ASK THE DOCTOR

by Wesley W. Wilson, MD

Artwork: Medical caduceus

NOTE: If you have any questions for "Ask the Doctor," please send them to the VOICE editorial office. The only questions Dr. Wilson will be able to answer are the ones used in this column. Wesley W. Wilson, MD has retired as an Internal Medicine practitioner at the Western Montana Clinic in Missoula, Montana. Dr. Wilson was diagnosed with type 1 diabetes in 1956, during his second year of medical school. He remains interested and involved in diabetes education for patients and professionals.

Q: I am told I have IGT and that I need to watch it. I know I could develop type 2 diabetes in the future. My question: How much difference do/will my current lifestyle choices make as to whether or not (or when) I go into full- blown diabetes? Can I stave off the Big Day by careful diet and exercise now?

A: You really do need to watch it since your life- style now has a major effect on your future health and your likelihood of developing overt diabetes.

What are your fasting blood sugars now? The level of blood sugar needed to establish a diagnosis of diabetes has recently been changed from 140 or higher to 126 or higher. If your fasting glucose is repeatedly above 126 you no longer have Impaired Glucose Tolerance (IGT) but already have diabetes. The lower sugar level was adopted because we now know that diabetic complications (eye, kidney, and nerve disease) are increased with even slightly increased blood sugar. Numerous studies have shown that the higher the blood sugar level the higher the risk of complication. You should do whatever you can to avoid diabetes and elevated blood sugar levels. Regular exercise and control of body weight certainly can delay the appearance of diabetes. I can t tell you how much benefit there will be since that varies greatly from person to person, but there should be a significant benefit.

Insulin resistance seems an important first element in the development of type 2 diabetes. Exercise and weight loss both decrease insulin resistance and allow insulin to do its job more effectively. I suspect most physicians who treat diabetes have seen persons with flagrant diabetes and very high blood sugars, who reverted to normal blood glucose levels with just weight loss, attention to diet and increased exercise. If you can reverse it with diet and exercise, why can t you prevent or at least delay the appearance of diabetes with those techniques? Development of type 2 diabetes seems to proceed from insulin resistance (with blood sugars controlled by increased insulin production by the pancreas) to exhaustion of the overworked pancreas (with decrease in insulin production), leading to elevation of blood sugar. It seems reasonable to assume that anything we can do to reduce the underlying major abnormality (insulin resistance) should delay the exhaustion of the pancreas and should be recommended to persons at risk of diabetes. This is especially true since diet and exercise have no harmful effects. And you know a hard workout makes you feel better!

More information on the prevention of diabetes will be coming from the Diabetes Prevention Program, which is now underway. This study is designed to see if type 2 diabetes can be prevented with diet and exercise or with the use of several drugs used to treat overt diabetes. While we await the results of that study, it would seem prudent to do the best we can to avoid elevated blood sugars with methods we have.