When my friend and colleague, Jill Weisenberger, published a new book on prediabetes, I couldn’t wait to interview her and ask her to answer questions that adults 50+ have when told they have high blood sugar levels and prediabetes.
Jill is an internationally recognized nutrition and diabetes expert. She is the author of the four books including the best-selling Diabetes Weight Loss, Week by Week and the new Prediabetes: A Complete Guide. Jill has a private practice in Newport News, VA. She is a freelance writer and a consultant and spokesperson to the food industry, as well as a panelist for the US News & World Report Best Diet Rankings. You can follow her on Twitter and Facebook.
How important is it for adults over 50 to get their blood sugar checked? What is the best way to get it checked….doctor, health fair, etc?
With each birthday, we have an increased risk of developing prediabetes and type 2 diabetes. Typically, healthcare providers screen for diabetes and prediabetes around age 45. Your provider may screen you earlier if you’re overweight, have fatty liver disease or heart disease risk factors such as high blood pressure or abnormal cholesterol levels.
It’s a simple blood test. If it comes back abnormal, your provider will take a second measurement to verify the first one. If you are screened at a health fair, be certain to understand the results and follow up with your healthcare provider.
|Fasting Plasma Glucose||100 – 125 mg/dl||> 126 mg/dl|
|2-hour OGTT (oral glucose tolerance test)||140 – 199 mg/dl||> 200 mg/dl|
|Random plasma glucose in an individual with symptoms of diabetes such as excessive thirst and urination||Not done to diagnose prediabetes||> 200 mg/dl|
|A1C||5.7 – 6.4 %||> 6.5%|
Some people think that if they don’t have any symptoms, they don’t need to see a doctor or get blood work…what would you say to that?
You’re breaking my heart! Sadly, there are 70 million adults in the US who have prediabetes and don’t know it. And that’s precisely because there are no symptoms. If you randomly count out 9 adults who you spend time with, three of them are likely to have prediabetes. That’s how common the problem is. Only about 10% of people with the disorder know that they have it.
What is prediabetes and can diabetes be halted if you have prediabetes?
If your blood sugar level is higher than normal but lower than diabetes, you have prediabetes. This is how we define and diagnose prediabetes. But, prediabetes (like type 2 diabetes) is much bigger than a blood sugar problem.
The two things going on with prediabetes are insulin resistance and the loss of some of our insulin-producing ability. It’s a nasty double whammy. The body is stubborn and resists the action of insulin. Because of this, the pancreas pumps out extra insulin. Early on in the course of the disorder, that extra insulin is enough to tamp down blood sugar levels to the normal level. No one has any idea that there’s a problem. But over time, the body can’t produce enough insulin to make up for the body’s resistance. That’s when blood sugar levels first increase. That’s prediabetes. As time goes on, if the insulin resistance continues, there’s likely to be further loss of insulin-producing ability. Then blood sugar levels rise more, and we have type 2 diabetes.
Other problems associated with insulin resistance, prediabetes and type 2 diabetes include blood vessel dysfunction, fatty liver, chronic inflammation, high blood pressure, abnormal cholesterol, heart disease, stroke, and even some types of cancer.
Because the problem is progressive, the best opportunity for a reversal is right this minute. There is some amount of urgency here because of the continued loss of insulin-producing capacity. Every day, your window of opportunity closes slightly. Without lifestyle changes, 37% of people with prediabetes are likely to progress to full blown type 2 diabetes within 4 years and most will have the diagnosis within 10 years.
Many people think every chronic disease is genetic and that there nothing they can do to prevent a disease like type 2 diabetes. What is the reality?
There are both genetic and environmental factors at play. We can’t change our genes, but we can do so much to improve our health and lower our risks of many chronic diseases, including prediabetes and type 2 diabetes. There are conditions that have lifestyle solutions that include diet, physical activity, sleep and more. And this is exactly what I cover in Prediabetes: A Complete Guide.
Many older adults think carbs must be eliminated if their blood sugar is high…can you explain why carbs are needed and what are the “best” carbohydrate foods?
Especially in the prediabetes stage, I really shy away from emphasizing carbohydrates. Instead I put the focus on the quality of the food. Instead of asking yourself if this food is high-carb or low-carb, ask yourself if this is a wholesome, health-boosting food. Other than having lots of carbohydrates, lentils and lollipops don’t have much in common!
Interestingly, there are several carb-containing foods that improve insulin resistance or lower the risk of type 2 diabetes. I always recommend oats, barley, lentils, beans, yogurt, nuts, and fruits, especially berries.
Can you explain why there is really not such thing as a “diabetic diet?”
As science has progressed, we’ve learned that there are many ways to a healthy plate, a healthy body weight, and blood sugar management. So again, the emphasis should be on food quality. However, once in the diabetes stage, we do have to put some limits on carbohydrate intake. This is when I help my clients become carb aware. I try so hard to keep them from being carb phobic. But regardless, food quality really matters.
How does exercise help lower blood sugar levels?
Soooo many ways, but I’ll keep it brief. First, every single time that you exercise, you boost your body’s insulin sensitivity. Yes, I mean that. Every single time! And it can last from 2 to 48 hours!
Taking a walk after a meal helps lower blood sugar levels from eating. Strength training helps to build muscle and that means that there’s more place for blood sugar to go because muscle is a big storage bucket for blood sugar. All exercise matters, and it all counts. It all reduces insulin resistance.
Reducing sedentary time is also important. The American Diabetes Association recommends breaking up long periods of sitting with three minutes of light activity every half hour. You can walk to the water fountain at work, take your dog outside, do push-ups against the wall. It doesn’t matter, just do something.
I really like the section in your book on preparing for “lifestyle reset,” many people want to dive in head first without any forethought; can you mention why your tips can help someone get on track to a healthier lifestyle?
So many people just want to follow rules and make big changes right away. They think that willpower and discipline will steer them the right way. But no one has enough willpower and discipline to do what they need or want to do all of the time. We need skills, strategies and a plan much more than we need willpower. It smart to learn about setting goals and building motivation. It’s smart to identify the habits that help you and those that hurt you. The time you put into these things will help you in the long run. My experience tells me that simply rushing to change leads to temporary success and more on and off dieting.
For more tips on eating well, moving well, and being well in your 50s, 60s, 70s, and beyond, see Food & Fitness After 50.