Diabetes is a disease in which blood glucose levels are above normal. Most of the food we eat is turned into glucose, or sugar, for our bodies to use for energy. The pancreas, an organ that lies near the stomach, makes a hormone called insulin to help glucose get into the cells of our bodies. When you have diabetes, your body either doesn’t make enough insulin or can’t use its own insulin as well as it should. This causes sugar to build up in your blood and can be very dangerous to ones’ health.
According to the Center for Disease Control, 29.1 million people, or 9.3% of the US population have diabetes. Approximately one quarter of those people (8.1 million) do not know they are diabetic, hence are undiagnosed.
Aside from the medical issues and complications that can arise when one has diabetes, the financial costs are high. The CDC estimates that the total medical costs and lost work wages for people with diagnosed diabetes are 245 billion dollars annually. Personal medical costs for a diabetic are twice as high compared to someone without diabetes. Alarmingly, but not surprisingly, someone with diabetes has a 50% higher risk of death.
Diabetes can cause serious health complications including heart disease, blindness, kidney failure, and lower-extremity amputations. Diabetes is the seventh leading cause of death in the United States.
People who think they might have diabetes must visit a physician for diagnosis. They might have some or none of the following symptoms:
- Frequent urination
- Excessive thirst
- Unexplained weight loss
- Extreme hunger
- Sudden vision changes
- Tingling or numbness in hands or feet
- Feeling very tired much of the time
- Very dry skin
- Sores that are slow to heal
- More infections than usual.
The two most common types of diabetes are Type 1 and Type 2. Type 1 diabetes, which was previously called insulin-dependent diabetes mellitus (IDDM) or juvenile-onset diabetes, accounts for only about 5% of all diagnosed cases of diabetes. People with Type 1 diabetes cannot make enough insulin to regulate the glucose in their bodies. Risk factors for developing type 1 diabetes include autoimmune issues, genetics, and environmental factors.
Type 2 diabetes, often referred to as non-insulin-dependent diabetes or adult-onset diabetes, may account for about 90% to 95% of all diagnosed cases. Type 2 diabetics cannot use insulin properly. Risk factors for type 2 diabetes include older age, obesity, family history of diabetes, impaired glucose tolerance, physical inactivity, and race/ethnicity. African Americans, Hispanic/Latino Americans, American Indians, and some Asian Americans and Pacific Islanders are at particularly high risk for type 2 diabetes.
People with blood glucose levels that are higher than normal but not yet in the diabetic range have “prediabetes.” Doctors sometimes call this condition impaired fasting glucose (IFG) or impaired glucose tolerance (IGT), depending on the test used to diagnose it. Insulin resistance and prediabetes usually have no symptoms. You may have one or both conditions for several years without noticing anything.
If you have prediabetes, you have a higher risk of developing type 2 diabetes. In addition, people with prediabetes also have a higher risk of heart disease. Progression to diabetes among those with prediabetes is not inevitable. Studies suggest that weight loss and increased physical activity among people with prediabetes prevent or delay diabetes and may return blood glucose levels to normal.
Who is at Risk?
There are certain risk factors that increase ones’ likelihood of developing Type 2 diabetes.
- Being overweight or obese.
- Being physically inactive—exercising fewer than three times a week.
- Having a parent, brother, or sister with diabetes.
- Being African American, American Indian, Asian American, Pacific Islander, or Hispanic American/Latino heritage.
- Having a prior history of gestational diabetes or birth of at least one baby weighing more than 9 pounds.
- Having high blood pressure measuring 140/90 or higher.
- Having abnormal cholesterol with HDL (“good”) cholesterol is 35 or lower, or triglyceride level is 250 or higher.
Obviously, the more risk factors one has, the greater the chance of developing diabetes. Therefore, controlling risk factors is critical. Exercise and weight management are two critical factors.
Exercise and Diabetic Management
One important question to answer is “Aside from helping maintain a proper weight, why does exercise help control diabetes?” This requires us to briefly look at how the body uses food.
When we eat, the body breaks down carbohydrates into glucose. A healthy person’s body keeps blood glucose levels in a normal range through several complex mechanisms. Insulin and glucagon, two hormones made in the pancreas, help regulate blood glucose levels: Insulin, made by beta cells, lowers elevated blood glucose levels. Glucagon, made by alpha cells, raises low blood glucose levels.
When blood glucose levels rise after a meal, the pancreas releases insulin into the blood. Insulin helps muscle, fat, and liver cells absorb glucose from the bloodstream, lowering blood glucose levels. Insulin also stimulates the liver and muscle tissue to store excess glucose. The stored form of glucose is called glycogen. Finally, insulin also lowers blood glucose levels by reducing glucose production in the liver.
Simply stated, once glucose is released into the blood stream, the body either uses it for movement or stores it. When the body releases more glucose than it is using, insulin kicks in as a mediator. For Type 2 diabetics, this process is impaired. By improving body mass—i.e. muscle tone—and increasing aerobic exercise; muscle-glucose uptake can be improved. This has been shown in numerous studies. Therefore, strength training and aerobic exercise is an important part of an exercise program to control or prevent any type of diabetes.
A major federally funded study, entitled the Diabetes Prevention Program (DPP), followed 3,234 people who were at high risk for diabetes. They were randomly assigned to different groups.
One group met regularly with study staff to focus on healthy behaviors, such as eating fewer calories and exercising more; they aimed to lose at least 7% of their body weight and to do at least 150 minutes of physical activity per week. Another group received metformin, a drug commonly used to treat type 2 diabetes, along with standard advice on diet and exercise. A control group received standard advice and an inactive placebo pill, which had no drug effects.
After an average of around 3 years, the researchers found that diabetes risk dropped by 58% in the group encouraged to make healthy lifestyle changes. About 38% in that group had achieved and maintained their weight loss goals and 58% their physical activity goals. The group taking metformin was also less likely to develop diabetes; their risk dropped by 31% compared to the control group.
In a follow-up study, both lifestyle changes and metformin continued to reduce the risk of developing diabetes, although their effects declined. After 10 years, people who continued with lifestyle changes delayed diabetes by about 4 years compared to people in the control group. People who continued to take metformin delayed diabetes by about 2 years.
Joanne Gallivan, director of the National Diabetes Education Program at NIH noted “Weight loss is key, and physical activity is very important . . . find some physical activity that you enjoy and can do every day.”
The Diabetes Prevention Program showed that diet and exercise can reduce the risk of developing type 2 diabetes, and that you’re most likely to succeed at weight loss.
The findings showed that people can delay and possibly prevent the disease by losing a small amount of weight (5 to 7 percent of total body weight) through 30 minutes of physical activity 5 days a week and healthier eating. This is fantastic news for anyone who is either diabetic or pre-diabetic.
Action Items for Diabetics
- Maintain a healthy weight and lose weight if necessary.
- Eat healthy, low glycemic index foods. Get some coaching from a nutritionist if necessary.
- Be more active! Strive for 30 minutes of activity every day, with a minimum of 75 minutes of vigorous activity per week.
- Monitor your numbers. These include your blood sugar and your blood pressure.
- Check your feet daily. Diabetes can cause nerve damage, typically starting in the feet due to poor circulation, resulting in your not noticing blisters, sores or swelling.
- Have your eyes checked regularly as a sudden loss of eyesight can be a sign of sugar regulation issues.