People with borderline diabetes often sit around hoping they'll never get the disease.
Or, because of family history, they assume they'll get it no matter what they do.
It's a light-switch mentality. On or off. You have it or you don't.
But the American Diabetes Association's new diagnosis guidelines suggest the beginning is more like a dimmer switch. Slightly elevated but gradually increasing blood sugar levels begin damaging blood vessels long before we thought. Borderline people, with fasting glucose between 126 mg/dl and 140 mg/dl, are already in trouble.
Even worse, the symptoms of diabetes are so subtle that people may have it seven years or more before it is diagnosed.
And damage is occurring all that time.
So now the ADA proposes that everyone over 45 years old be tested for diabetes every three years, with those at higher risk tested earlier and more often. The easier, cheaper Fasting Plasma Glucose test, with a cut point of 126 mg/dl rather 140/dl, is now preferred over the traditional Oral Glucose Tolerance test.
In addition, ADA has added a new category, "Impaired Fasting Glucose," a pre-diabetic condition where glucose is mildly elevated because the body is not using insulin properly.
People with blood sugars above the normal 110 mg/dl but below 126 mg/dl are at high risk for developing diabetes. A large nationwide study now in progress will determine whether early treatment can prevent or delay diabetes in this group.
Early detection and aggressive action could be powerful deterrents. Studies of large groups of people suggest those who exercise regularly have a lower risk for developing both diabetes and impaired glucose tolerance. And many adults who have been diagnosed with diabetes learn to control it completely with diet and exercise.
More good news is that the eating patterns and food choices now known to control blood glucose are far more humane than we used to think.
Research has shown, for instance, that carbohydrates from sugars and sweets are handled just as well as carbohydrates from bread, fruits and vegetables. So dessert is possible.
That's not carte blanche for a sugar festival, of course. High-sugar foods are still high in calories, low in nutrition, and often high in fat, so they need to be included as treats, not diet staples.
But that's true for everyone, not just people with diabetes.
Weight loss continues to be important, but less drastic measures are amazingly effective. Losing just 10 to 20 pounds, rather than achieving ideal body weight, reduces blood sugar levels and improves glucose tolerance for most people.
Frequent small meals are still the backbone of glucose management. They release glucose more evenly, so insulin works more effectively.
But eating plans are personalized now, so bigger and more active adults get to eat more, but still lose weight.
Low-fat, low-saturated-fat diets are recommended to reduce heart disease risks and promote weight loss for most people. But a small subgroup with high triglycerides does better with a little more monounsaturated fat from olive and canola oil, nuts, seeds, olives and avocados.
If you've been on the borderline, hoping diabetes won't strike, take action now.
Check in with your doctor, then see your dietitian for an updated eating plan. Need a referral?
Call the American Dietetic Association's Consumer Nutrition Hotline at 800-366-1655.
Then have some fun. Take a walk, ride your bike, go for a swim, play a little tennis. Dim the lights on diabetes.
Colleen Pierre, a registered dietitian, is the nutrition consultant to the Union Memorial Sports Medicine Center and Vanderhorst & Associates in Baltimore.
Pub Date: 7/08/97