By Hope Warshaw, MMSc, RD, CDE
To say there's a type 2 diabetes tsunami brewing in this country is a vast understatement. Centers for Disease Control and Prevention's 2011 statistics released recently indicate that:
~~ 26 million Americans have diabetes (90%+ have type 2)
~~ 79 million (35% of American adults) have prediabetes
Unfortunately, many old dogmas about type 2 diabetes prevail yet recent research has led to new understandings and treatment options. The new reality? Take action early and often. Don't delay, don't deny.
Here are four old dogmas dispelled and the new realities explained:
Old Dogma: Type 2 isn't the serious kind of diabetes. Typically diagnosed later in life, people just need to follow a healthy eating plan, lose a few pounds and perhaps over the years, they'll need a "diabetes pill."
New Reality: Recent research underscores that type 2 is a progressive disease and the progression is typically kicked off nearly a decade before diagnosis. Insulin resistance, due to excess weight, mixed with a positive family history are the common culprits. Type 2 diabetes is now being diagnosed in younger adults and even children. By the time of diagnosis, most people have already lost half to three-quarters of their insulin making pancreatic beta cells. Expert guidelines now recommend starting individuals on a medication to treat the insulin resistance right out of the starting gate. It's now known that insulin production will dwindle further over time. Most people will need a progression of blood glucose lowering medicines over the years. The good news: research shows early, aggressive management to control blood glucose can slow this progression. Healthy eating, losing a few pounds and being physically active will always offer an assist.
Old Dogma: Blood glucose control is goal number one.
New Reality: Having type 2 diabetes, it is said, carries a risk factor equivalent to having had a heart attack or stroke. The most common complication of type 2 is heart and blood vessel diseases, not eye or kidney disease, as is often thought. Research has shown that to get and stay healthy over time, people with type 2 need to focus squarely on their ABCs: A for glucose control (the A1C result), B for blood pressure and C for cholesterol. Studies show that when people think diabetes, they think glucose. They don't make the link between diabetes and circulatory problems. Yet, three-quarters of people with diabetes have high blood pressure.
Old Dogma: Losing weight will always rapidly control blood glucose. The dogma people hear from their providers ad nauseam is if you'd only lose weight your blood glucose would be lower.
New Reality: Research shows that the greatest impact of weight loss on blood glucose is in the first few years after diagnosis. In fact, the biggest bang per pound is in the prediabetes phase (sad fact is most people don't know they have prediabetes). With loss of 5-7% of body weight and 150 minutes of physical activity, research has shown people can prevent or delay the progression to type 2. Once insulin production is on its dwindling course, weight loss will have less impact on glucose control. The reality is if blood glucose is out of control, it's time for medication.
Old Dogma: People with type 2 diabetes must follow a low carbohydrate diet.
New Reality: Nutrition recommendations for people with type 2 diabetes from the American Diabetes Association and other health authorities echo the recently unveiled U.S. 2010 Dietary Guidelines for carbohydrate consumption: about 45 to 65% of our daily calories should come from carbohydrates. (Americans currently eat about 45- 50% of their calories as carbohydrates.) Countless research studies do not show long term benefit of low carb diets on blood glucose, weight control or blood fats. People with type 2 diabetes, like the general public, should lighten up on added sugars and sweets. They should eat sufficient amounts of fruits, vegetables, whole grains and low fat dairy foods -- all healthy sources of carbohydrate.
To get and stay healthy with type 2 diabetes means facing the diagnosis promptly and taking action immediately and continuously tracking and controlling blood glucose, blood pressure and blood cholesterol.
Remember: Take action early and often. Don't delay, don't deny.
Hope Warshaw, a registered dietitian and certified diabetes educator, is the best-selling author of 8 books, including Diabetes Meal Planning Made Easy, Real Life Guide to Diabetes and Guide to Healthy Restaurant Eating.
Learn more at her informational web site www.HopeWarshaw.com.