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.