The U.S. Centers for Disease Control & Prevention (CDC) estimate that more than 1 in 3 U.S. adults have prediabetes. That’s 88 million people — and the majority of them don’t even realize it.
America’s type 2 diabetes epidemic is only forecasted to get worse, which means a growing toll on the U.S. health care system and the economy in the decades ahead. But for the millions of people who are predicted to eventually become diabetics, there’s good news: Small, healthy lifestyle changes can mean big differences that have a major impact on quality of life and even longevity of life.
Type 1 vs. Type 2:
Understand the difference
To understand diabetes, you first must understand that there are two types of diabetes — and there are major differences between the two.
Type 1 and type 2 diabetes are alike in that they are chronic diseases that affect the way the bod regulates blood sugar. Both have risks for the same complications over time — kidney failure, amputation, blindness and heart disease, to name a few. But, beyond that, there are stark differences between the two.
People with type 1 diabetes do not produce insulin, the hormone that is used by the body to turn glucose into energy. Type 1 diabetes is an autoimmune disease in which the body attacks itself and causes the pancreas to stop producing insulin. This generally occurs early in life, often between the ages of 4 and 14, which is why type 1 diabetes is often referred to as “juvenile diabetes.”
People with type 2 diabetes do not process insulin the way they should, a condition known as “insulin resistance.” Later in the disease, their bodies often stop producing enough insulin. This often occurs later in life, usually in people over the age of 45, which is why it’s referred to as “adult-onset diabetes.” But the lines are becoming blurred; more and more frequently, type 2 diabetes is being diagnosed in younger adults and even in teens and children. Medical experts blame poor diet and unhealthy lifestyles, though there is a genetic component, as well.
Once you understand the differences between type 1 and type 2 diabetes, you can begin to understand prevention. Currently, no one knows how to prevent type 1 diabetes. Although research continues to find a cure, it has thus far been unsuccessful, and so the medical approach to type 1 diabetes is management. By keeping a tight control on blood sugar levels through medication, diet and exercise, type 1 diabetics can live a full and healthy life without developing complications — though it is a lot of work and requires constant attention and sacrifice.
The good news is that your chances of developing type 1 diabetes is low — especially if you’re an adult. Type 1 diabetes is diagnosed in about 64,000 people each year; there are currently 1.6 million Americans living with type 1 diabetes, including about 200,000 youth. Type 1 diabetes makes up less than 10% of all cases of diabetes in the U.S.
Type 2 diabetes is a completely different animal when it comes to prevention. Although there is a genetic component to both types of diabetes, and although some people with prediabetes progress to full-blown diabetes even when they take all of the recommended steps to prevent it, type 2 diabetes can at least be slowed, if not prevented. And once a person has type 2 diabetes, especially if they’re newly-diagnosed, management of their disease is easier than in type 1 diabetics, which means there is an opportunity for lower risks of complications later on.
How Diabetes Kills
Generally speaking, diabetes is not a health care emergency. There are exceptions, such as diabetic ketoacidosis (DKA), a condition that can occur in type 2 diabetics but usually occurs in type 1 diabetics. This is a life-threatening condition caused when your blood sugar is very high and acidic substances called ketones build up to dangerous levels in the body. In some cases, DKA is the first sign of type 1 diabetes. Low blood sugar — also known as hypoglycemia — can also be a medical emergency.
For the most part, though, diabetes kills slowly and silently. It is only after years of chronic high blood sugar levels that complications begin to develop. Diabetics — both type 1 and type 2 — are at an increased risk of cardiovascular issues like heart attack and stroke. They can also suffer nerve damage that, among other things, leaves them prone to skin infections and sores or cuts that won’t heal, which can lead to limb amputation. Diabetes is the leading cause of adult-onset blindness in the U.S., and can also cause other eye problems. And, after years of chronic high blood sugar, many diabetics suffer kidney damage that can eventually lead to renal failure.
Diabetes also leaves its sufferers susceptible to other illnesses. For example, more than 40% of the people who have been killed by the Covid-19 pandemic in the U.S. were diabetic.
Once you understand how chronically high levels of blood sugar over a period of years leads to diabetes complications, you understand the importance of carefully managing the disease. A solitary episode of high blood sugar usually won’t kill you — although very high levels of blood sugar can lead to coma, which can be fatal. But if you don’t follow your doctor’s orders and recommendations, years of high blood sugar will kill you.
Once you’ve been diagnosed with diabetes, you will be prescribed medication. For those with type 2 diabetes, this will likely be Metformin, a type of oral medication that is often prescribed to combat insulin resistance. However, some type 2 diabetics will also be prescribed insulin injections.
Beyond the medication, there are a number of steps that diabetics can take to keep their disease in check. Diet and exercise are vitally important.
Doctors generally recommend eating foods that are rich in fiber and healthy carbohydrates, eating at regular intervals and cutting out unnecessary snacks, and avoiding foods that are full of refined carbs, sugars and fats.
Experts also recommend half an hour of physical activity daily, which both keeps your heart healthy and helps control blood glucose.
Small Steps, Big Difference
For people with Type 1 diabetes, there is no warning sign that it is about to occur. Sometimes, there is no indication that diabetes is occurring until a child begins to vomit profusely and winds up in an emergency room. Most often, there are only the tell-tale signs that suddenly appear: weight loss, increased thirst or hunger, frequent urination or bed-wetting, and blurred vision.
Type 2 diabetes has most of the same early symptoms: constant hunger, lack of energy and fatigue, excessive thirst, frequent urination, blurry vision, and tingling in the hands and feet. In fact, people who drink sugary drinks can find themselves in a tormented cycle without knowing they have diabetes. They’re constantly thirsty due to their increased blood glucose levels, so they drink more. And the more they drink, the higher their blood glucose levels go and the thirstier they become.
Fortunately, though, type 2 diabetes usually includes warning signs that it’s about to occur. That means its onset can be delayed or even prevented entirely. Prediabetes can even be reversed in some instances.
How? The first important step is to keep your routine doctor’s appointments. Visit your physician annually for a physical. Many private insurance plans already require this step, and doctors may sometimes recommend that you visit more frequently: every six months, or every three months, if you have certain chronic conditions or are at risk for developing them.
At these doctor’s visits, your blood will often be drawn, which is the only conclusive way to check for diabetes or prediabetes. An instant blood glucose level can be obtained with a finger stick, but doctors also use a lab test called A1C that checks the average blood sugar level over the past three months. This requires a full blood draw, but it’s critical to assessing your risk of developing diabetes or complications from diabetes.
Because prediabetes doesn’t cause symptoms, it’s especially important to have your blood checked annually, and that’s even more important if you have any of the risk factors for diabetes, such as advancing age, being overweight, or leading a sedentary lifestyle.
If you’ve been told you have prediabetes — the condition where your blood glucose is consistently above normal, but not high enough to be considered diabetes, you don’t have to change everything about your lifestyle in one fell swoop. Health care professionals will often recommend small steps that can add up to make a big difference. Starting small, and adding more changes as you feel comfortable, carries less of a risk of failure than trying to change everything at once.
Among the changes: Move more. You should limit the amount of time you spend sitting down and try to get at least 30 minutes of physical activity at least five days a week. You don’t even have to exercise for 30 minutes at one time. You can break up your exercise routine and conduct it throughout your day.
Choose healthier foods and drinks. Pick foods that are high in fiber and low in sugars and fats. Choose a balance of vegetables, protein and healthy carbs, and drink water instead of sweetened drinks. Artificially-sweetened drinks such as diet soda don’t have actual sugar in them, but artificial sweeteners can cause the body to crave carbs and can also increase insulin resistance.
Make a concerted effort to lose weight. You can prevent or delay diabetes by losing just 5% to 7% of your starting weight. That means if you weigh 250 lbs., you can prevent or delay diabetes by losing just 13 lbs., though you shouldn’t stop there. And once you’ve lost weight, keep it off.
Support is critical. Other diabetics who have walked in your shoes can give you advice. Your doctor is also a critical part of your approach, as he or she can help provide accountability and give you advise on what you should be doing differently.
Finally, make sure you stay up to date on vaccinations. As previously mentioned, more than 4 in every 10 Americans who have died of Covid-19 had diabetes. The influenza season is equally hard on diabetics, due to their weakened immune systems.
The Bottom Line
All of the above applies to diabetics as well as prediabetics and even those who are currently healthy but at risk for becoming diabetic. If you have type 1 or type 2 diabetes, making small changes and living healthier can help you lead full, healthy lives with lower risk of being disabled by the disease or losing your life to it. If you have prediabetes, understand that living with prediabetes is easier than living with diabetes itself. You likely won’t have to take medicine and can control your blood sugar with diet and exercise alone, while preventing a progression to full-blown disease. Finally, if you are healthy, you can reduce your risk for developing diabetes and ever being put in a position where your daily routine includes taking Metformin, giving yourself insulin injections and counting carbs.