Avoid the Diabetes Epidemic

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Get your blood sugar checked, and watch that scale!

Before he turned 40, Frank Papsadore received some shocking news: His blood sugar levels had topped 400 (normal is 110 or less). No wonder he'd felt dizzy, thirsty, tired, and just plain lousy-he had type 2 diabetes.

"I was a classic case," says Frank, of East Sandwich, MA. "I loved to eat, I didn't get much exercise, and I had gained 150 lb over 10 years. It was a real shock, both physically and emotionally. Once I learned about the complications of diabetes, I knew I had to do something."

His battle plan? A 45-minute daily walk, exercise extras such as taking the stairs instead of the elevator, and portion control. He and his wife eventually hired a cook to prepare meals in advance. "We actually save money and eat better," says Frank. "I lost 50 lb and no longer need medication to control my diabetes."

As more Americans gain weight, more of us are developing type 2 diabetes-and at younger ages than ever before, points out Christopher Saudek, MD, director of the Johns Hopkins Diabetes Center in Baltimore and president of the American Diabetes Association. Diabetes in the US rose by 6% in 1999 alone, an increase that the government calls dramatic evidence of a heretofore hidden epidemic. At least 90% is type 2, or insulin-resistant, diabetes, in which the hormone insulin is unable to usher glucose out of the bloodstream and into the body's cells, where it's used as energy. Type 2 diabetes can often be controlled by diet and exercise. In contrast, people with type 1 diabetes produce little or no insulin and usually need to inject themselves with it daily.

When blood sugar levels rise in diabetes, so does the risk of complications-including the danger of amputation, blindness, kidney failure, heart attacks, stroke, high blood pressure, a decline in mental ability, and, according to new research, bone fracture.

"At least one-third of all diabetes is undiagnosed," says James Rosenzweig, MD, director of the office of disease management at the Joslin Diabetes Center in Boston. "It's very important for people to be tested and to take the simple, powerful steps that will prevent it."

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By Sar' Harrar

DO JUST 1 THING!
The following tips will lower your risk of diabetes and its deadly complications.

Take the test. Everyone 45 or older should have a fasting plasma glucose test-a snapshot of blood sugar levels after an 8-to-12-hour fast. High readings indicate that glucose isn't entering the body's cells, a sign of insulin resistance or a lack of insulin. Levels higher than 126 mg/dl on 2 different days indicate the presence of diabetes. But a reading higher than 110 can signal impaired fasting glucose, a condition that can lead to type 2 diabetes and that raises the risk of heart attack and stroke.

If your fasting plasma glucose levels are normal, get rechecked every 3 years, suggests James Rosenzweig, MD, of the Joslin Diabetes Center in Boston.

Know your risk profile. Get tested sooner-and repeat the test once a year-if any of these factors apply to you:

Blood sugar higher than 110mg/dl
A parent or sibling with diabetes
Physical inactivity
HDL cholesterol less than 35 mg/dl or triglycerides higher than 250
Blood pressure 140/90 or higher
Prior diagnosis of gestational diabetes, or have given birth to more than one baby weighing more than 9 lb (in this case, retest every 6 months)
Obesity-particularly if you've got tummy fat instead of hip fat
African-American, Hispanic, Asian-American, or Native American
Get your family involved.
Working with your homegrown support group to eat right, lose weight, and ..FT.-exercise helps in two ways: You gain a built-in cheering section, and you help them reduce their risk as well.

Losing just 5 to 10 lb can significantly improve insulin sensitivity. "It's much easier to change your diet and focus more on fruits, vegetables, whole grains, and low-fat meats and dairy products if everyone else at home is eating the same things you've got on your plate," Dr. Rosenzweig says. "So tell them why healthy eating is important. Set up a situation where you improve your chances for success."

While you're at it, talk up the pleasures and benefits of regular exercise too. "As little as 30 minutes of walking, gardening, aerobics, or any brisk physical activity three times a week will help reduce insulin resistance," Dr. Rosenzweig says. "When people take these steps, they always remark about how they look better, their clothes fit better, and they have more energy."

For more information on ways to lose weight, get more physical activity, and make healthier food choices, see pp. 148, 174, and 124.

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WHAT THE EXPERT DOES
Half a sandwich, no chips. Squash games with his buddies. And an afternoon spent chopping wood for the fireplace. That's how Christopher Saudek, MD, director of the Johns Hopkins Diabetes Center in Baltimore and president of the American Diabetes Association, tries to prevent diabetes.

"I work on fighting weight gain like everyone else does, but I'm not always as successful as I'd like to be," Dr. Saudek says. "What works for me is doing things I like. I love to play sports, so I make sure to set aside time for that every week. For someone else, the best choice might be jogging, walking, or swimming.

"When I'm trying to shed some pounds, my pattern is to have half my normal portion. If I'm at a lunch meeting where sandwiches are served, I'll take half and throw away the chips," he says. "Like everyone else, I struggle to control the craving for fatty foods. The important thing is finding what really works for you."

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JERRY MATHERS
You can just hear Wally now: "Geez, Beav, what a goofy thing to do."

Jerry Mathers, who several generations of Americans will always associate with Ward and June Cleaver's whimsical second son on the early '60s classic Leave It to Beaver, had allowed his weight to balloon from 170 lb to a staggering high of 250 by 1997. He was 49-too young to be facing his own mortality. But he was: His doctor told him he had 3 to 5 years to live.

"I was floored," Mathers admits. "No one in my circle of family and friends had ever been diagnosed with diabetes, so I didn't know a thing about the disease-just that I didn't have a single symptom, yet I was faced with living only 50 years. I was very, very scared." And very, very motivated to slim down: Within a year of starting a formal diet and exercise regimen ("I needed the structure," he says), Mathers had whittled his weight to 175 and wrestled his diabetes under control-without medication.

"Looking death in the face can be empowering," he says. His own close call motivates him to run for more than an hour every day on the trails that wind behind his Los Angeles home and closely monitor what he eats, especially his portion sizes, which represent his own Armageddon. "If I've learned anything from my experience, it's that it's never too late to change your ways. It's never too late to cherish life."

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