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Pre-diabetes
From the department of bad jokes (of which I am the keeper, as my
loyal readers will undoubtedly attest), let me start this column
by saying that I tried but I just couldn't manage to sugar-coat
today's message, which is about diabetes, of course.
And that unsugared message is this: you - we - all need to do a
much better job in preventing diabetes because if you don't, then
you'll suffer gravely as a result (and I use "grave"
advisedly).
To appreciate why anyone gets diabetes, you should know that
glucose (which is much more commonly referred to as sugar, the
term I'll use for the rest of this article) gets pumped into your
bloodstream after you eat. To get that sugar, which is the fuel
source your tissues need to keep working properly, into the cells
of your tissues, the pancreas produces the hormone insulin, which
eases the entry of sugar into cells.
Frankly, diabetes is diagnosed by a blood sugar reading that stays
above a certain level, in other words, it can't get into your
cells fast enough. This happens either because your body can no
longer produce enough insulin (as a result, say, of the death of
pancreatic cells) leading to what is known as Type 1 diabetes (the
old name was juvenile diabetes and it accounts for 10% of all
diabetes cases), or when your tissues become resistant to the
insulin that you do produce, leading to what is known as Type 2
diabetes (90% of all diabetes cases, and which used to be known as
adult-onset diabetes, except that with the plague of obesity in
our midst - see below - we're now seeing it in kids as young as
10).
What's important to understand with Type 2 diabetes is that at the
beginning, the pancreas is still producing a steady stream of
insulin, but for various reasons, the body's cells have become
resistant to its effects. If this is still a bit hard to get,
though, then think of it like this: you know how when your spouse
or your parent continually nags you, and at the beginning, you
respond to that nagging? But as time goes on, you stop paying
attention, in fact, you may even stop hearing the nagging voice
altogether (I don't know this first-hand, of course, it's just
what I've been told), so to get any effort at all out of you, your
spouse or parent will turn up the volume (or the heat).
Well, that's what happens with insulin, too. In people who are
overweight or sedentary, the tissues often stop responding to the
insulin that's supposed to goad them into accepting the sugar they
need. In the earliest stages of insulin resistance, before the
blood sugar level has gone too high yet, this is known as
pre-diabetes, and it's thought that eventually most of these
people go on to develop frank diabetes. In other words, people
with pre-diabetes don't have diabetes - yet - but they're well on
their way to it.
Now, there's been a lot of focus on pre-diabetes the last few
years as the circumference of the average person in the developed
world has grown so rapidly, with all the experts and health
officials worrying that if the populace continues to get fatter
and to do very little exercise, it's not long before we'll see an
explosion of diabetes and its complications, which include (among
many more) a much higher risk of heart attacks, strokes,
blindness, amputation, kidney failure, and - yikes! - impotence.
The problem is, for people with pre-diabetes, the idea of getting
diabetes eventually doesn't seem to worry them unduly because,
well, it's pretty far off in terms of time, and in the meantime,
pre-diabetes produces no symptoms or problems, so why worry, eh?
Well, I get paid to make you worry, so let me tell you of a study
that discovered that people with pre-diabetes already have
significant memory impairment, which presumably will only progress
with time as their condition worsens.
Not only that, but with sophisticated imaging techniques, this
study was also able to show that the hippocampus, an area of the
brain crucial to memory, has also already begun to shrink in
pre-diabetics.
In other words, if you're an overweight and sedentary midlifer, as
so many of you are, there's a good chance that you have
pre-diabetes, which means that there's also a good chance that
your memory has begun to go. If you begin to work out, however,
and lose weight, there's every reason to believe that you can not
only arrest that memory decline but even improve it, too.
By the way, since you may not remember most of what you just read,
why not write it down now so you can refer to it when you have
time to digest what it really means? You're welcome.
Art Hister, MD
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