Voice of the Diabetic

Voice of the Diabetic

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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.

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