Minding your sugar
RONI RABIN

April 6, 2004

You probably know what your blood pressure is. You've had your cholesterol checked. But do you know what your blood glucose level is?

Most people don't. A recent survey by the American Diabetes Association found that while 60 percent knew their blood pressure, only three out of 10 knew their blood sugar level.

"This awareness is considered extremely low," said endocrinologist Dr. Nathaniel G. Clark, national vice president for clinical affairs of the American Diabetes Association. "And African-Americans, who are at an increased risk for diabetes, are least likely to know their blood glucose." Only 23 percent of African-Americans surveyed knew their blood glucose number.

That's too bad - because the same fasting blood sugar test doctors use to diagnose diabetes can also detect levels that, though not high enough to indicate diabetes, are enough of a red flag to show the disease is on the horizon.

A normal fasting blood sugar level is less than 100 mg/dl (milligrams per deciliter). A level over 126 is diabetes. The range in between - 100 to 125 - is called impaired fasting blood glucose.

It's also called pre-diabetes, and it's a warning that you're at risk of developing this devastating chronic illness, one that doubles the risk of heart disease and, experts say, may increase cardiovascular disease fivefold in women.

Between 1 percent and 10 percent of people classified as pre-diabetes will develop full-blown diabetes each year. Within 10 years, almost all will.

Even as this test warns that diabetes may be imminent, the key word is may. You still have a fighting chance. And that's a pretty rare thing in medicine.

Doctors are zeroing in on pre-diabetes because of the sudden spike in diagnoses in the 1990s. The percentage of Americans with diabetes shot up 32 percent between 1990 and 1998, with an even higher increase among adults in their prime: their 30s and 40s. Even if doctors can't completely prevent the progression to diabetes, they believe in the value of postponement. The longer the disease is kept at bay, the greater the likelihood of avoiding such disabling complications as blindness, limb amputation and kidney disease.

Some medications may stave off the progression, and more are in the pipeline. But the big surprise from a large National Institutes of Health trial a few years ago was that medication was only half as effective as fairly modest lifestyle changes.

All 3,200 participants in the Diabetes Prevention Program had pre-diabetes, and all got the standard information on the importance of diet and exercise.

But they were randomly divided into groups: One group was treated with metformin, known as Glucophage, a drug that reduces diabetes in people at risk. Another group was assigned to an intensive lifestyle intervention, including 30 minutes a day of walking or other moderate exercise. A third group was given a placebo.

After three years, those on metformin reduced their risk of getting diabetes by 31 percent. But those who changed their diet and exercise habits reduced their risk of diabetes by 58 percent. And they lost weight, too.

"We had an inkling this might happen but did not know diet and exercise would be this successful," said Dr. Om Ganda, an endocrinologist at the Joslin Diabetes Center in Boston, one of

the centers that participated.

Though we tend to think of exercise as having long-term cumulative effects, new research shows that exercise actually has immediate physiological benefits, Dr. Ganda said. Even moderate exercise.

"People tend to have lower blood pressure when they exercise," he said. People with diabetes are insulin-resistant, which means their body doesn't respond to insulin well. "Exercise improves insulin sensitivity so the body tissues respond to their own insulin better. Exercise reduces blood sugar ... and improves cardiovascular function."

Diabetics who exercise can manage and control their diabetes better, often getting away with less medication and less insulin, he said.

Regular exercise is key. "The exercise benefits on insulin sensitivity dissipate in 48 hours," Ganda said. "People who exercise intensively once a week won't benefit as much as people who exercise moderately five days a week."

To gauge your risk of diabetes, answer these questions from the American Diabetes Association and tabulate your results.

And keep in mind that - in addition to African-Americans - Asian-Americans, Latinos, American Indians and Pacific Islanders are all at higher risk for diabetes than whites.

1. If you're a mother, did any of your babies weigh more than 9 pounds at birth?

If yes, give yourself one point ("No" is zero).

2. Do you have a sister or brother with diabetes? Yes is 1 point.

3. Do you have a parent with diabetes? Yes is 1 point.

4. If you are:

5 feet and more than 137 pounds;

5-foot-3 and more than 151 pounds;

5-foot-5 and more than 161 pounds;

5-foot-8 and more than 176 pounds;

5-foot-10 and more than 187 pounds;

6 feet and more than 199 pounds;

6-foot-3 and more than 215,

or fall at a height and weight in between, give yourself 5 points.

5. Are you under 65 years old and get little or no exercise? 5 points.

6. Are you 45 to 64? 5 points.

7. Are you 65 or over? That's 9 points.

If you scored 10 or more, you are at high risk for having diabetes, according to the American Diabetes Association, and you need to see your doctor and be evaluated. If you scored between 3 and 9, you're at low risk - for now.

Well, I got 10 points due to weight and age, but I'd say that I'm at little or no risk because I live low-carb. It's too bad they didn't survey for diet. I'd say if you low-carb, you should subtract 10 points. ;-)

BTW: When I started low-carbing, my fasting glucose was 138, and my doctor said that was pre-diabetes. 1 year later, I was in the low-normal range (she didn't tell me the number except to indicate that it was well below 100) and no longer at risk according to my doctor.