Help me not get diabetes please!
March 17, 2015 2:43 PM   Subscribe

I have a very strong family history of type II diabetes (all 4 of my grandparents, both of my parents, and most of their numerous siblings have been diagnosed, usually in their late 50s). I am in my early 40s and somehow over the past 20 years have been putting pounds (quit smoking and gained some weight, got pregnant and didn't lose all the weight, got a sedentary office job and added a few more pounds . . .). Now I'm at a BMI of 31 and the heaviest I've ever been at middle age, and I REALLY don't want to become diabetic like everyone else in my family.

If you've managed to avert diabetes, how did you do it?

(Note: diet is omnivorous but we eat red meat maybe once a week; I cook 75% of our food from scratch including baking the bread and making the pasta; we NEVER buy packaged cookies and things of that nature; we eat in restaurants relatively rarely and almost never fast food; no sodas or juices or alcohol).
posted by agent99 to Health & Fitness (28 answers total) 19 users marked this as a favorite
 
From my own experience and from the experience of a close friend: you have, have, have to cut the carbs out. No bread, no pasta, no rice, no potatoes, and even limit fruit and starchy vegetables. That plus a 30 minute walk after every meal will do wonders.
posted by KathrynT at 2:49 PM on March 17, 2015 [25 favorites]


Someone I know well was diagnosed pre-diabetic, went low-carb/Paleo, lost 70 pounds, totally went off diabetes meds, and has perfect bloodwork and an A1C number as though they never had diabetes at all.
posted by matildaben at 2:52 PM on March 17, 2015 [5 favorites]


Carbs and sugar are your enemy, get them out of your diet. Start eating a large percentage of greans and low sugar fruits, don't eat a lot of anything. Rinse and repeat. Sorry, it's a simple diet really but it's pretty boring and very challenging to maintain.
posted by doctor_negative at 2:53 PM on March 17, 2015 [6 favorites]


Yep, seconding cutting carbs. Meat and non-starchy veggies won't give you diabetes. Pasta and sugar will. I've watched my father-in-law go from prediabetic to diabetic because he's convinced himself that if he eats whole wheat bread alongside sugary stuff it'll all be ok. It's not. He's also had several stents in his heart in that time. Not to scare you, but a lot of times heart disease and diabetes go hand in hand.

On the contrary, I had high triglycerides and a borderline high A1C a few years ago and fixed it entirely with diet. Low carb, Paleo-ish (I still eat Greek or Icelandic yogurt 3x/week and have the occasional milky espresso drink). My family has a history of diabetes and heart disease and I had all the signs of developing it early, and all I had to do was stop eating sugars and starches. I'll trade health and long life for pasta and bagels, no question.
posted by bedhead at 2:57 PM on March 17, 2015 [4 favorites]


A little exercise is a good thing - bike riding, walking, anything that gets your heart rate up and sheds a few pounds.

My endocrinologist is always telling me to drink lots of water, too.
posted by DandyRandy at 2:57 PM on March 17, 2015 [1 favorite]


If you can swing it, a doctor or dietician (the one who is a registered scientist, not the unregulated profession of nutritionist) can help you come up with a workable plan. For example, you mention homemade bread and pasta (mmm, homemade bread and pasta) and everyone here is telling you to completely cut them out. Whereas a medical professional might be able to tell you you're allowed a certain amount of these items per week as long as you're getting x amount of fiber/protein/exercise. I agree that cutting down on sugars and starches will help but it's not workable for some of us to say no more grapes or rice ever and call it a day.

For a start, you could try cutting out what I call "blatant" sugar-- sugar in coffee, any desserts and baked goods-- and adding a daily walk, and see how you feel.
posted by kapers at 3:15 PM on March 17, 2015 [2 favorites]


I have an inflammatory condition that can lead to diabetes. I have worked on eating a less acid diet to get inflammation under control. I eat plenty of carbs, though I skew towards corn, potatoes, and rice. I limit wheat, because it makes my inflammation worse. I have seen multiple articles linking inflammation and diabetes.

Stress and financial problems this year had me not eating right for a few weeks and some of my symptoms came back dramatically in a short period of time. In order to reverse those symptoms, I am currently having a bowl of lettuce almost every night as part of my evening meal. People always recommend salads for weight loss on the theory they are low cal. I eat lettuce because it is one of the best alkaline foods. My symptoms are clearing up and I am feeling better.

So, in addition to limiting problem foods, I will suggest you add salad to your diet (and, to me, salad means lettuce plus other raw veggies like carrots -- NO salad dressing) and look for articles about the link between inflammation and diabetes and see if what they say makes sense to you.

Also, walking is one of the best exercises around and you can do more of that without adding exercise per se to your life. Just park a littler further out, take the stairs for one or two floors instead of the elevator, etc. You can sneak in substantial exercise here and there. It really adds up and in a low stress way and that can make it easier to add a real exercise regimen to your life at some point.

That was basically my approach after being bedridden for a few months. I now walk everywhere. Trying to do too many things can be a recipe for failure. So start with some modest dietary changes and some reading up on things and add a little walking. You need to be doing things you can sustain. If you can't sustain it, you are just putting stress on your body, not making it healthier. But, also, find a way to track your progress. One of the reasons people try to too much is they want to be able to see that they are getting results. So find some means to keep track of the fact that you are actually doing more, gradually losing weight and seeing progress on other metrics that matter to you. It helps you stick with it when the progress is slow enough to actually be sustainable. Otherwise, people tend to feel like it doesn't matter and give up.
posted by Michele in California at 3:19 PM on March 17, 2015 [5 favorites]


I joined the Nerd Fitness Academy, which includes Paleo shopping lists, some recipes, and workout programs. I switched to about 90% Paleo/low-carb diet (I use a little Greek yogurt in my breakfast shake and a splash of half-and-half in my espresso); I don't eat bread or pasta, and I don't miss it. Bread & pasta used to be my comfort food, now I don't touch them. I eat a lot of veggies, fruit, and protein.

I've been doing cardio for years, but I added in a couple of days of weights a week and that has really helped with weight loss.
posted by mogget at 3:26 PM on March 17, 2015 [4 favorites]


I started seeing a registered dietitian (RD) -- diabetes runs in my family as well -- and I also recommend looking into doing the same (specifically an RD as someone else mentioned) Given your family history of diabetes I think your primary care doctor would likely support this too. Cutting back on all carbs including pasta, bread, beans, and fruit is a major part of my plan as is increasing my exercise and strength training. But this is relative to the quantity of those foods I would eat (a lot). I have no sweet tooth or affinity for desserts, but I didn't really realize how many carbs from "healthy" sources I was consuming until I took a good look at my diet with a dietitian.
posted by NikitaNikita at 4:01 PM on March 17, 2015 [1 favorite]


Last year I had a similar wake-up call with regard to my health risk factors coupled with being in my early 40's. I was managing my pre-diabetes level blood sugar/A1C with metformin.

After a ton of research, I decided on trying a ketogenic diet. It's a very low carb, moderate protein, higher fat diet that has helped me to lose 75 lbs in a year and I'm off all meds and have the best blood work I've had in 8 years. My diabetes risk is now negligible. It sounds dramatic to cut carbs so much, but it's worked better for me than any other approach for both weight loss as well as getting my other risk factors (blood sugar, cholesterol, blood pressure) into the very healthy range instead of the risky range.

I was never a Reddit user before starting a ketogenic diet, but I found that the keto board on Reddit is a fantastic free resource to do more research via their links and get some concrete guidelines.
posted by quince at 4:36 PM on March 17, 2015 [7 favorites]


First of all, you need data. Go to your PCP and get blood tests done. You want the HbA1c. Our red blood cells replace themselves every 3 months, and this test measures the sugar on average for the last 3 months, and gives you a handy number to see where you're at.

I have been in the so-called pre-diabetic stage, that is, 6.5. Then a few months later, it went down to 6.2.

What really helped me was the fact that my doctor was very aggressive with it, and the office had a diabetes education class. I went for two 4-hour sessions, and then had follow-up with the diabetic nurse specialist. I learned a lot about nutrition, how the body works, and what changes I could implement. She also gave me references to an easy workout program that I could do any time of year, in my own home, and books to help count carbs and calories.

One thing they stressed was: it takes about a year to even get a handle on all of this, to make the dietary and lifestyle changes, and that's with support from your medical team. I'm the type of person who will make changes if I know I have to go back and report to someone, so you have to find your own individual motivation. So get that support system in place, because lots of people are going through this.

So, for instance, I learned that beans have fiber, and anything you eat with fiber, you can subtract the fiber from the carbs. So, beans are good! They are carby, yet they have fiber. So I could eat beans on the side, put them into say, low fat turkey meatloaf, and use tomato paste instead of ketchup in my meatloaf (regular ketchup has corn syrup). I learned about portions, and weighing food. I learned that exercise not only helps your heart health, but it lowers your blood sugar. Berries are better than say, bananas or mangos, in terms of sugar and calories and fiber. So a breakfast would be: Greek yogurt, mixed with 1 cup of blueberries and two tablespoons of crushed walnuts. Lunch could be, a turkey sandwich with Romaine and Swiss, on high fiber bread (as opposed to regular bread).

It got me reading labels on the food I buy and looking at sodium and fiber content. I lost about 30 pounds, by doing the DVD walking program and avoiding takeout pizza. Sometimes I slack off, but lately I've been getting back into it and found that by chewing more slowly, I get full and push the plate away (like I did naturally when I was younger).

My current doctor is female, and my age, and she struggles with keeping it off. That is, she is average size, but last time, her pedometer beeped at her because she had been sitting down too long. She also recommended the Beck Diet Solution, because it addresses the psychological issues surrounding food, and she said she got some good tips from it. I really like that I have a PCP who talks to me like a real person, and trusts me to do what's right, and yet she looks out for me and refers me to a specialist if necessary (like when I recently had an allergic reaction to my umpteenth BP med).

So it's not just about cutting carbs, it's about learning what foods are better for you overall, and how you can "cheat" once in a while (you can totally make black bean vegan brownies), and what portions you should be eating. Talk to your doctor and get into a good class -- all the hospitals and medical systems offer them now. And stop worrying. You can do this.

And remember, baby steps. Change one thing at a time, like breakfast. Make that a routine. Then do, say, breakfast and then walking via the tape linked above for 30 minutes. Get that down. Then do lunch. Then do afternoon snack. Then do dinner. Etc. Give yourself a year to get a handle on it, and you will be miles ahead of where you are today. Best of luck!
posted by Marie Mon Dieu at 4:36 PM on March 17, 2015 [15 favorites]


I know that this is not going to be the most popular answer but here goes. I have a similar family history of diabetes and issues with weight. I'm ALWAYS trying to lose weight and cut carbs. But a lot of people with family history of diabetes also have metabolic syndrome which makes it really hard to lose weight. As soon as my blood sugar started trending the least bit high, my doctor started me on metformin. My A1C now runs about 5.5.

Get a blood sugar monitor and start keeping track of your readings. There are lots of apps that will help you do that.

So long story short, get a checkup, blood work, etc. and see where you are now. Work with your doctor to make a plan. In an ideal world, it would be as simple as cutting carbs but I'm betting you knew that already.
posted by tamitang at 4:37 PM on March 17, 2015 [2 favorites]


Just to add: agree with tamitang: I have a blood sugar monitor and it helps.
posted by Marie Mon Dieu at 4:40 PM on March 17, 2015


Stay away from fads (and if the diet has a name, it's probably a fad!)
For many people, its about relearning a relationship with food, esp if you come from a family of eaters. Slow and steady wins the race. I can't tell you how many of my family members get on the up and down diet track, but never learn how to eat for a lifetime.


Portion control is very important. Many people have gotten in the habit of eating faster than it gets registered that they are no longer hungry. Never eat of a container (e.g. put chips in a small bowl, ate them, get more if you must)

Exercise to build muscle mass that will help burn calories even at rest. Build it into your life (walk at lunchtime or after work) Build it into how you get around. Bike to the store if its less than a mile away, etc...

Get medical help as needed, but shortcuts never seem to become lifestyles.

Good luck!
posted by bottlebrushtree at 4:43 PM on March 17, 2015 [2 favorites]


You need to restructure your life to center around a significant amount of regular exercise. I find this is only possible by making it mandatory: I don't drive to work, I walk to the bus. I don't eat at my desk, I walk a half-mile or more to get food or meet people to eat. I regularly bicycle or walk to the grocery store, even though it takes way longer than driving. Pulling this off might have a huge cost: maybe moving house or even towns, changing jobs. But, well, you know the alternative.

Also, white flour is same as sugar. People push the low-carb thing for a reason: because it works.
posted by flimflam at 5:29 PM on March 17, 2015 [3 favorites]


Seconding @quince, check out /r/keto/
posted by pyro979 at 5:54 PM on March 17, 2015


Nthing those who say to start testing your blood sugar. Here's a basic overview of testing. If you test using the sites they recommend, paper cuts hurt more than testing does. You can either get a script from your physician, or get a meter, test strips and lancets yourself -- the only store I know of that carries OTC strips is Walmart, but there are likely others. Testing and noting what you eat will give you a record for your medical care team, and it could also give you an idea of sensitivities you might have. (E.g., effects of different foods, what time of day they're eaten, etc.)

Maybe related to Marie Mon Dieu's answer: I have heard good things about this book. Even though you don't have a diagnosis, knowledge is huge in this particular medical game.
posted by gnomeloaf at 6:17 PM on March 17, 2015 [1 favorite]


Target has a cheap meter & strips*. It's the Consumer Reports Best Buy. The regular one, not the premium.

*significantly cheaper than most others.
posted by Neekee at 6:50 PM on March 17, 2015


People who get Diabetes get it for a variety of reasons. It's not just weight, it's a complex interplay of your genetics, lifestyle, whether you've had gestational diabetes, ethnicity, and age.

You've asked about how you can prevent the onset of Diabetes. You should definitely talk to your doctor. Losing weight is important, but it might help to know how, and how much, and why.

I'm assuming your question is about non-pharmacological methods of preventing Diabetes (there are drugs out there that claim to help reduce the onset of Diabetes with varying benefits and risks and you should talk to your doc about that).

Lets look at some of the evidence behind the lifestyle advice that's often given out. The Finnish Diabetes Prevention Study Group is one of the biggest clinical trials that looked at just this issue. They took about 500 middle aged, overweight (average BMI of 31) white people with impaired glucose tolerance - often referred to as "pre-diabetes."

Half of them were subject to an intervention, and half of them just continued with regular medical advice.
The intervention was pretty intense:
The target was a reduction in weight of 5%
1. Dietary interventions:
Reduction of fat to < 30% of energy consumed, Saturated fats to < 10 perecent
Increase in Fiber to 15g per 1000 kcal
They each had at least 7 sessions with a dietician, including regular food diaries.

2. Physical Activity
Moderate exercise for 30 minutes a day
They all had opportunities for supervised physical activity which consisted of circuit-type resistance-training sessions were also offered with the aim of improving the functional capacity and strength of the large muscle groups. Subjects were instructed to perform a moderate to high number of repetitions and to take a break of 15 to 60 seconds between the stations on the circuit


Did it work?
Well, the average weight loss after 1 year of this was about 4kg, or about 5% weight reduction in the intervention group, compared to 1% in the control group. After 2 years, a total of about 3.5 kg weight loss was seen and maintained.

With regards to the Diabetes, the control group -- after 4 years -- had a rate of Diabetes of 23%. The intervention group had a rate of Diabetes of 11%. That is an astounding 58% risk reduction in the probability of getting DMII.

Again, IANYD, and this was just one trial (there have been many others!), and it'd be challenging for just one person to reproduce those conditions, but it gives you an idea of the numbers. 10lbs in 2 years doesn't seem that much, right?

I'd suggest you have a look at the evidence (the Canadian Diabetes Association is great start), look through the various clinical guidelines to find some reasonably evidence-based goals and talk to your doc about it.

Good luck!
posted by cacofonie at 6:51 PM on March 17, 2015 [6 favorites]


The problem with the CDA is they're still in the low-fat mentality. A sample recipe for granola bars has sugar, honey, flour, and 60% calories from carbs. Most diabetics follow their advice, and most get on more and more meds. I didn't actually find any research on that site. I believe their recommendations come from 'expert panels', many of whom, like the CDA itself, take funding from pharma. Also many of these experts are wedded to the cholesterol/fat dogma that's been questioned currently.

Although there aren't great long-term studies yet, a good deal of research does suggest the answer to your question is low-carb. (e.g.)
posted by kevinsp8 at 8:18 PM on March 17, 2015 [4 favorites]


You might do best to go see a nutritionist or dietitian who works with diabetes patients. The diabetes clinic at the nearest big hospital should have one.
posted by radioamy at 8:39 PM on March 17, 2015


I can't add to the excellent nutritional advice you have received, but I did want to recommend this book by Gretchen Reynolds, the author of the NY Times Phys Ed column. It demystifies a lot of exercise-related stuff and also gives you realistic pointers for what you should be aiming for.

The First 20 Minutes: The Surprising Science of How We Can Exercise Better, Train Smarter and Live Longer

NY Times interview with Gretchen Reynolds

Excerpt:

If you are overweight but fit, meaning you have a reasonably good V012 max (a measure of oxygen uptake), then your risk of premature death, all the chronic diseases — diabetes, heart disease, cancer — will drop. If you have to choose, choose to be fit, whether you lose weight or not.

If someone starts an exercise program and improves his fitness, even if he doesn’t lose an ounce, he will generally have a longer life and a much healthier life.


Please do not take this as a suggestion not to modify your diet. That is very important for someone who is worried about developing diabetes. But exercise will massively help you on your way. Good luck.
posted by Ziggy500 at 3:27 AM on March 18, 2015


Been there, beat that (for now).

First, congratulate yourself. By realizing you need to make a change, you have completed the hardest step in your journey. By asking for help you have completed the second-hardest step in the journey. The remainder of the steps are easy -- the human body WANTS to be lean, you just have to stop sabotaging it and let it return to that natural state.

Here's what I did:

(1) asked a doctor to give me a full-blown glucose tolerance test, as opposed to a single glucose reading. My single glucose readings were always ok, but the tolerance test revealed that I had impaired fasting glucose and insulin resistance. The doc prescribed me metformin, which I took religiously.

(2) went to a naturopath who talked to me about my food insensitivities. She made a list of foods I could eat that would not trigger inflammation in my body. I ate only things from that food list for 6 months. I was averaging 1000 cals/day without feeling hungry and desperate all the time. Much of the weight came off with very little effort (60 lbs) and essentially little exercise. I exercised when I felt like it (2 hours a week or so) but was by no means a gym rat.

(3) when my weight plateaued (for 1 year I ate the same way, took my meds, etc. and lost only 3 lbs) I was tested for low thyroid (which I had). With the thyroid fixed, the remainder of the weight is melting off. I have 15 lb to go, which will bring me to a total 100 lb weight loss.

By far the best resource I found on the web: www.marksdailyapple.com

That site taught me how to eat properly, that is, to balance carbs, protein and set my target numbers of calories properly. I had been a big fan of Atkins for years and had twice lost more than 70 lb on Atkins and gained it back (and then some). Have come to the conclusion that Atkins is too much stress on the body and can't be maintained in the long run. Should say I am NOT paleo and never was -- but this site taught me how much carbs and protein I can and should eat to remain healthy.

Also helpful: www.paleotrack.com

YOU CAN DO EET! Trust me. I am the most sedentary fool on the planet. If I can do it, so can you!
posted by amy27 at 5:05 AM on March 18, 2015 [1 favorite]


I also vote dietitian. For the last few years, every couple of blood tests, my fasting blood glucose pops over 100. This has been met with "Try eating less white stuff", "You're not overweight and you exercise, so that's weird, oh well", "Hey, look it's below 100, let's not worry about the last time" and so on. I'm now on something like the fourth or fifth doctor I've seen in that time (yay moving and disastrous student health center visits) and the last time around, the doctor said "Well, that's weird, why don't you try phoning this dietician." I don't know that she told me anything I didn't already know, but I found it helpful to talk through what I eat. For me, it seemed like the starting point was not "eat fewer carbs" but "eat more at meals and shift carb consumption to meals and away from snacks".

I've also found doing some meal planning with the ADA's exchange lists helpful.
posted by hoyland at 5:08 AM on March 18, 2015


Dr. Mirkin has something to say about this.
posted by oceano at 7:30 AM on March 18, 2015


Stay away from fads

A fad diet is only a fad bc it's "in" and people don't stick to it. Technically, 'low-carb' has been a fad several times in the last 30 years. But it's a lifestyle for others. Same goes for gluten-free. It's a lifelong diet for celiacs.

I think you mean "stay away from crash course diets", the ones that last a couple of weeks and then you go back to eating exactly the way you are before. Which is bad. Lifelong, stick to it, lifestyle changes are good.
posted by Neekee at 8:04 AM on March 18, 2015 [1 favorite]


N-thing advice to see an RD, but also wanted to put in a plug for My Fitness Pal, a free app I've been using to lose weight, mainly bec. it's cheaper than Weight Watchers. Good luck!
posted by Shoggoth at 8:14 AM on March 18, 2015


In addition to "inflammation" (which is rather generic and not particularly helpful, as the science on anti-inflammatory diets isn't great yet), saturated fats have actually been linked to insulin resistance, however studies have shown that if your dietary fat is 5-10% fish oil, that negates the effect of saturated fats on insulin sensitivity.

I have PCOS so I'm prone to insulin resistance. At the start of the year I bought myself a blood glucose monitor and with some dietary changes (was already exercising for 3 hours a week) my fasting blood glucose was down to 5.1 from 6.1 and lost 14lbs (despite actually eating more) in the first month. I also tested my glucose tolerance and it was "normal" after 1 month of changes - on the upper end of normal but still normal.

The changes I made were to completely cut out alcohol and sweets/cakes, reduce saturated fats, eat oily fish and eggs every day, no carbs with breakfast (my blood sugar was always highest first thing in the morning), lunch is reheated pasta bake (cooking, cooling and reheating starches turns them into resistant starches, which means they act more like fibre so no blood sugar spike - confirmed this myself with blood sugar testing).

I've been able to relax things now, so I can have a few drinks a week and occasional dessert without it causing a problem and I keep monitoring myself so I can keep the IR in check.
posted by missmagenta at 10:39 AM on March 18, 2015 [2 favorites]


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