Antidepressants may increase diabetes risk. fltn a recent study, people at high risk for type 2 diabetes who did not take diabetes medications were two to three times more likely to develop diabetes if they were taking antidepressants than similar people who were not taking antidepressants. High-risk patients who were given the diabetes drug metformin (Glucophage) did not have a higher risk of diabetes. If you are taking an antidepressant and are at risk for diabetes-for example, because you are overweight or have a family history of diabetes—talk to your doctor.
How Not to Get Diabetes
The epidemic of type 2 diabetes is alarming—and more dangerous than many people ever imagine. The disease, which affects 20 million Americans, increases the risk for heart attack and stroke. Complications include blindness, kidney failure, impotence and poor wound healing that can lead to amputation.
Until recently, doctors diagnosed diabetes only when a patient had full-blown symptoms, which typically develop gradually over a period of years.
Now: You can stop diabetes in its tracks if you recognize and take action against "prediabetes," which affects more than 40 million people ages 40 to 74. Here's how...
WHEN SUGAR ISN'T SWEET
Glucose, a simple sugar molecule that is metabolized from the food you eat, is basic fuel for your body. It's broken down in cells of all kinds to produce energy that powers your muscles, lets you think and keeps your heart pumping and your lungs breathing.
The hormone insulin, which is produced by your pancreas, plays a key role, escorting glucose from the bloodstream into the cells. When there isn't enough insulin to do the job or the insulin is not effective, sugar builds up in the blood. That's when the trouble begins.
To diagnose diabetes, doctors order blood tests that measure the amount of glucose in your bloodstream. One test, fasting plasma glucose (FPG), checks the level first thing in the morning, before you've eaten anything. A normal glucose level is less than 100 milligrams per deciliter (mg/dl).
The oral glucose tolerance test (OGTT) is a bit more complicated—after fasting all night, you're asked to drink a sugary liquid, and your glucose level is tested two hours later (normal is less than 140 mg/dl).
If your FPG is 126 mg/dl or higher...or the two-hour OGTT is above 200 mg/dl, you likely have diabetes. Your pancreas no longer secretes enough insulin for proper glucose metabolism. This means that your chance of developing complications, such as heart disease, kidney failure or vision loss, has more than doubled.
AN EARLIER DIAGNOSIS
There's also an intermediate condition. Fasting blood sugar of 100 mg/dl to 125 mg/dl is called impaired fasting glucose. If the two-hour OGTT is 740 mg/dl to 200 mg/dl, it is known as impaired glucose tolerance.
Nowadays, these conditions are called prediabetes. With prediabetes, your insulin activity has already started to fall short of the amount your body needs. And if something isn't done, there's a good chance you'll go on to develop full-blown diabetes.
What are the odds? Fasting blood sugar between 100 mg/dl and 110 mg/dl means you have a 20% chance of developing diabetes within five to 10 years. If it's above 110, it's a 40% chance. If both the fasting blood sugar and two-hour glucose tolerance tests are elevated, the odds increase even more.
At the prediabetes level, excess blood sugar already has started to take its toll, researchers have discovered. For example, the risk for heart disease is one-and-one-half times higher than that of people with normal blood sugar.
DO YOU HAVE PREDIABETES?
To determine whether you have prediabetes, ask your doctor for a fasting glucose test—especially if you are at increased risk due to...
- Excess body weight.
- Family history of diabetes (parent, brother or sister).
- Diabetes during pregnancy (gestational diabetes).
- Asian, African-American or Hispanic ethnicity.
If any of these risk factors apply to you, have your blood sugar checked at your next physical—after age 45, do it at least every three years. Given the high rates of diabetes today, everyone over age 45 should consider getting tested.
TREATMENT FOR PREDIABETES
Slightly elevated blood sugar doesn't mean you're destined to get diabetes. \7ith fairly moderate lifestyle changes, you can reduce that risk by more than 50%.
Obesity increases diabetes risk. If you are overweight, bring your weight down by 5% to 10% (an achievable goal for most people). Ideally, your weight should be brought down to the normal range, which means a body mass index (a ratio of weight to height), or BMI, of 18.5 to 24.9. To find your BMI, use the free calculator at the National Heart, Lung and Blood Institute Web site at http://nhlbisupport.com/bmi. Or use the formula (weight in pounds x 703) ÷ height in inches squared.
Important finding: A Finnish study of 522 middle-aged, overweight people with prediabetes found that diabetes risk among those who participated in a diet and exercise program for three years was reduced by 58% compared with a control group, who experienced no reduction.
How to stop prediabetes...
- Diet wisely. Consuming fewer calories than you burn is the key to weight loss. Some research also suggests that reducing saturated fat (most beef and some dairy products), and the resulting weight loss that can occur, helps reverse prediabetes, allowing your body to use insulin more efficiently. A diet rich in complex carbohydrates, such as fruits, vegetables and whole grains, will meet these goals—and is best for everyone's general health.
- Exercise regularly. Physical activity helps control your weight and improves your body's ability to use insulin. Aim for at least 30 minutes five or more days a week. The type of exercise doesn't seem to matter, as long as it requires modest exertion—brisk walking, swimming, riding a bike, etc.
- Forgo medication. Blood sugar in people with prediabetes can be reduced with prescription diabetes medication such as metformin (Glucophage). However research on prediabetes suggests that this drug is not as effective as diet and exercise in preventing diabetes.
Important finding: In a New England Journal of Medicine study, 3,234 men and women with prediabetes were randomly assigned to a lifestyle program or the drug metformin. Weight loss and exercise reduced diabetes incidence nearly twice as much as drug treatment over the next three years (a reduction of 58% versus 31%).
