Can you Have Diabetes without Knowing It?

Diabetes can be a slow silent killer and closer than you realize.  With one in three Americans insulin resistant and in the pre-diabetes range soon these people could be diabetic.

Double the amount of people in the US getting cancer and swine flu combined have diabetes, yet many are not even aware of the risk or take it seriously.  Diabetes is a serious disease with multiple complications, yet can so easily be prevented and or controlled with simple lifestyle management.

So where do we begin?  I am going to take a few blogs to answer questions and invite those reading to ask questions they may have regarding nutritional diabetes management.

If you have a parent with diabetes you have the gene and are at a much higher risk that those without a family history and/or have a poor lifestyle.  In general it is a good idea to have your doctor monitor your fasting blood glucose level (sugar taken prior to your am meal).  This number should be less than 95.  If you find your fasting blood sugars rising over several years you are slowly becoming diabetic.  Fasting numbers in the 100-115 range are considered pre-diabetic.  What are other measures to check if you suspect you are diabetic?

Glycosylated hemoglobin A1C – a fancy name for what your blood sugar averaged over the last 3 months - can be easily measured with a regular blood test. That number should be less than 6.0.  Many times patients will come to me stating they have pre-diabetes or a few higher blood sugars when indeed they are diabetic.  Once this number is over 6.0 you are technically diabetic.  Another way to diagnosis diabetes is to test your blood sugars 2 hours after a meal.  If that number is over 126 on more than 2 occasions then you are diabetic, according to the American Diabetes Association guidelines.

If you want to get more technical then have 2 other tests done- a fasting insulin level and c-peptide.  Both these measures can become elevated before the A1C rises and measure how hard your pancreas is working to achieve a normal blood sugar level.  The fasting insulin should be less than 10 and the c-peptide should be less than 4.0.  Normal ranges for some laboratories may slightly differ from these numbers.

Have these laboratory tests measured annually with a physical exam to keep track to prevent a possible surprise diagnosis.  Taking control of your health may mean you need to monitor these levels yourself since they may be in range, and passed over by your physician who may be looking for flagged numbers.  Because a lab does not differentiate whether a “normal” glucose is fasting or non-fasting it is very possible to be diabetic and not be aware of it.  So yes, you can have diabetes and not know it sometimes for many years.

Tomorrow – Preventing Diabetes

To Sweeten or Not to Sweeten?

What about non-nutritive sweeteners?  There are now a variety of non-nutritive or fake sweeteners on the market, from Sweet and Low^TM (saccharin), to NutraSweet^TM (aspartame) to Splenda^TM (sucralose). Although they are treated as substitutes, they all range from half as sweet as sugar to 8,000 times sweeter than sugar, with the average being 200-300 times sweeter than sugar. 

Many diet programs and health-care professionals highly advocate the use of these sweeteners, and foods containing them, to decrease the amount of sugar and calories a person takes in.  What is interesting, however, is that the longer these sweeteners have been out, the more obese our nation has become.  When you are consuming alternative sweeteners, you are trying to fool your body, but it doesn’t work. It knows that what you are giving it is fake, so instead of being satisfied, it continues to give the signal that it wants to consume something sweet.

Sharon Fowler, MPH, and her colleagues at the University of Texas Health Science Center, San Antonio, collected data for eight years that was reported at the American Diabetes Association’s annual meeting in San Diego in 2005.  What they discovered was that people who drank diet soda did not lose weight, but gained weight.  “What didn’t surprise us was that total soft drink use was linked to overweight and obesity,” Fowler said.  “What was surprising was that when we looked at people only drinking diet soft drinks, their risk of obesity was even higher.  There was a 41 percent increase in risk of being overweight for every can or bottle of diet soft drink a person consumes each day.”

In 2008, a study was published in the Journal of Circulation, which followed the health status of 9,500 men and women, ages 45-64, over a period of nine years. The researchers found that the typical Western diet increased levels of metabolic syndrome (insulin resistance or carbohydrate sensitivity as described in the next section). The most surprising results of the study linked drinking a diet soda each day to a 34 percent increased risk for metabolic syndrome compared to those who drank none.

Another study done in February 2008 at Purdue University compared rats fed regular feed and yogurt sweetened with saccharin to rats that ate regular feed and yogurt sweetened with regular sugar.

The rats that ate the feed and the saccharin-sweetened yogurt took in 20 percent more calories than the rats consuming regular feed and yogurt sweetened with sugar, and they gained body fat.  Researchers have theorized that taking in large amounts of non-nutritive sweeteners over time conditions the body not to associate sweetness with calories, which can then disrupt the body’s ability to assess caloric intake accurately and lead to overeating.

In countries where much of the food is fresh and there are less processed foods containing non-nutritive sweeteners, the multitude of low fat or “light” foods is miniscule. This may explain why the epidemic of obesity is less prevalent in countries outside the U.S.  These products create the illusion that one can eat more of them and not gain weight.  The body was made to process real foods that are fresh and whole, not manufactured processed foods.