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The Hidden Epidemic of Early Diabetes

Many people with high blood sugar levels are told by their doctors that they do not have diabetes because their fasting blood sugar levels are below 100 mg/dl, which is considered normal. Early in the disease, diabetics often have a "normal" fasting blood sugar, but one hour after they eat, their blood sugar levels rise above 140, which signals that they are at increased risk for heart attacks, strokes, cancers, nerve damage and premature death. Not knowing that you have early diabetes is a real tragedy because most cases of early diabetes can be cured with lifestyle changes.

Early Diabetics Often Have Normal Fasting Blood Sugar Levels
Everybody's blood sugar levels rise after they eat. If blood sugar levels rise above 140 mg/dl (7.8 mmol/L) after you eat, the sugar in your bloodstream can stick to the outer membranes of all types of cells in your body. Once stuck on a cell, blood sugar cannot get off and it is eventually converted by a series of chemical reactions to sorbitol that destroys that cell.

This month, researchers showed that people whose blood sugar levels rise above 140 one hour after a meal already have all the same markers of arteriosclerosis as proven diabetics, even though they may have normal fasting blood sugar levels and a normal glucose tolerance test (Atherosclerosis, Jan 2017;256:15-20). Another study followed people with one-hour-after-eating-blood-sugar levels over 155 and showed that they die significantly earlier than those whose blood sugar levels do not rise that high after eating (Diabet Med, March 21, 2016. 10.1111/dme.13116).

The American Association of Clinical Endocrinologists, composed of doctors who treat diabetics regularly, recommends that blood sugar levels should not be allowed to rise above 140 mg/dl two hours after a meal. Having normal fasting blood sugar levels but high blood sugar after meals is associated with increased risk for:
• diabetes (N Engl J Med, Oct 6, 2005;353(14):1454-62)
• heart attacks (J Clin Endocrinol Metab, May 2013;98(5):2100-5 and Diabetes Care, Nov, 2009)
• cancer (Diabetes Care, Mar 2007;30(3):561-567)
• stroke (Diabetes Care, Mar 2007;30(3):561-567)
• premature death (J Clin Endocrinol Metab, May 2013;98(5):2100-5)
• a damaged left heart muscle (Diabetes Care, June 2011;34(6):1406-11)
• abnormal diastole, the heart's ability to relax after each beat (Diabetes Care, Oct 2011;34(10):2291-6)
• high blood pressure (PLoS One, 2012;7(9):e44470)
• low blood levels of vitamin D (Cardiovasc Diabetol, Feb 20, 2014;13:48)

Nerve Damage and High Blood Sugar After Eating
Many people who come to doctors with loss of feeling or severe pain are not diagnosed as being diabetic because their fasting blood sugar levels are below the "normal" 100. Having post-meal blood sugar levels above 140 mg/dL can cause nerve damage (Diabetes Care, Aug 2001; 24(8):1448-1453). The most common cause of slow healing of wounds and nerve damage in people who eat a typical Western diet is diabetes, and doctors often fail to make this diagnosis. Instead, they prescribe drugs like Neurontin and Lyrica that can help to relieve pain, but they do not heal damaged nerves and they can cause horrible side effects. Early nerve damage caused by high blood sugar levels can often be reversed just by keeping blood sugar levels in the normal range.

When compared to people without nerve damage, those with nerve damage are far more likely to have one-hour-after-eating-blood-sugar levels greater than 140 mg/dl {7.8 mmol/L} (Diabetes Care, 2001;24(8):1448-1453). In one study, 56 percent of patients with nerve damage had high two-hours-after-eating-blood-sugar levels above 140 (Neurology, 2003;60:108-111). More than half of the patients diagnosed with nerve damage caused by high blood sugar levels have normal fasting blood sugar levels, but high blood sugar levels one hour after eating (Arch Neurol, 2006;63:1075-1079). You can predict which people with nerve damage have high blood sugar levels after eating just by checking to see if they have increased amounts of fat stored in their bellies (Diabetes Care, 2008;31:464-469). Keeping one-hour-after-eating blood-sugar levels below 140 mg/dl (7.8 mmol/L) can reverse many cases of nerve damage.

Warning Signs of Early Diabetes
If you have more than two of the following signs of diabetes and your fasting blood sugar is "normal" (under 100), ask your doctor to check your blood sugar one hour after eating a meal. If it is above 140, you are in the early stages of diabetes and are at increased risk for damage to every cell in your body. This is a signal that you should change your lifestyle immediately before you suffer serious damage to your health or even death.

Signs that you are at increased risk for being diabetic:
• systolic blood pressure > 120 at bedtime (J Am Coll Cardiol, 2010;56(14):1113-1132)
• fasting blood sugar >100
• blood sugar over 140 two hours after eating
• triglycerides >150 mg/dL (European Journal of Internal Medicine, February 6, 2014)
• good HDL Cholesterol <45
• store fat primarily in the belly, rather than the hips
• have a fatty liver (picked up by abnormal liver blood tests or a sonogram of the liver)
• pinch more than three inches of fat under the skin near your belly button
• have small buttocks
• have a family history of diabetes
• are overweight
• have an HBA1c greater than 5.5. (HBA1c is a blood test that measures how much sugar is stuck on cells and predicts cell damage from high blood sugar levels)
• have small particle HDL and LDL cholesterol (Ann Clin Biochem, 2011;48(Pt 2):166-169)
• smoke
• take more than one alcoholic drink a day or binge drink
• have small muscles
• do not exercise
• in men, a thick neck or male pattern baldness
• in women, excess hair on the face or body, or have diabetes during pregnancy

Symptoms of diabetes:
• frequent urinating
• frequent defecating
• eating all the time and still feeling hungry
• being thirsty
• feeling tired
• losing weight without trying
• genital itching or fungus infections
• cuts and wounds that do not heal
• blurred vision

Lifestyle Changes to Prevent Diabetes, Heart Attacks and Cancers

February 5th, 2017
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About the Author: Gabe Mirkin, MD

Sports medicine doctor, fitness guru and long-time radio host Gabe Mirkin, M.D., brings you news and tips for your healthful lifestyle. A practicing physician for more than 50 years and a radio talk show host for 25 years, Dr. Mirkin is a graduate of Harvard University and Baylor University College of Medicine. He is board-certified in four specialties: Sports Medicine, Allergy and Immunology, Pediatrics and Pediatric Immunology. The Dr. Mirkin Show, his call-in show on fitness and health, was syndicated in more than 120 cities. Read More
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