CHOOSE LIFE -- Prevent and Manage Diabetes

By Erik Nieuwenhuis MS, PT St Luke’s Regional Medical Center 712-279-1842 Nieuween@stlukes.org

Are you at risk for diabetes? Did you know that 23.6 million people or 7.8% of the United States population has diabetes? 17.9 million people have diagnosed diabetes (with 90 to 95% being type II, and the rest being type I, or gestational diabetes), and 5.7 million have undiagnosed diabetes. November is national diabetes month, so this month we’ll focus on the lifestyle risk factors to prevent and manage diabetes or that increase your risks for diabetes.

Diabetes is an illness that causes the body’s sugar levels in your blood to be high. Another word for blood sugar is glucose. Most of what you eat is changed into glucose during digestion. All of the cells in your body (especially your brain and muscles) need glucose to give you energy! The best forms of glucose for your brain and muscles are whole grains, fruits and vegetables as these foods balance blood sugar levels and break down slower in your body to give you balanced energy. Your body makes a hormone called insulin. Insulin works to keep your blood glucose in the normal range by helping it move from your blood into your cells. When you have diabetes; your body does not make insulin (type I diabetes, I have type I or juvenile diabetes and was diagnosed in my senior year of high school), it does not make enough insulin (type II diabetes), or the insulin your body makes does not work right to break down the sugars (glucose) in your body for energy (type II diabetes). Type II diabetes is associated with older age, obesity (especially abdominal obesity or increased waist size), family history of diabetes, history of gestational diabetes, impaired glucose metabolism, physical inactivity, and race/ ethnicity.

Impaired fasting glucose (IFG) or Prediabetes is on an epidemic rise in the United States today, with the rise of Americans being overweight and obese. In 2007, there was an estimated 57 million adults, aged 20 and over, that had impaired fasting glucose (high morning blood sugar >100 mg/dl). That is approximately 25.9 percent of the United States population aged 20 and over. What is really scary is that for those children born in the year 2000 or later, that they will have a 33% (1 in 3) chance of developing type II diabetes during their lifetime living in America (because of our poor lifestyle habits of most Americans today).

The uplifting news in today’s information age of the 21st century is that approx 90% of type II diabetes is preventable by losing weight or maintaining a healthy weight (and body composition), increasing your physical activity, and choosing healthy nutrition throughout your lifetime. The Diabetes Prevention Program, a large prevention study of people at high risk for diabetes showed that lifestyle intervention reduced developing diabetes by 58% over 3 years. The reduction was even greater, 71%, among adults aged 60 years or older. Research from the Centers of Disease Control and Prevention has found that healthy lifestyle interventions are more cost-effective than medications.

Following are LIFESTYLE Habits that are research based to Prevent diabetes or improve your management of diabetes, and improve your quality of LIFE!!

1) Keep your weight in a healthy range or having a Body Mass Index (BMI) that is less than 25, between 18.5 and 24.9. For every point your BMI increases above 25, your future risks of diabetes increases by 6%. Thus, on a positive note for every point you reduce your BMI your future risk of developing diabetes is reduced by 6%!! Obese women (BMI >30) were 10.6 times more likely to develop diabetes than healthy weight women. Obese men (BMI >30) were 4.2 times more likely to develop diabetes than healthy weight men. Waist circumference and risks of developing type II diabetes; Men’s healthy waist size is less than 37 inches with 32 inches being ideal. From 35 to 39 inches the risk increases from 1.2 to 1.6 times the diabetes risk and increases to 3.4 times more likely to develop diabetes with waist size for men greater than 40 inches. For women a healthy waist size is less than 33 inches and the ideal size is 29 inches. From a waist size increase from 30 to 35 the diabetes risk increases to 3.2 to 4 times the risk and above 36 inches for women you have almost an 11 times the risk of developing type II diabetes.

2) Get regular physical activity and aim for 30 to 60 minutes of moderate to vigorous activity daily. People who exercise regularly have improved insulin sensitivity and lower blood sugar levels all day long. This will give you the following benefits; increased energy level all day long, improved self esteem (mental and emotional health) and ability to be productive at work and with family and friends. Improved ability for your children to focus in school and obey their parents/ teachers. Exercise acts similar to insulin to keep your blood sugar levels lower and with less peaks/ valleys. The nurses health study showed that exerciser’s who walked briskly for 3 hours or more per week cut their risks of getting diabetes in half (reduced by 50%) compared to those who didn’t exercise regularly.

3) Don’t Smoke or If you smoke…Stop! Smokers in this study were 37% more likely to develop diabetes than nonsmokers. Now that is another great reason to quit!!

4) Keep your blood pressure is a healthy range (less than 120/80). For every 5 points your systolic blood pressure increases (top number) over 120/80, your risks of developing diabetes is 2% higher. If you already have high blood pressure; 140-159/ 90-99 your risk of developing diabetes is increased by 51%.

5) Keep your good blood cholesterol (HDL) level in a healthy range > 45 mg/dl for men and >55 mg/dl for women. For every 5 point increase in HDL your risk of developing type II diabetes is reduced by 10%. Lifestyle factors shown to increase HDL levels is; getting regular aerobic exercise, losing excess body fat, not smoking, eating healthy fats (people who regularly eat nuts 5 to 7 servings/ week reduce diabetes risks by 29%) and avoiding trans fats, red wine, and eating berries daily.

6) Eat 5 to 6 or more servings of Fruits and Vegetables each day reduced your risks of developing diabetes by 74%!!

7) Engage in Strength/ Resistance Training exercises at least 2-3 times each week, especially as you age to maintain good health, stronger muscles and bones (prevent fractures and osteoporosis), and maintain independent living. Eating adequate protein is also important, especially soon after exercising for building stronger, healthier muscles. Two key principles for maintaining muscle strength are; 1) Muscles must be challenged and do more work than is regularly required. Doing a strength exercise to near fatigue gives maximum stimulus to the muscle to grow stronger, even in adults in their 70’s-80’s. 2) Supply the muscles with adequate protein needed to build stronger muscles. Muscles are maximally stimulated to uptake protein and rebuild muscles immediately after your strength training exercises are completed. 2 glasses of milk or soymilk (18 grams of protein) immediately after your workout raised amino acid levels in the blood to stimulate muscle building and growth.

8) Drink at least 40 or more ounces of water daily, working up towards half of your body weight in ounces.

9) Make sure to sleep at least 7 to 8 hours each day for proper rest and recovery.

10) Make sure to spend quality time with family and friends daily, maintain a positive attitude and outlook on life, and keep a time for daily spiritual reflection and renewal and watch your spirit and LIFE soar, and diabetes disappear or be managed for LIFE!!

Sources:
Wellsource “Making Healthy Choices” Newsletter Issue 48: Oct 1, 2008 articles; What should your blood sugar level be?, Fruits and vegetables decrease your risks of getting diabetes, maintaining weight loss, and Building muscle.
Center of Disease Control and Prevention National Diabetes Fact Sheet 2007 from http://www.cdc.gov/.
Wellsource “Making Healthy Choices” Newsletter Issue 39: Feb, 2007 article; Body fat measures and risk of type II diabetes.
Preventive Ways to Monitor your Fitness and Health Level by Erik Nieuwenhuis MS, PT St Luke’s Center for Preventive Medicine Health Coach 279-1842.