En español l Actress S. Epatha Merkerson still remembers the moment a doctor took her aside and said he needed to talk to her.
Merkerson, best known as Lt. Anita Van Buren on Law & Order, had volunteered at a health event in Washington and, with cameras rolling, had agreed to be tested for type 2 diabetes — a way to encourage people at risk to see their doctors.
When the doctor pulled her aside, "I thought he wanted to get a photo with me or an autograph," Merkerson says with a laugh. "In fact, he told me that my blood sugar levels were way too high. I went to my doctor and discovered that I had type 2 diabetes."
In retrospect, she admits, she shouldn't have been surprised. "My dad died of complications of diabetes. My grandmother went blind because of diabetes. I had an uncle with amputations." Like many, she'd ignored some classic warning signs — excessive thirst and frequent urination. Twelve years later, the Emmy Award-winning actress has joined forces with drugmaker Merck in an initiative called America's Diabetes Challenge, to spread the word about prevention and treatment of type 2 diabetes.
"What I've learned is that this is a manageable disease," Merkerson says. It's also a preventable one. Yet type 2 diabetes continues to exact a terrible toll. Untreated, diabetes can damage the retina, causing blindness, and destroy the kidneys. Over time, abnormally high blood sugar levels can reduce circulation to the limbs, ultimately necessitating amputations. Recent research links type 2 diabetes to a higher risk of dementia. People with diabetes are also up to four times more likely to develop heart disease.
Fortunately, there's plenty you can do to prevent or delay the disease. Here's what you need to know.
1. Genes determine some — but not all — of your risk
Researchers have identified roughly 45 genes linked to type 2 diabetes. Exactly how these genes increase susceptibility, however, is unclear. One of the hallmarks of type 2 diabetes is insulin resistance, which makes the body less responsive to insulin, the hormone that helps break down glucose, or blood sugar. "Insulin resistance may have evolved as a 'thrifty' gene or genes, to help the body store energy for times of famine," says Daniel Lorber, M.D., director of the Division of Endocrinology at New York Hospital Queens. But in our modern world, with food available everywhere we turn, this genetic evolution sets the stage for diabetes. Insulin resistance, obesity and poor glucose control run in families, so if any close relatives have the disease, you're at greater risk. Men are also more likely than women to develop type 2 diabetes.
2. Classic heart disease risk factors also raise your risk
High blood pressure, elevated triglycerides and abnormal cholesterol levels — three common risk factors for cardiovascular disease — are all closely associated with type 2 diabetes. One connection is an unhealthy lifestyle. "Being overweight and sedentary increases the odds of both type 2 diabetes and many risk factors for heart disease," Lorber says. But there are other links. New evidence suggests that diabetes causes low-level inflammation in the lining of blood vessels, leading to damage that increases the risk of heart disease. In a 2014 study by Danish researchers, 40 percent of people newly diagnosed with type 2 diabetes had elevated levels of C-reactive protein, a marker of inflammation. Diabetes-related damage to blood vessels in the kidneys may be a leading reason diabetes and hypertension often occur together. What's more, compromised blood vessels in people with diabetes appear to be more susceptible to damage from cholesterol build-up and high blood pressure. The bottom line: If you have risk factors for heart disease, you're at greater risk for diabetes.
3. Not everyone with type 2 diabetes is overweight or obese
Dominique Wilkins, the NBA basketball superstar whose spectacular shots earned him the nickname the Human Highlight Film, had just retired from the game at age 40 when he learned that he had type 2 diabetes. "I remember thinking, 'How can the Human Highlight Film — how can I — have diabetes?' " says Wilkins, 54, who recently launched the Diabetes Dream Team in collaboration with drugmaker Novo Nordisk, to spread the word about this often silent killer. Like many, Wilkins figured only overweight or obese people got type 2 diabetes — and he was neither. "It's a dangerous myth that type 2 diabetes is exclusively caused by being overweight or obese," says Robert Lustig, M.D., a pediatric endocrinologist at the University of California, San Francisco, who specializes in diabetes research. An unhealthy BMI, or body mass index, does raise your risk. Excess body fat can lead to insulin resistance, which can then progress to type 2 diabetes. But about 20 percent of obese people don't show signs of the disease. And about 15 percent of people diagnosed with type 2 diabetes are at a normal weight — proof, Lustig says, that excess weight isn't the cause. The bottom line: Being overweight or obese is a good reason to be tested for type 2 diabetes. But being thin is no excuse for ignoring your risk.
4. Risk rises with age — but it's never too late to make healthy changes
Once most of us hit middle age, our risk climbs with each year. The majority of new cases of type 2 diabetes are diagnosed among people 45 to 64 years old. But the demographics of type 2 diabetes are changing fast. Researchers used to call type 2 "adult-onset" diabetes because it almost always occurred in people over 45. No longer. An estimated 5,000 people age 20 and under are newly diagnosed with type 2 diabetes annually. In 2012 some 370,000 new cases were diagnosed among people between 20 and 44. "Type 2 diabetes risk increases with age, but the fact that it's showing up in children tells us this is also a disease of the environment, a toxic environment where people at all ages eat badly and get far too little exercise," Lustig says.
At any age, experts say, making a few changes can make a big difference. In a landmark study called the Diabetes Prevention Program, researchers tested whether a lifestyle regimen that included a lower-calorie diet and 150 minutes of exercise a week could prevent or delay the onset of type 2 diabetes. All the participants were overweight and had prediabetes. One group followed the lifestyle program. Another started taking metformin, a drug commonly used to reduce blood sugar levels. After three years, the lifestyle group reduced their risk of developing diabetes by 58 percent — faring far better than people on the drug, who lowered their risk by 31 percent, compared with a placebo control group. "People over 60 did even better, lowering their risk by more than 70 percent" through the lifestyle program, says M. Kaye Kramer, an assistant professor in the Department of Epidemiology at the University of Pittsburgh. "We know from the data that we can prevent or delay type 2 diabetes. It's a matter of getting people to take the risk seriously."
5. The more you move, the better
Glucose is one of the body's key fuels, says John Dubé, an assistant professor of medicine at the University of Pittsburgh. If we're not active, glucose levels in the blood can rise, causing damage throughout the body. That's where exercise comes in. "Aerobic exercises like riding a bike or brisk walking cause skeletal muscles to contract and use circulating glucose," Dubé explains. Repeated exercise actually trains muscles to better respond to insulin, the hormone that helps the body convert glucose to energy. Resistance exercises such as lifting weights are also important in training muscles to respond to insulin, but aerobic exercise has the biggest payoff. When Dubé and his colleagues encouraged 55 sedentary adults to participate in an aerobic exercise program, they found that insulin sensitivity improved dramatically over the four-month study. The more intense the exercise, the bigger the improvement.
"You don't need a gym. You really don't," says NBA superstar Wilkins, who controls his diabetes by doing interval exercises, shooting hoops with his sons and taking two-mile walks with his wife. "You just have to walk and get yourself moving." The best prescription depends on your starting position. "If you're very inactive, even a little bit of extra activity — a walk around the block, 10 minutes on an exercise bike — may help your muscle use glucose more efficiently," Dubé says. "If you're already fairly active, push yourself to do a little more to lower your risk of type 2 diabetes even further. The goal should be doing at least 30 minutes of activity all or most days."
6. The healthiest foods for preventing type 2 diabetes don't come with nutrition labels
Most experts recommend a heart-healthy diet to prevent or delay type 2 diabetes. "Type 2 diabetes, because it damages blood vessels, raises your risk of heart disease — so the more you do to protect your heart, the better," says Marjorie Cypress, president of health care and education at the American Diabetes Association. "And since type 2 diabetes is associated with being overweight and obese, a lower-calorie diet that helps people lose excess weight will also lower risk."
Participants in the Diabetes Prevention Program were all overweight, and most of the benefits they experienced were associated with losing roughly 7 percent of their body weight. Shedding pounds is notoriously difficult, of course. Lorber tries to cut through the confusion of competing diets by telling his patients to follow the "less of everything" plan. "For people who are overweight," he says, "the key is consuming fewer calories." Lustig's advice: Steer clear of processed foods, which often contain added sugar and salt. Instead, build your diet around whole foods that have been refined as little as possible — brown rice, whole wheat and other unprocessed grains, nuts and seeds, beans, and generous helpings of fruits and vegetables.
7. Easing stress can lower your risk of diabetes
Stress at home or work may add to the risk of developing diabetes. In a 2014 study led by University of Colorado psychologist Mark Whisman, researchers found that men in rocky marriages had a higher prevalence of the disease than men in happier unions. Another study published last year found that chronic stress adds to the harmful effects of a high fat/high sugar diet, and may cause people to carry more abdominal fat and increase their risk of insulin resistance. "Stress hormones like cortisol and norepinephrine can bind to receptors on cells, including muscle and fat cells, and change the way they respond," says Kirstin Aschbacher, an assistant professor of psychiatry at the University of California, San Francisco, who led the study. "If you're at risk of type 2 diabetes, it's advisable to take some steps to manage stress." Physical activity, which has many benefits, may help, as can meditation, yoga and breathing exercises.
8. It's up to you
Physician Daniel Lorber sees many patients with diabetes. "As physicians, we counsel, we coach, we prescribe, we cheerlead. But the only person who treats diabetes is the person who has it."
That's the message S. Epatha Merkerson hopes to spread as she travels around the country. "If you're at risk, it's time to get tested. If you've got prediabetes or diabetes, work out a treatment plan with your doctor for a healthy diet, exercise and — if you need it — medication." During a rehearsal for the new play she'll be starring in, Merkerson discovered that several other people in the production have type 2 diabetes. "We were sharing all kinds of tips with each other," she says. "And right now, my older brother, two years older than me, is really being challenged by his diabetes. We never really discussed it before," she admits. "But believe me, we're having that conversation now. That's what we all need to start doing."
Peter Jaret writes on health and medical issues for national publications.
4 Tests for Diabetes
Doctors use several different blood tests to diagnose type 2 diabetes. Your doctor may recommend more than one test, especially if you are at increased risk.
1. A1C the most convenient test. A1C uses a drop of blood from a finger-stick to measure average blood glucose over the past 2 to 3 months. A measure of 6.5 or higher indicates diabetes. Results between 5.7 and 6.4 indicate prediabetes. A1C is often used to monitor how well blood sugar is being controlled.
2. Random plasma glucose (RPG). Using blood from a finger-stick, this test shows your blood sugar levels at the moment the test is performed. Readings of 200 mg/dL or higher suggest diabetes.
3. Fasting plasma glucose (FPG). For this test, blood is drawn after you've fasted for at least eight hours. A measure of 126 mg/dL or higher indicates diabetes.
4. Oral glucose tolerance test (OGTT). This blood test is performed before you've been given a sugary drink, and then again two hours after. A reading of 200 mg/dL or greater indicates diabetes.
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