Healthy Ways to Prevent Diabetes By Sylvia Oakes, Urban Regional Extension Agent, Madison County

If type 2 diabetes was an infectious disease, public health officials would say we're in the midst of an epidemic. This difficult disease, once called adult-onset diabetes, is striking an ever-growing number of adults. Even more alarming, it's now beginning to show up in teenagers and children.

More than 18 million Americans have diabetes; about 5 million don't know they have the disease. If the spread of type 2 diabetes continues at its present rate, the number of people affected in the United States (U.S.) will increase from about 14 to 22 million between 1995 and 2025. Worldwide, the number of adults with diabetes is expected to rise to 300 million by the year 2025. The problems behind the numbers are even more alarming.

Diabetes is the leading cause of blindness and kidney failure among adults. It causes mild to severe nerve damage that, coupled with diabetes-related circulation problems, often leads to the loss of a leg or foot. Diabetes significantly increases the risk of heart disease. It is now the sixth leading cause of death in the U.S., directly causing nearly 60,000 deaths each year and contributing to thousands more.

The good news is that type 2 diabetes is largely preventable. About 9 out of 10 cases could be avoided by not smoking, keeping weight under control, exercising more, and eating a healthy diet.

What is type 2 diabetes?
Our cells depend on a single simple sugar called glucose for most energy needs. That's why the body has intricate mechanisms in place to make sure glucose levels in the bloodstream don't go too low or soar too high. When you eat, most digestible carbohydrates are converted into glucose and rapidly absorbed into the bloodstream. Any rise in blood sugar signals the pancreas to make and release insulin. This hormone instructs cells to sponge up glucose. Without it, glucose floats around the bloodstream and is unable to slip inside the cells that need it.

Diabetes occurs when the body can't make enough insulin or cannot properly use the insulin it makes. One form of diabetes occurs when the immune system attacks and permanently disables the insulin-making cells in the pancreas. This is type 1 diabetes. Formerly known as juvenile-onset or insulin-dependent diabetes, type 1 diabetes affects about one million Americans.

The other form, type 2 diabetes, tends to creep up on people and takes years to develop into full-blown diabetes. It begins when muscle and other cells stop responding to insulin glucose signals. Therefore, the body responds by making more and more insulin, essentially trying to ram blood sugar into cells. Eventually, the insulin-making cells get exhausted and begin to fail.

In addition to the 18 million adults with diabetes, another 41 million have "pre-diabetes." This early warning sign is characterized by high blood sugar levels on glucose tolerance test or a fasting glucose test. Whether pre-diabetes develops into type 2 diabetes is largely dependent on whether the individual maintains a healthy diet and exercises to maintain weight. Under these circumstances, it is possible for the blood glucose levels to return to normal.

Type 2 diabetes can be prevented
Although the genes you inherit may influence the development of type 2 diabetes, they take a back seat to behavioral and lifestyle factors. Data from the Nurses' Health Study suggest that 90 percent of type 2 diabetes in women can be attributed to five factors, such as excess weight, lack of exercise, an unhealthy diet, smoking, and abstaining from alcohol. Making a few changes can dramatically lower the chances of developing type 2 diabetes. The same changes can also lower the chances of developing heart disease and some cancers.

Control your weight
Excess weight is the single most important cause of type 2 diabetes. Being overweight increases the chances of developing type 2 diabetes seven-fold. Being obese makes you 20 to 40 times more likely to develop diabetes than someone with a healthy weight. Losing weight can help if your weight is above the healthy-weight range. Losing 7-10 percent of your current weight can reduce your chances of developing type 2 diabetes by as much as 50 percent.

Get Moving!
Inactivity promotes type 2 diabetes. Every two hours you spend watching TV instead of being active, increases your chances of developing diabetes by 14 percent. Working your muscles more often and making them work harder improves their ability to use insulin and absorb glucose. This puts less stress on your insulin-making cells. Long bouts of hot, sweaty exercise, are not necessary to reap this benefit. Findings from a Nurses' Health Study and Health Professionals Study suggest that walking briskly for a half hour every day reduces the risk of developing type 2 diabetes by 30 percent. Besides, greater cardiovascular activities provide other benefits as well.

Tune-up your diet
Two dietary changes can have a big impact on the risk of type 2 diabetes. First, choose whole grains and whole-grain products over highly processed carbohydrates. White bread, white rice, mashed potatoes, donuts, bagels, and many breakfast cereals have what's called a high glycemic index. That means they cause sustained spikes in blood sugar and insulin levels. Carbohydrates that aren't as easily digested cause lower, slower increases in blood sugar and insulin. As a result, they stress the body's insulin-making machinery less, and help to prevent type 2 diabetes. Such foods have a low glycemic index. Examples include whole wheat, brown rice, other whole grains, most beans and nuts, and whole grain breakfast cereals.

Choose good fats instead of bad fats. These types of fats in your diet can also affect the development of diabetes. Good fats, such as the polyunsaturated fats found in tuna, salmon, liquid vegetable oils, and many nuts, can help ward off type 2 diabetes. Trans fats do just the opposite. These bad fats are found in many margarines, packaged baked goods, fried foods in most fast-food restaurants, and any product that lists "partially hydrogenated vegetable oil" on the label. If you already have diabetes, eating fish can help protect you against a heart attack or dying from heart disease.

If you smoke, try to quit. Add type 2 diabetes to the long list of health problems linked with smoking. Smokers are 50 to 90 percent more likely to develop diabetes than nonsmokers.

Alcohol now and then may help. A growing body of evidence links moderate alcohol consumption with reduced risks of heart disease. The same may be true for type 2 diabetes. Moderate amounts of alcohol, a daily drink for men, and a drink every other day for women, increases the efficiency of insulin at getting glucose inside cells. Some studies indicate that moderate alcohol consumption decreases the risk of type 2 diabetes. If you already drink alcohol, the key is to keep your consumption in the moderate range. If you don't drink alcohol, there's no need to start-you can get the same benefits by losing weight, exercising more, and changing your eating habits.

The burden of diabetes in Alabama
Alabama leads the nation in diabetes with more than 333,500 citizens diagnosed with the disease. The growth rate for new cases is 30 percent above the national average. It is estimated that diabetes is costing Alabama businesses more than $3 billion annually.

For additional healthy ways to prevent diabetes, consider joining support groups, cooking schools, or a fitness center; reading Extension's Diabetes Newsletter or other fact sheets; or contacting the public health department, a certified dietician, physician, or your local Extension office.

References
Schulze, M., Hoffmann, K., Manson, J., Willett, W., Meigs, J., Weikert, C., et al. (2005). Dietary pattern, inflammation, and incidence of type 2 diabetes in women. American Journal of Clinical Nutrition, 82, 675-684.

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