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diab2According to a just published UCLA research study, more than one out of every two adults in California today is either “diabetic” or “pre-diabetic.” Are you a member of the new majority? Hopefully not, but—depending on your genes and your habits—the odds might just be against you.

Diabetic means your untreated average blood sugar levels exceed a threshold level that the medical community defines as . . . diabetic. One can argue that this stated threshold is perhaps arbitrary. However, if your untreated average blood sugar levels exceed that number, you’d better stop arguing and come to grips with it. More than 100 “diabetic” Californians alone lose a leg, a foot or a toe every week because of this “disease,” so the state data reflects. And that’s before taking into account the number of California diabetics who suffer heart attacks, strokes, blindness and kidney failure every week. Being in denial is . . . risky.

Pre-diabetes means your untreated average blood sugar levels are above “normal,” but below “diabetic.” For now. But probably not for long. Unless you do something about it. Think I’m just trying to scare you? Think again. Up to 70% of all those who are pre-diabetic today will graduate with dishonors and go on to become diabetic during their lifetime.

According to the study released by the UCLA researchers, and summarized in the Los Angeles Times, for decades more and more Californians have been putting on weight “and” been falling “ill” with this “disease,” at least implying that the first inevitably means the second.

As one who is diabetic, I’m troubled by at least two implications inherent in the opening UCLA premise (a premise generally subscribed to by most of the national medical community). More on what troubles me below. But first some additional statistics that do seem inescapable.

According to federal data, about 9-10% of all Americans are diabetic (many of them undiagnosed until it is . . . too late) and 33% of all Americans are pre-diabetic. This bears repeating. One in every ten Americans today is diabetic. One in every three Americans today is pre-diabetic, well on the way likely to becoming diabetic. These numbers are simply staggering. So are the costs of dealing with this . . . epidemic. Billions and billions of dollars every year. And climbing more rapidly every year than health insurance premiums!

What UCLA researchers have found in the course of their extensive study is that, at least in California, the number of pre-diabetics thought to be 33% is actually about 46%. Put the figures together and the combined number of diabetics and pre-diabetics is thus approximately 55%. More than one in every two Californians. Welcome to the new majority!

There is no reason to think that these statistics are any different elsewhere in the country. According to the federal government, the rate of diabetes has increased 175% since 1980. Give or take, that’s an annual growth rate of about 4-5%. That’s more than the rise in the cost of living and certainly more than what our average investments are earning us.

The question is why we are seeing this kind of growth? And is there any end in sight?

“Our genes and our environment are kind of on a collision course,” says Dr. Francine Kaufman, the former head of the American Diabetes Association, who was not involved in the UCLA research, but was invited by the Los Angeles Times to comment. “It’s not stopping,” she added.

“This study [tells] us that the storm is coming,” says Harold Goldstein, head of the California Center for Public Health Advocacy, the nonprofit organization that funded the UCLA study.

Why are these statistics on the rise? Because 90% of those who are pre-diabetic don’t know it. There are generally no detectable side effects of pre-diabetes. Without a blood test, there is no way to find out if you are or are not pre-diabetic. So, by the time you become aware that you are pre-diabetic and embark upon a course of action—it’s too late.

For those who discover early enough that they are pre-diabetic, there is, however, some really good news. (Nice to have something good to say here!)

 Approximately 90% of those who become diabetic are “type 2” (their pancreas still produces some natural insulin) rather than “type 1” (their pancreas no longer produces any natural insulin). The prevailing professional sentiment (no guarantees) is that type 2 diabetes is preventable “simply” by adopting a healthier diet and increasing physical activity. But how much healthier and how much more physical activity?

To add some context: Reported findings indicate that pre-diabetics who go on available meds reduce their risk of diabetes 31%, while those who improve their diets and exercise regimens reduce their risk 58%. The oft-heard mantra: “Exercise is the poor man’s insulin.”

So, to summarize, here’s “the” sage “one size fits all” “solution” the experts offer:

First, everyone should be screened regularly (say once a year or whenever you otherwise have a physical) to test for pre-diabetes. If Obamacare can mandate that people buy insurance, the government can certainly mandate annual blood tests—and pay for them. It costs only pennies to screen, but timely detection will save billions of dollars in treatment costs borne by our taxpayers that could have been avoided. Where can you get that kind of return on your investment?

Second, people have to eat more wisely and they have to avoid becoming sedentary (in spite of arthritis, sore joints, and sore feet that often comes with age, and too much weight). Where there’s a will, there’s a (smart) way. Panic and excess is neither necessary nor, the grand scheme of things, particularly helpful. Still, getting up off the couch is not always an easy sell, but adequate public education will help. Haven’t millions of Americans quite smoking? Inform them of the importance of consistent exercise and they will learn to quit . . . sitting.

Third, we need to put manufacturers of unhealthy food out of business. Or at least get them to change their businesses. Again, we have all but done that with the cigarette manufacturers. We can do it with the manufacturers of sugared and carbonated sodas (carbonated diet drinks are better than sugared drinks, but not a lot, certainly not as much as the manufacturers tell you) and fast food—spelled “really bad junk food.” Some local laws are being enacted (Berkeley, California for example) and some manufacturers are improving, but not enough to make a difference. Yet.

All three of these points are sound. And, in disciplined responsible moderation, they have no downside. Get tested regularly. Exercise carefully, and more. Eat and drink better. A lot better. You have nothing to lose (except some weight) and everything to gain (except some weight).

But there’s something that’s bothering me. Missing from all of the above. What?

The answer: Too many health care providers and too many educators trying to get to a one size fits all fix. It doesn’t work that way. Until we have an outright cure for diabetes, if there is any one instance where one size does not fit all, diabetes is it.

Another saying very germane in the field of diabetes: “One person’s meat is another person’s poison.” There are just too many variables in the diabetes paradigm to generalize things so neatly. For example, what about genetics? How come plenty of incredibly obese and sedentary people don’t become diabetic? How come there are people thin as rails who are diabetic?

Science hasn’t begun to scratch the surface on how metabolism impacts this equation. Doctors, including endocrinologists, are way too quick to say “calories in minus calories out” is all that is required for weight management. Not true. That’s just an excuse for the fact that the medical profession hasn’t yet come up with the correct formula.

Consider the obvious: You can take two people (diabetic or not) with the same general characteristics (age, height, weight, health, etc.) and put them on the same controlled diet and the same controlled exercise regimen and their weight results will be incredibly different. Even more compelling: I know one person who wasn’t losing any weight at a reliably measured 1,200 calories a day. Under the supervision of a nutritionist, his daily calories were increased to 2,200 equally reliable calories per day and most of his other variables (amount of exercise, amount of sleep, etc.) were held unchanged. And yet he started losing weight, gradually but steadily. Would could possible account for that if calories in minus calories out was the correct formula?

The answer was what he ate and when he ate it. The fact is, not all calories are created equally. What you eat and when you eat it and in combination with what else you eat can make a profound difference on your metabolism and how it burns or doesn’t burn weight.

Along with the uncertainties of metabolic impact on weight management, another factor not yet receiving nearly enough attention is . . . sleep—the fact that in many people diabetes appears to increase as sleep decreases? Why is that? For many (not all, those pesky genes again) less sleep does significantly increase the incidence of diabetes. But we don’t know why. Yet. Is it possible that poor sleep habits contribute to poor health in general and that increases susceptibility to diabetes? Or is it something more complicated?

And The Wife: She believes the rampant increase in diabetes we are experiencing across the U.S. suggests that diabetes may yet be an undiagnosed . . . virus.

So, like me, are you part of the new majority? Well, it’s not the end of the world folks. If you need to, own it, embrace it, don’t deny it. If I don’t brush my teeth, they’ll decay. So, I brush them. And, similarly, I do what I need to do to manage my diabetes. I can handle it. If you need to, so can you.

Editor’s Note: I can be a cheerleader, and I can offer some educated observations after managing my diabetes for three decades, but I’m not a substitute for responsible and regular medical checkups and blood sugar screenings and a sound and respectable diet and exercise plan under proper professional supervision. And while Rome was not built in a day, it did get built. So did the Pyramids.


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  • Jane S Taber

    Haven’t you noticed all the cupcake shops? The food channel is telling you about the best sweets in America. People are drinking wine by the gallons.

    Rather than get government involved in regulation … how about a little dose of person responsibility. In other word self control. Indulge in moderation. Government cannot cage people like animals and feed them a restricted diet according to what government decides is appropriate.

    Again I suggest reading the book This Perfect Day by Ira Levin.

    • Good comments . . . for those who don’t eat and exercise responsibly. But what about those who DO . . . and are still diabetic or pre-diabetic, or prone to becoming so to the extent that they are still overweight, which inescapably increases the odds of becoming diabetic or pre-diabetic? Some diabetics and pre-diabetics are both thin and fit. And some who are overweight are neither diabetic nor pre-diabetic. There is more–much more–to this condition than just weight. Weight is but one factor in this complex equation.

      And I understand Levin’s This Perfect Day, I do. We can’t expect the government to legislate what we eat and don’t eat, but we can expect the government to campaign against bad food as they did against cigarettes and we can expect the government to campaign for, and underwrite, if not mandate, annual blood testing, and to underwrite more diabetes and weight management research, the cost of which would be but a tiny fraction of the public cost of treating diabetes after the fact.

      Consider the number of deaths each from Cancer, AIDS and Diabetes. Then tell me if we are spending enough to find a cure for diabetes and to educate the public about how to avoid it in the meanwhile to the extent that is possible.

  • Fred Taber

    While you allude to it, the importance of avoiding “white” carbohydrate foods (bread,potatoes, white rice) cannot be overemphasized in controlling diabetes and pre-diabetes.

    • I didn’t emphasize carbohydrates enough (or at all) because my focus was on what leads or supposedly leads to diabetes and pre-diabetes, and not on how to manage diabetes or pre-diabetes. While one who is neither diabetic or pre-diabetic has no need to limit carbs beyond a generally healthy and balanced diet, you are absolutely right that one who is already diabetic or pre-diabetic has to be very disciplined about avoiding carbs, i.e., to the point of adjusting a diet to what is not “balanced.”

      That said, there are carbs and there are carbs. It is not quite the case that, for diabetics and pre-diabetics, the “only good carb is a dead carb,” but it is close to that. For example, the carbs in pasta or rice or potato or most breads really must be almost totally avoided by one who is diabetic or pre-diabetic. However, in moderation, the right fruits at the right time of day with the right proteins is beneficial (or at least not harmful) to a diabetic or a pre-diabetic even though fruit definitely contains carbohydrates. Vanilla ice cream is not wise for a diabetic or pre-diabetic, but a modest amount of lemon sorbet is pretty much okay. One more admonition. One size really does not fit all when it comes to this subject. What is good for the diabetic or pre-diabetic goose is not always good for the diabetic or pre-diabetic gander.

      Thanks very much, Fred, for raising this really important point.