Blood Sugar, Prediabetes, and Diabetes – Are you at risk?

I never thought that diabetes would be something for me to worry about.  I have never been overweight, love to exercise, and thought I ate healthy.  When I was in my 30s, I worked long hours pulling a 36-hour shift hour shift at least once a week.  My breakfast was usually a bagel and cream cheese or biscuits and gravy (it was Texas), lunch was a sandwich or burger sans fries (even then I knew that fries were not good), and not infrequently dry cereal and milk for dinner.  I remember a day when I had no time for lunch and had a 6 pm meeting.  I grabbed a roll of Girl Scout chocolate thin mint cookies and by the time I made it to the meeting, I had eaten the entire package of cookies!  Mind you, this was all “low fat”.  I needed a constant flow of high carbohydrate to boost my flagging energy.  After my previously discussed crash and recovery, I had genetic testing done and found that I had a gene that increased my risk for diabetes by 25%.  Curious about my previous numbers, I looked at old labs and was surprised to see that by blood sugar consistently ran in the 100s.  My numbers then were consistent with the now new numbers for diabetes.  I have made major changes in my diet and now follow my blood sugars with a glucose monitor.  I was amazed to see how my blood sugar was affected by what I ate.  One morning when my fasting blood sugar was 121, I decided that the monitor must be wrong and I took my husbands blood sugar – 75.  I was shocked.  So, I began a quest to learn about prediabetes and how to prevent the onset of frank diabetes.

What are the numbers?

So, what IS a normal glucose?  Well, the range for blood sugar or glucose is 70-125mg/dl with 126 being a diagnosis of diabetes. 100-125mg/dl is now considered pre diabetes. A glucose greater than 90 is cause for concern.  Hemoglobin A1C is a measure of your average glucose over the last 3 months and should be less than 5.6 and ideally 4.4-5.0.  In my medical career, I have seen the numbers for diabetes adjusted downward as we realized that the damage of elevated glucose begins much earlier.  Diabetes used to be diagnosed at 140 mg/dl for glucose and 6.5 for HemoglobinA1C.

The Blood Sugar Rollercoaster so many of us are on...and don't even know it.

Diabetes does not happen overnight but likely begins on a continuum over 10 or more years.  We now know that metabolic changes and damage from high glucose begins years before diagnosis and the ongoing damage is largely silent with no symptoms.  A glucose level above 90 shows impairment in the metabolism and utilization of blood sugar. The damage to blood vessels, neurons, and the microvasculature begins and slowly progresses to full-blown diabetes resulting in the ravages of this disease including blindness, renal failure, and cardiovascular disease and death.

Why are we developing diabetes?

Your blood sugar is affected by a number of things including hormones, toxic exposures, and genetics.  Mostly though, your blood sugar is a result of what you eat.  Far and away, we eat too much sugar found in processed and packaged foods full of sugar and chemical preservatives, and sugary drinks; and we simply eat too much.  Our appetites are fueled by hormonal imbalances in cortisol, thyroid hormones, and insulin, making us pack on the pounds.  The increasing fat, particularly abdominal fat, sets up its own metabolism and alters the internal environment to favor continued fat deposition making it very difficult to lose the weight.  Our stressful lives and polluted environment trick our body into thinking that we are in danger, and it turns up your stress fighting hormones, which slows your metabolism. Your body stores fat preparing for the long winter of food scarcity that never comes.  The high levels of glucose and insulin begin doing their damage well before the diagnosis of diabetes.

Type I and Type II Diabetes

Two types of diabetes occur.  Type I Diabetes is a result of destruction of the islet cells in the pancreas that make insulin and is a very different disease than Type II Diabetes, which is not due to pancreatic islet cell failure but to an inability of the body to utilize glucose due to insulin resistance and too much glucose and insulin. The etiology of Type I diabetes is not clear and is not included here.  It is Type II diabetes that is becoming epidemic in our nation due mostly to our ballooning waistlines.

The Good News

The good news is that Type II diabetes is completely preventable.  Once you are in the prediabetic stage of diabetes, you already have impaired glucose tolerance and weight loss becomes increasingly difficult.  Just decreasing calories won’t do it.  But we now better understand the mechanisms behind the metabolic derangements that occur with high blood sugar.  We can track progress with new tools and biomarkers. With nutritional support, discipline, commitment, and a clear determined mind, diabetes can be prevented and perhaps even cured.