.
I have a friend who approached me with this question. Her husband Jack had been for a yearly physical. He came home and reported that everything was good but his blood sugar was “slightly high.” When my friend inquired how high, Jack responded “the Dr said it was no big deal.” Jack was definitely trying to downplay the problem.
My response to her question was a definite YES! It is a huge deal! Blood sugar high enough to be considered pre-diabetes is a warning sign, a cry for help from the beta cells that make insulin. If we catch problems in the pre-diabetes state and take care of them, we can eradicate Type 2 diabetes. It’s the closest thing we have to a cure!
Type 2 Diabetes is a progressive disease. It starts with the body being resistant to insulin (the hormone that clears sugar from the blood). Insulin resistance correlates with a variety of things like being overweight, not being active enough, smoking, genetics, aging, ethnicity, some medications, and sleep problems. If any of these issues cause the body not to use insulin well, it causes an overworking of the beta cells that produce insulin and can lead them to fail. If the beta cells fail completely, insulin from an outside source (injections) will be needed to keep blood sugar at a healthy level. The progression is a gradual death of the beta cells. If we find Pre-Diabetes we might be able to “Save the Beta Cells”!
The CDC says one out of three people have pre-diabetes and 90% of them don’t have a clue! Sometimes there are red flags that the body is struggling to clear sugar like high blood pressure, high triglycerides, and weight gain around the waist. But usually there aren’t obvious symptoms. For that reason, the American Diabetes Association (ADA) recommends testing everyone over 45 years old for pre-diabetes. They also recommend testing anyone under 45 who is overweight with an additional risk factor like family history, cardiovascular or polycystic ovary disease, or Latino, Native American, Asian, or African ethnicity.
So many times, when I have a group diabetes education class, there will be a patient who says “I’m just pre-diabetic”. I quickly tell them they are the most important person in the room. They are at a point in the diabetes progression where they have the most control over how things turn out. So many times, the issues are missed at this stage and the beta cell failure progresses to a point where it takes more than diet and exercise to gain control of the blood sugars. I have so many others in my classes who tell me they were diagnosed with pre-diabetes years back but nothing was ever done about it and now they are on insulin. This makes me sad and a little angry!
I met with Jack and told him about the progression of diabetes. We talked about his family history, his usual day’s food intake and activity, and the medications he takes. It turned out Jack had many of the causes of insulin resistance previously stated. He had a family history, he had a sedentary job and got little exercise, and he was on a mood- altering medication that was causing weight gain. This medicine was greatly improving his quality of life and he had no intention of stopping it. So, we talked about the lifestyle changes that could help lighten the load on his beta cells. We discussed ideas for increasing his activity and spreading his carbohydrate intake out throughout the day. And we talked about testing his blood glucose periodically to make sure it was remaining in goal.
Last I heard Jack is still trucking along with no diagnosis of diabetes. I’m sure his provider is keeping a close eye on his blood sugar. If you have been told you have pre-diabetes, “borderline diabetes”, or the sugars are running “slightly high”, take it seriously. There is no guarantee you can prevent Type 2 Diabetes but at least you can give it your best shot-wait and see should never be the plan. Small changes now could prevent big changes in the future. It is a very big deal! pre-diabetes.docx
I remember vividly my first encounter with diabetes. I was walking through the kitchen of the busy home I grew up in in small town Arkansas. And out of the corner of my eye I see my Aunt Jo, who was visiting from up north, fiddling with something strange. I stopped to see and was intrigued as I watched her pull out a syringe, and a bottle of clear liquid and inject herself.
My mom’s sister Aunt Jo was a special person. She was loud and boisterous- unlike myself- and she was fun. Things always seemed a little more exciting when she and uncle Bugs were around. They had three children of their own who are a bit older than me and my six siblings and they would make the trip down south usually once or twice a year to visit us and Grandma- mom and Aunt Jo’s mother.
I knew nothing about diabetes and later asked my mom about the strange “shot” Aunt Jo had given herself. My mom then told me that Aunt Jo had diabetes and had to take insulin. She went on to say that Aunt Jo wouldn’t have to do that “if she would just eat right”. As a child of probably ten, this statement did not sit well with me. I remember thinking “What does “eat right” mean?...there has to be more to it than that…Aunt Jo ate the same thing we all ate for breakfast- the family favorite strawberries and pancakes…is she not supposed to eat that?…what can she eat?...how does she know?...is there someone who teaches her how to eat?” This would later be the motivation for my career as a Registered Dietitian.
After spending half of my life as a Registered Dietitian and Certified Diabetes Educator the statement “if she/he would just eat right” still doesn’t sit well with me. I hear it sometimes from loving family members of someone with diabetes. Sometimes I hear it from well-meaning doctors and nurses, and I often hear it from the patients themselves. I definitely now know there is so much more to diabetes control than “just eating right”. Food plays a big part- don’t get me wrong- but there is oh so much more...
Like… at diagnosis with Type 2 diabetes most people are only making about half of the insulin (the hormone responsible for clearing sugar from the blood) that a person without diabetes makes. And a person with Type 1 diabetes is usually making close to none. So even if that person ate perfectly (whatever that is) they most likely would still need help from meds or insulins to clear sugar that our bodies just naturally produce.
Like… “eating right” is different for everybody. For some it is eating the family favorites (pancakes and strawberries) especially on special occasions because that makes them feel love. For some it is not going back for seconds at supper. For another it might be sharing in a special celebratory event with a piece of cake (birthday, wedding). All of these things are right. What is not right are the feelings of deprivation, guilt, and excruciating hunger so many think are necessary for blood sugar control. And it is not right to leave out foods or food groups that help heal and protect our bodies from the complications that often accompany diabetes.
In my mind “eating right” means you are nourishing your body and your soul with a variety of nutrients, in the right amount, at the right time. It does not mean leaving out all the foods you love or choking down foods you hate. I believe there is room for every food in the life of a person with diabetes- there is no one food that is so bad that you can never have another bite of it again.
Having said that, many of us could benefit from putting a little more thought into our food choices and portion sizes. And I encourage anyone dealing with diabetes to get education from a Registered Dietitian who is a Certified Diabetes Educator to learn how to do just that. With proper education you can be the judge of what “eating right” means to you. I hope and pray it means changes that you can make while continuing to enjoy your life. Good blood sugar control is a balance of activity, good nutrition, and usually medications. There are no extra points for doing it all with diet. Especially if being overly restrictive with food is interfering with quality of life. If a person has diabetes, being in control is the thing that matters most, how they get there is not.
It turns out that Aunt Jo had developed Gestational Diabetes during her last pregnancy which left her at double risk for developing Type 2 diabetes, and she eventually did. She went on to live her joy filled boisterous life more than 50 years after being diagnosed and I have many fond memories with her. I think she figured out what “eating right” meant to her.