The Invisible Epidemic

Larisa Brass

When Tanya Cochran went to her doctor, all she had was a sense of not feeling well. “I don’t feel bad, and I don’t feel great,” she told him. “Something is off.”

Lab tests showed elevated liver enzymes and fasting blood glucose levels. The English and writing professor learned she suffered from prediabetes. She was not yet 30.

Cochran has plenty of company.

An estimated 86 million Americans—greater than one out of three—have prediabetes, a condition in which fasting blood sugar levels are elevated above the recommended 100 mg/dl but still below the 126 mg/dl level that marks full-blown diabetes.

The epidemic is largely silent and unknown. Among this group, nine out of 10 have no idea they have prediabetes.

“In terms of public awareness, I think there’s more awareness of it in the media than among patients,” says Eva Tseng, M.D., assistant professor with Johns Hopkins University’s Division of General Internal Medicine. “There have been very few patients who have directly asked me about it.”

As it turns out, there isn’t much more awareness of the growing epidemic among doctors either.

Tseng and colleagues from Johns Hopkins surveyed a group of primary care providers on an annual retreat to see what they knew about screening for prediabetes and how to help patients manage the disease. Among 140 physicians who participated, just 17 percent knew how to identify prediabetic patients from fasting glucose and hemoglobin A1c laboratory test results. And just 11 percent of providers would refer patients to a behavioral weight-loss program.

According to Tseng, doctors should be testing high-risk patients, such as those who are overweight or obese and those who have a family history of diabetes or are in “high-risk ethnic categories,” such as Hispanics or Asians. “I think it’s difficult to stay current on the latest information about diabetes, especially if, say, you’re a primary care physician out in a more rural area or not associated with an academic institution.”

That means, patients must put their health in their own hands.

With prediabetes comes increased risk of neuropathy, heart disease, stroke and—of course—diabetes.

When Cochran’s doctor gave her the news, she cried. Then, her doctor gave some advice she’s never forgotten.

“Who’s responsible for your health?” he asked her.

“Through tears, I quickly replied, ‘You?’” Cochran says. “He chuckled, ‘No. Who’s responsible for your health?’ I paused, tears still streaming down my face. ‘Me?’”

The risks and results

Diabetes is a disease in which the body can no longer properly break down the sugars found in food, transforming them into needed energy for the body. There are two types of the disease. Type 1 diabetes results from the body’s immune system turning on itself and destroying insulin-producing cells. It has typically been found in children and young adults.

Prediabetes is actually the precursor to type 2 diabetes, which is a lifestyle-based illness that results when the cells build up a resistance to insulin, resulting in excess hormone in the bloodstream. Because sugar cannot enter the cells, it flows through the bloodstream, attaching to any tissues and organs it can find along the way, systemically altering their healthy function.

Higher-than-optimal glucose levels affect the entire body, from the heart and vascular system to the circulatory system and the immune system. That’s why insulin resistance and diabetes are closely associated with heart disease, high blood pressure, stroke, blindness, poor circulation (which can lead to amputation), and even infertility and cancer.

According to the Centers for Disease Control and Prevention, risk factors for prediabetes include:

being overweight

being 45 years or older

having a parent, brother, or sister with type 2 diabetes

being physically active less than 3 times a week

having gestational diabetes

giving birth to a baby who weighed more than 9 pounds

having polycystic ovary syndrome.

Although prescription drugs can help control blood sugar levels, the American Diabetes Association and those experienced in dealing with the disease emphasize a critical lifestyle component to reversing the disease and reducing the risk of developing full-blown type 2 diabetes.

Insurance typically covers a visit to a nutritionist, Tseng says, and she also recommends patients explore local weight-loss and group lifestyle change programs if no diabetes-focused education programs are available.

Winning against diabetes

Taking control is what Tracie DeLarco did after being diagnosed with prediabetes following the birth of her second child.

“My doctor told me very little. I knew very little about diabetes . . . no one in my family had ever been diagnosed,” says DeLarco, a former school teacher who is now a stay-at-home mom and skincare consultant.

In spite of suboptimal support at the doctor’s office, plus the challenge of caring for two small children, she ventured forth on her own—adopting a low-carb diet plan and exercising regularly. She’s made some adjustments since—going gluten-free after being diagnosed with celiac disease, dropping the low-carb regimen, but still cutting out desserts and eating a vegetarian diet. She also makes sure to sleep seven to eight hours per night.

“I wasn’t interested in meds,” she says. “Making healthy choices is hard, especially with children and being married to an Italian. For me, it’s about feeling good. If I eat horrible, I feel horrible.”

Cochran’s doctor gave her a few months to make new lifestyle choices, with the plan to put her on medication if necessary. It wasn’t.

She made a trip to Barnes and Noble, toting a stack of books on diabetes to a table at the in-store cafe. Already a vegetarian, she crafted a diet based on what she read, along with the American Diabetes Association’s recommended diet.

“The major change for me was that I cut out all high-glycemic carbohydrates: breads (except for Ezekiel Bread), pasta, potatoes, rice (except small portions of brown rice),” Cochran says. “I never counted calories or even portions. I just ate more vegetables, fruits, nuts, and low-glycemic grains. I also began a simple exercise plan that involved walking two miles each day. That’s it.”

She lost 20 pounds in the first two months. She shed a total of 40 pounds in the first year, and another 20 pounds the second. Fifteen years later, her blood glucose levels remain normal.

There were other benefits too. Besides losing weight, Cochran saw her skin clear, her energy increase, and her monthly cycles regulate.

She learned how to cope in social situations that involve food by bringing along a healthy dish she could eat and share. And as she met her health goals, she allowed herself to splurge on special occasions.

“My desire to avoid medication or insulin injections fueled my lifestyle changes,” she says. “Though I felt motivated at first by fear, I eventually began to love and trust myself more and more as I made healthy changes and saw results.”

For DeLarco, the wake-up call to pay attention to her health hasn’t just impacted her personally, but her family as well.

“This diagnosis has absolutely changed the way I cook and how I raise my kids with food,” she says. “Junk food is a treat in our house, not an expectation. We have a veggie garden every summer and play outside as often as possible.

“It was so hard in the beginning, but it has gotten easier over time.”

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