November is Diabetes Awareness Month®.  The theme this year from the American Diabetes Association is #ThisIsDiabetes - "Whether you're living with diabetes, caring for someone who is, or you're fighting to stop it, there's a hero in you.  One in 11 Americans has diabetes.  So put on your cape and take a stand."  It's a month to draw awareness to the disease as well as to call attention to those at risk.

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I taught a class last week called "Dining Out and Diabetes" in Spanish, "Comer Afuera y la Diabetes".  Ironically no one in class had diabetes, so I shifted my focus of class to discuss what diabetes was and more so how to prevent it (what I prefer anyways).  One lady in class mentioned she was too scared to go in and have her levels checked.  She kept asking a lot of questions but yet didn't know what her numbers were.  Bottom line she's like so many others out there:

Approximately 84 million American adults - more than 1 out of 3 - have prediabetes.  Of those with prediabetes, 90% don't know they have it. 

To me that's a staggering statistic and the reason why we have National Diabetes Awareness Month®.  Experts say a "diabetes tsunami" is coming our way.  Why are the numbers SO high?  One of the main reasons is that  ⅔ of adults (and  ⅓ of children) are overweight or obese, not to mention we're couch potatoes - binge watching TV is the new norm, sadly.  Type 2 diabetes develops because the body is resistant to insulin.  Insulin acts like a key that allows sugar to enter the cells, where it can be burned for fuel or stored for later.  However, in some people, the key struggles to open the lock.

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This puts the pancreas into overdrive - to compensate for this insulin resistance the beta cells have to pump out more insulin just to keep up.  Over the years the beta cells wear out.  When this occurs this is when the blood sugar levels fall into the "diabetes" range.  Americans are headed towards this breaking point because of a couple of reasons:  we're gaining weight at alarming rates (due to portion sizes, sugary beverages, and less exercise) and because of age.  Beta-cell failure occurs more rapidly with age.  

I read an article this week that discussed this issue - of needing to know your numbers, yet doctors are not communicating how important it is to make a change once you've been diagnosed with prediabetes.  "Prediabetes doesn't trigger much of a fuss in the doctor's office.  A lot of healthcare professionals see the numbers are in the prediabetic range and simply tell the patient that their numbers are high.  They should go home and exercise and eat less."  Many patients I saw (at my previous job that were referred by their primary care doctors) had NO idea what their numbers were and and/or why they were even being referred - many knew they needed to lose weight, but stated they had NO idea of their blood sugar levels.  Now in the doctors' defense the patients may have been told this, but in the education/prevention world we call this the "Charlie Brown effect".  They get their diagnosis and then all they heard was "whaa whaa whaa whaa".  The truth is you're going to have some doctors that are more proactive than others.  I encouraged all my patients to be their own advocates and one, know their numbers and what they mean, and two take preventative action with their nutrition.  One other good piece of advice is to see a specialist if your numbers are in the prediabetes range, an endocrinologist.  They specialize in endocrine disorders.  If you have heart disease you see a cardiologist - so why wouldn't you see an endocrinologist if you have prediabetes?  Back to the numbers and what they mean:

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If you have a fasting blood sugar drawn (eight-hour fast) and the numbers fall in between 100 - 125 mg/dL this signals that you have an irregularity in your blood sugar levels, impaired glucose tolerance.  A diagnosis is not made from one blood sugar level, however, you should have your A1c level checked.  The A1c level is a 3-month average of your blood sugar levels.  This will give a better picture of what is going on (as well as the ability to diagnosis if your blood sugar levels are normal, prediabetic, or diabetic).  If the A1c level falls in between 5.7 - 6.4% this is considered prediabetes.  6.5% and higher is diabetes.  This is the first place I start with patients, in understanding their numbers.  Diabetes works on a continuum - it cannot be reversed (contrary to what people may say), however it can be controlled.  The first step is knowing your numbers and if they are in a range of concern, begin to make changes in order to offset/prevent developing diabetes.  

How can we lower the risk of developing type 2 diabetes?  How can we help control type 2 diabetes if one already has it?  There was a whole study focused solely on preventing type 2 diabetes - Diabetes Prevention Program.  Here's what the findings said along with other helpful tips to help prevent diabetes:

-The best way to dodge diabetes is to lose weight (or not gain) extra pounds.  Losing 7-10% of your current weight can cut your chances of developing type 2 diabetes in half.

-Do at least 30 minutes of brisk walking or other aerobic exercise every day.  Include strength training two or three times a week as well.  Working your muscles more often and making them work harder improves their ability to use insulin and absorb glucose.  Limit the time you spend sitting at work, at home, or in between.  

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-Limit sweets, especially sugar-sweetened drinks.  The sugar you sip may add flab more than the sugar you chew.  Liquid calories don’t seem to lead to satiety and it’s easy to take in a large amount, easily.  Think your drink! 

-Fill up half your plate with vegetables and only a quarter with (preferably whole) grains.  Whole grains don’t have a magical nutrient that fights diabetes and improves health.  It’s the entire package – elements intact and working together – that’s important.  The bran and fiber in whole grains make it more difficult for digestive enzymes to break down the starches into glucose.  This leads to lower, slower increases in blood sugar and insulin.  As a result, they stress the body’s insulin-making machinery less, and may help prevent type 2 diabetes. 

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I also wrote a whole blog post last time about how to choose healthier carbohydrates - they're not all created equal.  Read about it here.

-Replace saturated fat and trans fats with unsaturated fats to lower the risk of heart disease.  The unsaturated fats found in liquid vegetable oils, nuts, and seeds can help ward off type 2 diabetes.  Trans fats do just the opposite.  Trans fats are found in many margarines, packaged baked goods, fried foods in fast-food restaurants, and any product that lists “partially hydrogenated vegetable oil” on the label. 

Baptist Health South Florida, my current employer, is finishing up a year-long program that implemented the Diabetes Prevention Program - education, support, changing lifestyle habits - all in an effort to prevent Type 2 diabetes.  We'll be starting another program in January.  If you or someone you know has prediabetes and is looking for help and support and is ready to implement change, comment below so I can refer you to get signed up for the program!  You must live in Miami.  A year might sound like a long time, but it takes time to implement change and undo habits that you've had for a lifetime, all in an effort to help prevent diabetes.  It'll literally be a life-changing program.

The bottom line and the good news about diabetes:  you're not destined to get diabetes if you practice prevention.  Keep your weight - and especially your waist - under control, and spend more time on your feet than on your seat!

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The key to healthy eating is balancing your plate - protein/carbohydrate/healthy fats - and aiming to include LOTS of non-starchy veggies to fill you up with fiber!  Delish, healthy food!