Hidden Diabetes - You Can Get a Clean Bill of Health and Still Be at Risk

With all the devastating complications of type 2 diabetes, such as heart disease, stroke, dementia and blindness, you might assume that most doctors are doing everything possible to catch this disease in its earliest stages. Not so.

Problem: There are currently no national guidelines for screening and treating type 2 diabetes before it reaches a full-blown stage.

Research clearly shows that the damage caused by type 2 diabetes begins years-and sometimes decades-earlier, but standard medical practice has not yet caught up with the newest findings on this disease.

Fortunately, there are scientifically proven ways to identify and correct the root causes of diabetes so that you never develop the disease itself .

When The Problem Starts

Diabetes is diagnosed when fasting blood sugar (glucose) levels reach 126 mg/dL and above. "Prediabetes" is defined as blood sugar levels that are higher than normal but not high enough to indicate diabetes. Normal levels are less than 100 mg/dL.

What most people don't know: Although most doctors routinely test blood sugar to detect diabetes, it's quite common to have a normal level and still have "diabesity," a condition typically marked by obesity and other changes in the body that can lead to the same complications (such as heart disease, stroke and cancer) as full-fledged diabetes.

Important: Even if you're not diabetic, having "belly fat"-for example, a waist circumference of more than 35 inches in women and more than 40 inches in men-often has many of the same dangerous effects on the body as diabetes.

Important finding: In a landmark study in Europe, researchers looked at 22,000 people and found that those with fasting blood sugar levels of just 95 mg/dL-a level that's generally considered healthy-already had significant risks for heart disease and other complications.

An Earlier Clue

Even though we've all been told that high blood sugar is the telltale sign of diabetes, insulin levels are, in fact, a more important hallmark that a person is in the early stages of the "diabetes continuum."

High blood sugar is typically blamed on a lack of insulin-or insulin that doesn't work efficiently. However, too much insulin is actually the best marker of the stages leading up to prediabetes and diabetes.

Why is high insulin so important? In most cases, it means that you have insulin resistance, a condition in which your body's cells aren't responding to insulin's effects. As a result, your body churns out more insulin than it normally would.

Once you have insulin resistance, you've set the stage to develop abdominal obesity, artery-damaging inflammation and other conditions that increasingly raise your risk for prediabetes and diabetes.

A Better Approach

Because doctors focus on prediabetes and diabetes-conditions detected with a blood sugar test-they tend to miss the earlier signs of diabesity. A better approach...

Test insulin as well. The standard diabetes test is to measure blood sugar after fasting for eight or more hours. The problem with this method is that blood sugar is the last thing to rise. Insulin rises first when you have diabesity.

My advice: Ask your doctor for a two-hour glucose tolerance test. With this test, your glucose levels are measured before and after consuming a sugary drink-but ask your doctor to also measure your insulin levels before and after consuming the drink.

What to look for: Your fasting blood sugar should be less than 80 mg/dL... two hours later, it shouldn't be higher than 120 mg/dL. Your fasting insulin should be 2 IU/dL to 5 IU/ dL-anything higher indicates that you might have diabesity. Two hours later, your insulin should be less than 30 IU/dL.

Cost: $50 to $100 (usually covered by insurance). I advise all patients to have this test every three to five years... and annually for a person who is trying to reverse diabetes.

Steps To Beat Diabesity

With the correct lifestyle changes, most people can naturally reduce insulin as well as risk for diabesity-related complications, such as heart disease.

Example: The well-respected Diabetes Prevention Program sponsored by the National Institutes of Health found that over-weight people who improved their diets and walked just 20 to 30 minutes a day lost modest amounts of weight and were 58% less likely to develop diabetes. You can reduce your risk even more by following these steps...

Manage your glycemic load. The glycemic index measures how quickly different foods elevate blood sugar and insulin. A high glycemic slice of white bread, for example, triggers a very rapid insulin response, which in turn promotes abdominal weight gain and the risk for diabesity.

My advice: Look at your overall diet and try to balance higher-glycemic foods with lower glycemic foods. In general, foods that are minimally processed-fresh vegetables, legumes, fish, etc.-are lower on the glycemic index. These foods are ideal because they cause only gradual rises in blood sugar and insulin.

Eat nonwheat grains. Many people try to improve their diets by eating whole-wheat rather than processed white bread or pasta. It doesn't help.

Fact: Two slices of whole-wheat bread will raise blood sugar more than two tablespoons of white sugar. If you already have diabetes, two slices of white or whole-wheat bread will raise your blood sugar by 70 mg/dL to 120 mg/dL. Wheat also causes inflammation... stimulates the storage of abdominal fat... and increases the risk for liver damage.

These ill effects occur because the wheat that's produced today is different from the natural grain. With selective breeding and hybridization, today's wheat is high in amylopectin A, which is naturally fattening. It also contains an inflammatory form of gluten along with short forms of protein, known as exorphins, which are literally addictive.

Best: Instead of white or whole-wheat bread and pasta, switch to nonwheat grains such as brown or black rice, quinoa, buckwheat or amaranth. They're easy to cook, taste good and they don't have any of the negative effects. Small red russet potatoes also are acceptable.

Give up liquid calories. The average American gets 175 calories a day from sugar sweetened beverages. Because these calories are in addition to calories from solid food, they can potentially cause weight gain of 18 pounds a year. The Harvard Nurses' Health Study found that women who drank one sugar-sweetened soft drink a day had an 82% increased risk of developing diabetes within four years.

Moderation rarely works with soft drinks because sugar is addictive. It activates the same brain receptors that are stimulated by heroin.

My advice: Switch completely to water. A cup of unsweetened coffee or tea daily is acceptable, but water should be your main source of fluids.

Bonus: People who are trying to lose weight can lose 44% more in 12 weeks just by drinking a glass of water before meals.

Important: Diet soda isn't a good substitute for water-the artificial sweeteners that are used increase sugar cravings and slow metabolism. Studies have found a 67% increase in diabetes risk in people who use artificial sweeteners.