Were you diagnosed with diabetes or pre-diabetes? You are not alone!
Diabetes and pre-diabetes are diagnoses that are typically made well into a person’s adult life. It is a pathophysiological process that requires two main players – genetics and lifestyle – much like many other chronic conditions. Because we are not yet far along in medical advancements to alter the multiple genetic combinations that make diabetes possible in some, lifestyle modifications and pharmacotherapies when needed, compose the bulk of diabetes management.
So, what is diabetes?
In simple terms, diabetes is a “chronic” medical condition in which the body has developed resistance to its own insulin. Because the main role of insulin in the body is to remove sugar from the blood stream for energy use in body tissues, like muscles and internal organs, insulin resistance creates a bodily environment in which the blood stream is overly saturated with sugar.
Some of you may know family members with diabetes and fear how life altering this diagnosis can be, or even have experienced first-hand specific sequalae related to many years of abnormally elevated blood sugars. However, understanding what the low-lying fruit in the path to self-healing from a diagnosis of diabetes and pre-diabetes is very important. (And no, if you have already been diagnosed with diabetes/pre-diabetes, it does not necessarily mean you will end up like your aunt or uncle who “died” of diabetes.)
Can I Really Reverse My Diabetes?
A man named Mr. M was in his 40s when he came to see me because of blurred vision and headaches. He was ultimately diagnosed with very poorly controlled type 2 diabetes mellitus. Some of you may understand what a hemoglobin a1c is, and to be concise, his was 13%, which meant that on average, his blood sugar had been around 326 mg/dl over the past 3 months (normally less than 114 mg/dl).
Mr. M was an obese man. He had a family history of diabetes. Yet, he never really thought this would happen to him. After an in-depth discussion on how diabetes develops and a thorough explanation on how to specifically target those mechanisms with lifestyle modifications, Mr. M was very eager and committed to get started. Ultimately, Mr. M was able to completely reverse his diabetes and come off the pharmacotherapies initially prescribed to him.
Has Mr. M been the only patient I have had with a similar outcome? No.
Will everyone be like Mr. M? No.
This case simply demonstrates certain factors that make an outcome like this possible. Those three simple factors are education, motivation, and time of diagnosis.
Our Process
I showed Mr. M a simple diagram I draw for all my patients with newly diagnosed pre-diabetes and diabetes. I jokingly tell them I will take them through a quick crash course on diabetes physiology. I start by making the following simplification:
First, your genetics pre-dispose you to this diagnosis.
Second, excess fat cells in your abdomen and internal organs create negative feedback signals to resist the effects of insulin. In this tug-of-war, fat cells resist further storage of unused energy. The pancreas on the other hand produces more and more insulin to try to clear the excess sugar in the blood stream. And the fight goes on, until the pancreas loses more and more ground in that tug, and blood sugars and fats get higher and higher in the bloodstream.
Then I told Mr. M, the strategic foci to help the pancreas in this tug are the following:
First, reducing the amount of dietary simple-sugars that become immediately absorbed into the blood stream, that then further contribute to a greater load against the pancreas.
Second, exercising to create an outflow of these sugars into the muscles, further reducing the load on the pancreas.
And ultimately, with at least these two modifications, and maybe with the help of medication, start eliminating some of the opposition- the fat cells generating the negative feedback signals.
Diet – Simple Carbohydrates
Simple carbohydrates do not require much metabolism to be converted to simple sugars, of which the main one is glucose. These are found in processed, packaged foods and sweets, sugary drinks, simple starches like potatoes, plantains and white rice, and white processed flours and its derivatives, such as pasta, white breads, and pastries.
In our tug-of-war illustration between the pancreas and fat cells, simple sugars that are quickly turned into glucose certainly pull against the pancreas and its ability, through insulin, to regulate blood sugar levels.
Therefore, from the sugar load perspective, the main recommendation is to stay away from simple carbohydrates, while favoring green leafy raw vegetables like lettuce, spinach, and kale; lean proteins; and complex carbohydrates like quinoa, couscous, brown rice, lentils, beans, and garbanzos.
Exercise
In our illustration, exercise directly reduces the load on the pancreas by using excess blood sugar for energy within the muscles.
People with diabetes and pre-diabetes may initially present with fatigue or feel that fatigue is the main barrier for exercise. This makes sense because insulin cannot appropriately get sugar into tissues for fuel “combustion” due to insulin resistance. Breaking the fatigue cycle that perpetuates a sedentary lifestyle is very important.
The answer?
Slowly building endurance. We often hear recommendations of moderate intensity aerobic exercise of at least 150 minutes per week to combat obesity and diabetes. However, for most people, already weighed down by aerobic deconditioning, extra pounds, and fatigue, this task can be daunting. But the start low and go-slow motif could not be truer here. By starting with 10 minutes once daily, one can almost be halfway to the recommendation.
What is moderate intensity aerobic exercise?
Any exercise that increases your heart and breathing rate enough to the point where you cannot comfortably carry a conversation with someone else while exercising, is at least moderate intensity.
What are some recommended exercises?
Because most people with diabetes are obese or overweight, it is important the exercise be low impact, at least while working towards a healthy weight. This means our knees and ankles should not have to constantly absorb the load of our bodies as they drop from a height and decelerate against the ground. Examples are running on hard surfaces and sports like basketball. Low-impact exercises include brisk walking, elliptical, stationary bike, and swimming.
Weight loss
Above, we reviewed how a low carbohydrate diet and exercise immediately and directly impact blood sugar. However, these two in combination, as previously alluded, also indirectly impact blood sugars by means of weight loss. Weight loss, particularly loss of central/abdominal fat, reduces the signals that propagate insulin resistance. Therefore, weight loss is the ultimate player in reversing insulin resistance, which is the definition of pre-diabetes and diabetes.
At Avance Care, we have registered dietitians who guide patients in the weight loss journey through medical nutrition therapy, while providing separate additional care with the management of diabetes, which not only includes diet and exercise, but also medication management and blood sugar monitoring.
When needed, pharmacotherapies can temporarily supplement weight loss while a patient is getting started with lifestyle modifications or when lifestyle modifications alone have not achieved weight loss targets.
Bariatric procedures can also be of help to a select group of patients. These have been shown to be effective in some to completely reverse diabetes. It is always important to partner with your doctor to determine whether medications or procedure would be recommended in your management.
So, can pre-diabetes and even diabetes be reversed?
The answer is yes!
If you have been diagnosed with pre-diabetes or diabetes, can you lead a lifestyle similar to and experience the longevity of others without diabetes?
The answer is also yes.
With simple education that leads to a basic understanding of how to combat diabetes, commitment, and an early diagnosis, pre-diabetes and diabetes can be reversed.
To get started on managing your diabetes with your care team at Avance Care, request an appointment by visiting here.
